Many of you know that this year I’ve been fortunate enough to be working with the Boston Blades in the Canadian Women’s Hockey League (CWHL) – a professional women’s hockey team/league – as their primary therapist for the season. It’s been a very exciting season so far, and it’s very rewarding to utilize some skills with the team (i.e. lots of taping) that I wouldn’t have the luxury of using in the clinic as much. I’ve also learned so much on the job just from observing. I can’t stress enough how crucial it is to be able to refine your observation skills as a physical therapist – even more so as a SPORTS PHYSICAL THERAPIST. It is paramount in our field to be able to pick up on the nuances and subtle movement patterns and be able to hone in on what is causing an athlete’s dysfunction, fast! It’s even more critical when you’re not as familiar with the sport at hand – which was my case starting the season.
My specialty area for treatment when it comes to sports and athletes – while I do treat athletes of all sports, my true expertise lies in overhead athletes such as baseball/softball players and volleyball players. Having gone to undergrad in Maine, I’m familiar with hockey (attending many Bowdoin v. Colby hockey games back in the day), but I’ve never ice skated before, let alone play hockey. However, through plenty of observation and research, I’ve come to understand movement/strength patterns necessary for the elite hockey player to be successful.
Hockey players are always in a hip hinged position that requires plenty of control from their core. Without a strong core, their posture will become compromised and the athlete will end up loading in a flexed spinal position that can lead to low back pain. For anyone who knows me, you’ll know that I consider the glutes as an important part of supporting the deep core muscles. Glutes are important for stability in the frontal plane as well as required for push off while skating (posterolateral movement – hip abduction with extension). This allows the athlete to project themselves forward on the ice. However, often times, the athlete will become quad dominant and will compensate with knee extension more than hip extension – staying in the hip hinged position and increasing stress on the low back while keeping the glutes in a lengthened state.
Hockey players don’t only develop LE dysfunction, but they can also develop increased UE (bilateral) dysfunction as well. They are constantly in a rounded and protracted position of the scapula. Depending on which hand they shoot with – their top UE is excessively internally rotated and their bottom hand is excessively protracted relative to neutral. This creates muscular imbalances when compared side to side (dominant Latissimus dorsi and Serratus Anterior, under-active RTC, rhomboids, and lower trap). Goalies are a separate category all on their own due to the demands of their position – this post serves as a general guide for screening hockey players.
A screen I really like, and am a bit biased towards, is the Selective Functional Movement Assessment (SFMA). It really does capture everything in one screen! What I’ve found through screening the hockey players is that most have poor scapular control (sometimes accompanied by cervical ROM deficits) with excessive winging in the Medial Rotation Extension (MRE) pattern and Dysfunctional Non-painful (DN) in LRF. Muscular imbalances arise from the upper traps (hyperactive due to overuse during bracing), increased pec major/minor and lat activation, and under-active lower traps and RTC – often leading to impingement patterns. Of course, T spine is always involved with scapular control issues. In lower extremities, players often have decreased glute recruitment overtime, decreased SLS balance, decreased hip mobility into IR/ER/flexion, and DN of overhead deep squat (ODS).
As I mentioned in the series on treating the competitive volleyball player, it’s not enough to just correct these dysfunctional patterns or tell the athlete to avoid those positions – you have to understand the demands on the sport and why the athlete has now assumed these postures and developed painful or high risk movement. As this was very surface presentation of screening a hockey player – it should help point you in some areas that need to be assessed – performing your own assessment and drawing your own conclusions is just as important because every athlete is different. I hope this post can help any therapist unfamiliar with the sport of hockey and guide them towards problem areas as a starting point.