Ice Hockey Injuries: How To Maximize Treatment Results

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

The initial focus of the ankle rehabilitation program should concentrate on return of motion. An exercise bicycle and an ankle board are valuable in this early phase. As the tenderness over the anterior tib-fib ligament and interosseous space begins to subside, have the patient initiate inversion-eversion strengthening and heel cord stretching. Encourage proprioception training, using a tilt board or other balance device, in conjunction with the stretch and motion program.
Once the patient can tolerate full weightbearing, ankle strengthening, range of motion and proprioception well, you can allow the patient to proceed to straight ahead running. The final, most difficult phase of the rehabilitation is returning to skating because of the inherent external rotation, everson forces placed across the ankle with normal skating stride. To help protect the ankle against excessive stress in this period, apply immobilization taping. In nonoperative cases, return to function occurs within three to six weeks after the injury while a surgical case will require 15 to 18 weeks for functional recovery.

Be Aware Of Skate Bites
The skate bite — an inflammation of the sheath that covers the tendons that cross the anterior ankle and dorsum of the foot — is another common ankle injury you would see among hockey players. Skate bites are caused by pressure from skate laces. In lacing skates, it is usual to make the distal and upper laces very tight, while leaving the throat area lacing looser for flexibility. However, the tightness of the upper boot lacing sometimes causes extensor tenosynovial reactions and even painful thromboses of the superficial veins.
The player may first feel an aching discomfort when he or she puts on the skates. The player may not even feel pain or discomfort after warming up. However, after playing, the ankle and foot will swell and become painful.
Initial treatment consists of ice and NSAIDs as well as adding a protective cushion to the skate. As the skate tongue softens or molds to the foot and ankle, you’ll often be able to achieve decreased pressure and reduced irritation. Emphasize to hockey playing patients that skate bite injuries, if left untreated, could become chronic, leading to scar tissue formation. The scar tissue will cause compression of the structures in the area and may require surgery. To prevent skate bite, some players wear padding over the area where their laces cross while others shave the inside of the tongue of their skate.
Other hockey players leave the skate tongue down for greater flexibility and comfort. This has lead to an incidence of lacerations of the anterior of the ankle caused by skate blades. These “boot top” injuries have caused damage to the anterior tibial tendon, extensor hallucis and digitorum longus tendons, and the dorsalis pedis artery, vein and nerve.

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