Ice Hockey Injuries: How To Maximize Treatment Results

By Mark A. Caselli, DPM, Ann Gagne, LLB, and Eric Kaplan, BS

Ice hockey is widely known as one of the world’s fastest and most dangerous sports. With the game’s popularity growing at record levels, participation in ice hockey in the United States has experienced substantial growth over the last decade. Over 400,000 male players and 40,000 female players participate under the auspices of USA Hockey (the national hockey governing body), compared to about 190,000 male and 6,300 female players ten years ago.
With the increased participation in hockey has come an increasing number of injuries. The potential for hockey injuries stem from razor sharp skates, 30 mph skating speeds, 100 mph slap shots with a frozen 6-ounce rubber puck, unyielding boards, long wooden or metal sticks and legal body checking.
Hockey injuries fall into two broad groups: the high speed, low mass injuries caused by a puck or stick which result in contusions, lacerations and concussions; and the low speed, high mass injuries caused by collisions with bodies or boards, frequently resulting in sprains and fractures. Lower extremity injuries account for approximately 27 percent of all hockey injuries with 11 percent occurring in the foot.

Recognizing And Treating Hockey-Related Ankle Injuries
Ankle sprains are a common problem in most sports. However, in hockey, the common ankle sprain caused by plantar flexion, inversion and internal rotation is a relatively rare occurrence. This is due to the protection afforded by the modern stiff skating boot and because there is relatively little jumping and landing, which is a frequent cause of inversion injuries in other sports. More frequent and much more troublesome in skating is the dorsiflection-eversion-external rotation ankle sprain.
There are two principal etiologies for this sprain. The first and most common injury occurs when a player catches his or her support blade in an ice rut, causing the skate to follow the rut, forcefully rotating and everting the ankle. The second etiology is a fall over the front of the skates, with the foot being caught in an externally rotated, dorsiflexed position under the body. Both cases result in a strain of the deltoid ligament followed by progressive loading of the tibiofibular ligament and interosseous ligament.
This type of sprain results in immediate pain which is localized in two distinct areas, the medial aspect of the ankle over the deltoid ligament and the anterolateral aspect of the ankle over the anterior inferior tibiofibular ligament and distal interosseous ligament. The pain is increased with eversion-external rotation stress of the dorsiflexed ankle. Inversion-internal rotation of the plantar flexed ankle is relatively painless. When the mechanism of injury and clinical examination are consistent with an eversion sprain, you should perform stress X-rays to rule out a diastasis of the ankle syndesmosis. Be sure to include the entire tibia and fibula on the film in order to avoid missing a proximal fibular fracture.
Immediate treatment for these sprains should include prompt compression, ice and elevation since the amount of swelling predicts the amount of ankle pain and the length of recovery you can expect. When the radiograph demonstrates evidence of mortise widening or instability, consider performing open fixation with a syndesmodic screw in order to reduce and hold the ankle anatomically. If the stress X-rays are negative for diastasis, continue with crutches and a compression dressing until the initial injury pain subsides. At that point, you can allow weightbearing as tolerated and proceed to emphasize ankle rehabilitation.

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