Hockey Injuries Presented to USA Hockey Coaches by Dr. Susan B. Hoppe, Ed.D, ATC

3 key injuries & topics to know 1. Neck injuries 2. Concussions/Head injuries 3. Prevention and Training Techniques including nutrition tips

Spine Anatomy Different curves in the spine built for shock absorption Different curves in the spine built for shock absorption More likely to have cervical spine fractures More likely to have cervical spine fractures More likely to herniate discs in lumbar spine More likely to herniate discs in lumbar spine

Functional Anatomy Movements of the spine include flexion, extension, right and left lateral flexion and right and left lateral rotation Movements of the spine include flexion, extension, right and left lateral flexion and right and left lateral rotation Minimal movement w/in the thoracic region Minimal movement w/in the thoracic region Superficial and deep musculature functioning and abdominal muscular functioning affect movement Superficial and deep musculature functioning and abdominal muscular functioning affect movement Flexion and extension Flexion and extension Trunk rotation and lateral flexion Trunk rotation and lateral flexion

Cervical Spine Conditions Cervical Spine Conditions Mechanisms of Injury Mechanisms of Injury

Neck Injuries If an athlete tells you that: If an athlete tells you that: They can’t move their fingers or toes They can’t move their fingers or toes Something “feels different” in my fingers or toes Something “feels different” in my fingers or toes They have a burning, tingling or numb sensations in any of their extremities They have a burning, tingling or numb sensations in any of their extremities They have any pain along their spine… They have any pain along their spine… What should you do? What should you do?

DO NOT MOVE THEM!

Neck injury management At a game: At a game: Tell your athlete not to move Tell your athlete not to move Ask them where their pain is located Ask them where their pain is located Ask the EMT’s for assistance Ask the EMT’s for assistance At practice: At practice: Do not allow the athlete to move Do not allow the athlete to move Ask them where the pain is located Ask them where the pain is located Call if there is any question that there is a fracture present Call if there is any question that there is a fracture present

Concussions & Head injuries

Concussion An impairment of normal neurological function due to a blow to the head or abrupt movement of the head An impairment of normal neurological function due to a blow to the head or abrupt movement of the head

“Mild” concussion Minimal intensity Minimal intensity Dazed and disoriented Dazed and disoriented No amnesia or any other signs of serious head injury No amnesia or any other signs of serious head injury Back to normal in 5’ – 15’ Back to normal in 5’ – 15’ No further play that day No further play that day

“Moderate” Concussion Mild intensity Mild intensity No loss of consciousness (LOC) No loss of consciousness (LOC) Slight temporary anterograde amnesia (can’t make new memories) Slight temporary anterograde amnesia (can’t make new memories) Minor mental confusion Minor mental confusion Tinnitus Tinnitus Dull headache Dull headache Unsteady Unsteady Minor dizziness Minor dizziness Post-concussion problems Post-concussion problems Headaches Irritability No further play that day No further play that day

“Severe” Concussion S & S of “mild” and “moderate” concussions S & S of “mild” and “moderate” concussions Loss of consciousness Loss of consciousness Moderate tinnitus Moderate tinnitus Retrograde amnesia (before injury) and or anterograde amnesia (after injury) Retrograde amnesia (before injury) and or anterograde amnesia (after injury) Mental confusion Mental confusion Balance problems Balance problems Automatism Automatism No return to play that day No return to play that day

What do you need to know? If there are any residual symptoms, athlete cannot play If there are any residual symptoms, athlete cannot play Every concussion is different…symptoms may last 5 minutes or 5 months Every concussion is different…symptoms may last 5 minutes or 5 months Never give them aspirin or Ibuprofen Never give them aspirin or Ibuprofen The second hit is when more damage can be done! The second hit is when more damage can be done!

Postconcussion Syndrome Etiology Etiology Condition which occurs following a concussion Condition which occurs following a concussion May be associated with head injuries that don’t involve a LOC or in cases of severe concussions May be associated with head injuries that don’t involve a LOC or in cases of severe concussions Signs and Symptoms Signs and Symptoms Athlete complains of a range of postconcussion problems Athlete complains of a range of postconcussion problems Persistent headaches, impaired memory, lack of concentration, anxiety and irritability, giddiness, fatigue, depression, visual disturbances Persistent headaches, impaired memory, lack of concentration, anxiety and irritability, giddiness, fatigue, depression, visual disturbances May begin immediately following injury and may last for weeks to months May begin immediately following injury and may last for weeks to months

Postconcussion Syndrome continued Management Management Health care team should treat symptoms to greatest extent possible Health care team should treat symptoms to greatest extent possible Return athlete to play when all signs and symptoms have fully resolved (upon physician’s direction) Return athlete to play when all signs and symptoms have fully resolved (upon physician’s direction)

Second Impact Syndrome Etiology Etiology Result of rapid swelling and herniation of brain after a second head injury before symptoms of the initial injury have resolved Result of rapid swelling and herniation of brain after a second head injury before symptoms of the initial injury have resolved Second impact may be relatively minimal and not involve contact w/ the cranium Second impact may be relatively minimal and not involve contact w/ the cranium Impact disrupts the brain’s blood autoregulatory system leading to swelling, increasing intracranial pressure Impact disrupts the brain’s blood autoregulatory system leading to swelling, increasing intracranial pressure

Second Impact Syndrome Signs and Symptoms Signs and Symptoms Often athlete does not have a LOC and may looked stunned Often athlete does not have a LOC and may looked stunned W/in 15 seconds to several minutes of injury athlete’s condition degrades rapidly W/in 15 seconds to several minutes of injury athlete’s condition degrades rapidly Dilated pupils, loss of eye movement, LOC leading to coma, and respiratory failure Dilated pupils, loss of eye movement, LOC leading to coma, and respiratory failure

Second Impact Syndrome (continued) Management Management Life-threatening injury that must be addressed within 5 minutes with life saving measures performed at an emergency facility Life-threatening injury that must be addressed within 5 minutes with life saving measures performed at an emergency facility Best management is prevention from the AT’s perspective Best management is prevention from the AT’s perspective

Prevention of Head injuries Protective equipment Protective equipment Headgear Headgear Helmets and facemask Helmets and facemask Mouthpieces (teeth) Mouthpieces (teeth) Proper techniques in initiating contact Proper techniques in initiating contact Education about concussions and second impact syndrome Education about concussions and second impact syndrome

Prevention of other injuries Dynamic warm up Dynamic warm up Flexibility Flexibility Core stability Core stability Equipment needs Equipment needs Proper care of small injuries before they become big problems Proper care of small injuries before they become big problems Nutritional needs Nutritional needs

Dynamic warm-up Major muscle groups Major muscle groups Move laterally as well Move laterally as well Controlled movements Controlled movements Progress to quicker and higher intensity activities Progress to quicker and higher intensity activities Should be sweating BEFORE on the ice Should be sweating BEFORE on the ice

Flexibility Static stretching Static stretching Throughout day, not just 10 minutes on ice before & after practice Throughout day, not just 10 minutes on ice before & after practice Only need to hold 15 seconds x 3 sets Only need to hold 15 seconds x 3 sets Hip mobility is key Hip mobility is key

Core strength: Abdominal Muscles

Core: not just Abs!

Exercises

Let’s try a couple…

Nutrition: Keys to Success Breakfast Breakfast Eating balanced meals Eating balanced meals Healthy Snacking Healthy Snacking Recovery nutrition Recovery nutrition Hydration Hydration

Breakfast Improves concentration Improves concentration Enhances focus Enhances focus Jump-starts the metabolism Jump-starts the metabolism Helps muscles maximize strength Helps muscles maximize strength Boosts endurance Boosts endurance Supports weight control Supports weight control Contributes to increased academics Contributes to increased academics

½ Fruits and Vegetables ½ Fruits and Vegetables ¼ Protein ¼ Protein ¼ Whole Grains ¼ Whole Grains Small Amount of Fats Small Amount of Fats Hydration Hydration

¼ Fruits and Vegetables ¼ Fruits and Vegetables ¼ Protein ¼ Protein ½ Grains ½ Grains Small Amount of Fats Small Amount of Fats Hydration Hydration

Healthy Snacking Choose nutrient-rich foods Choose nutrient-rich foods Don’t go more than 4 hours without eating Don’t go more than 4 hours without eating Choose items high in fiber and antioxidants to keep your system functioning at its peak Choose items high in fiber and antioxidants to keep your system functioning at its peak

Recovery Nutrition: 3 R’s Refuel: Eat simple carbs to replace those used during activity Refuel: Eat simple carbs to replace those used during activity Rebuild: Eat protein to promote muscle repair & maximize muscle strength Rebuild: Eat protein to promote muscle repair & maximize muscle strength Rehydrate: Drink water, sports drinks, flavored milk to replenish fluids & electrolytes lost in sweat Rehydrate: Drink water, sports drinks, flavored milk to replenish fluids & electrolytes lost in sweat

Hydration Important for achieving peak performance Important for achieving peak performance Helps prevent heat illness Helps prevent heat illness Early signs of dehydration: Early signs of dehydration: Thirst Thirst Flushed skin Flushed skin Increased body temperature Increased body temperature Faster breathing and pulse rate Faster breathing and pulse rate Increased perception of effort Increased perception of effort Decreased exercise capacity Decreased exercise capacity

Hydration tips Drink every 15 minutes during exercise Drink every 15 minutes during exercise Drink 3 cups of fluid for every pound lost during physical activity Drink 3 cups of fluid for every pound lost during physical activity Individuals check urine for color Individuals check urine for color

If ever in doubt about your athlete’s health… Ask a health care provider!

Any questions? Dr. Susan Hoppe, EdD, ATC