Dealing with Low Back Pain from Hockey

The majority of the hockey players we work with are still playing competitively at a professional or major junior level. But, that only represents a small percentage of those playing the game, and we also want to help recreational players feel better on and off the ice. 

One of the reasons we love hockey so much is that it's a lifelong pursuit. The rink that our training facility is in has over 65, over 70, and over 75 leagues!

If you're going to play into your eighties - we plan on it - the chances are pretty high that you'll have to deal with a few injuries along the way. As frustrating as they can be, injuries are part of the game, and you can use the opportunity to build back stronger. 

(Pic of Gary – He knows a thing or two about building back)

Deciding what injury to talk about first was no easy task: shoulder, elbow, hip, knee, ankle, neck. All of those were potential options that we see every day with both our younger and older clients and we'll get to them in time. 

But, if we could only choose one injury to address that affects the most people, it is low back pain. 

Low back pain (LBP) is present in hockey at all levels and ages and has severe consequences for day-to-day life. In fact, a study out of Switzerland (1) estimated that the lifetime prevalence for non-specific LBP is between 60%-70% and peaks between the ages of 35-55. Furthermore, the number of reported LBP incidences appears to also be increasing in children as well, making this information even more important. 

*If you experience LBP you should consult a medical professional for diagnosis and treatment. There are a series of very painful injuries – disc herniation, arthritis, stress fractures, and we couldn't possibly cover them all. So today, we will focus on more general low back pain. 

Some studies have estimated that north of 85% of hockey players will experience at least one incident of lower back pain as a result of the sport over their lifetime. But why is LBP so prominent in hockey?

Skating Posture

Skating is not a natural action. 

Just watch someone put skates on for the first time and step on the ice. It doesn't matter how athletic they are off the ice; as soon as their blades hit that frozen sheet, they're in immediate jeopardy of a full yard sale.  

(Pic of wipe out wit equipment everywhere)

Not only do you have to balance on a pair of blades, but the way you create motion – the stride – is so counterintuitive to every other sport. 

(Running vs. Skating Stride) 

In a running stride, propulsion is achieved by sending force down and back. Skating requires a lateral pushing action, one that we never encounter in day to day life. 

Why is this worth mentioning? 

Because much of the LBP in hockey is a result of poor player posture, and utilizing the wrong muscles to stride. Sitting in an athletic, and powerful hockey stance is not an easy task, it burns the legs, taxes the core and threatens to tear your groin apart with every push. 

If you're unable to maintain that position a series of things happen. 

1. You fold over at the hip. Your low back becomes responsible for keeping you upright instead of your core. 
2. You stop utilizing your glutes to skates and start recruiting your erectors/over-rely on your groin. 
3. You're immediately at an increased risk of injury. With your head tilted down, you've lost the ability to see the play develop and may get hit without realizing it. 

Even if you don't get hurt in any way, failing to maintain proper skating positon prevents a full stride. You will lose power and speed as a result. 

(Hockey Picture – No one likes playing slow) 

In addition to the stride itself, hockey requires frequent violent rotations to pass and shoot the puck. This rotation is accomplished through a kinetic chain of events. If you lack the physical attributes necessary in your pelvis and thoracic spine - hips and upper back - you'll be forced to torque through your lumbar spine. Repeatedly creating this rapid rotation can quickly lead to lower back pain. 

Whether you are looking to prevent any LBP or trying to rehab a chronic issue, the exercises below can help. 

LBP Prevention          

We're going to break down our preventative approach into 3 categories.

1. Hip Mobility 
2. Core Activation 
3. Strength Drills 

We'll discuss what we've seen work in the gym with athletes and what the research suggests for each category. 

If you're interested in diving deeper into LBP, we'd suggest checking out Stuart McGill's work and the book Gift of Injury with Brian Carroll. It takes an athlete-focused approach that can be easier to relate to then some of Dr. McGill's more academic works. 

There is a concept from (FMS Person) called the joint-by-joint approach, it was later popularised in the hockey training space by Mike Boyle. The joint-by-joint approach it is a simplistic way to look at each joint inside the body and identify each joint's primary function, mobility or stability. 

(Graphic) 

Although it's not a perfect system - and each area of the body performs multiple functions – it helps establish a rough overview. 

As a hockey player, you are continually required to rotate, as we mentioned earlier. You can see that the lumbar spine's primary focus is stability instead of mobility. An inability to use your pelvis and thoracic spine to create motion will cause your body to compensate and use excessive lumbar spine (lower back) rotation. Over time this can lead to both acute and chronic pain. 

The same is true of the skating stride, although in a slightly different context. The lumbar spine when skating must remain stable and upright to allow you to see the stick handle, shoot, and see the play develop. If you're unable to maintain an upright position, you'll end up pitched forward at the hip and facing the ice as opposed to the play. You'll be unable to properly activate your glutes in this position and begin compensating elsewhere in the body, increasing strain to the lumbar region. 

Mobility Drills 

If you're experiencing low back pain or want to mitigate the chance of suffering from it the, we suggest you target your mobility work to your pelvis and thoracic spine, – hips and upper back – it will also help with your golf game...if you're into that sort of thing. 

Half-Kneeling Hip Flexor Stretch w/ Stick 

In addition to being one of the most often mispronounced words, the psoas is an essential skating muscle that can cause significant pain when it becomes restricted. It's unique in that it originates on the lumbar spine and attaches to the femur. A combination of hockey, excessive sitting, 

(Psoas Pic) 

GR Tip: If you're a hockey player gab yourself a PSO-RITE. We have zero affiliation with the company, but they make a great product and we use them all the time. 

Band Assisted Glute Rock 

Utilize a band to add extra traction to the exercise and better mobilize your hip. 

Adductor Rock Back

Sidelying T-Spine Rotation 

There are several options for improving thoracic rotation, and you should experiment to see which you like best. 

Mobility is best delivered in microdoses rather than extended sessions, working on the above drills multiple times each day for 5-10 minutes would be a better use of time than one extended session. 

As valuable as these drills can be, opening up your hips and thoracic spine is only the first step in minimizing and preventing low back pain. 

The next step is core activation. 

Core Activation 

Your core is arguably the most important attribute you can develop as a hockey player. It's responsible for shooting, passing, protecting the puck from opponents, and skating. 

But, off the ice, your core is critical in helping prevent low back pain. If you lack adequate muscular activation, you'll instead rely on passive aspects – ligaments and bones – to support the body. This will, in turn, place stress on the discs and nerves and can lead to low back pain. 

As important as core training is, not all exercises are created equal. This is true for both pre/rehab purposes and performance. 

We separate core training into three reciprocal pairs and pelvic floor drills for the hockey players we work with.  

- Flexion / Anti-Flexion 

- Extension / Anti-Extension 

- Rotation / Anti-Rotation 

- Pelvic Floor 

Avoid excessive flexion and rotation until any pain has calmed down when it comes to low back pain. It does not mean that actions that flex and rotate your spine are bad. In fact, they are necessary for all athletic movement, but they do put additional stress on the lower back musculature and are worth avoiding if you're in pain. As a hockey player, you're in those ranges continuously, and performing the opposing movements will help you to avoid issues from constant repetition of the same pattern. As a general guideline, we aim to achieve a 2:1 ratio favoring anti-movements.

Birddog 

Focus on maintaining a canister from pelvis to ribcage. Extend with your glute and upper back musculature not arching through the spine. 

Deadbug 

Side Plank 

Half-Kneeling Pallof 

We'd suggest two sets of 8 reps for each exercises 2-3 times per day and definitely before training or skating. This will help to 'prime' the musculature and help prevent against any additional strain. 

Strengthening

As valuable as the above drills are for developing your core, they aren't enough on their own. You must be able to brace and fire your core in all positions, and a proper, full-body strength program is the best thing that you can do for both your hockey and your health. 

We'd suggest starting initially with unilateral lower body exercises, especially if you've dealt with previous low back pain. Unilateral refers to one limb only, reverse lunges, split squats, step-ups, single-leg RDLs, are all great examples. 

Why not start squatting or deadlifting? 

It's a valid question. Squatting and deadlifting are fundamentals patterns that allow you to load the bar and increase your strength. But, they also require significant core strength to execute apply much more shear force to the lumbar spine than single-leg exercises. 

(Shear force example) 

We have several NHL players that no longer squat or deadlift with any significant weight as a result of injuries. Fortunately, they are able to train and develop their strength in other ways and can enter each season just as strong. 

Unilateral upper body exercises are also a wonderful way to challenge your core to stabilize under load and although not as important for low back pain as lower body exercises should still be incorporated. 

Below are our favourite strength exercises to help mitigate low back pain. 

DB Split Squat 

SA DB Incline Press 

SL DB RDL 

SA 3 Pt DB Row 

Start subbing a few of these exercise into your workouts to help prevent low back pain and get you back on the ice and confident in your body. 

This is in no way a comprehensive list of all the things necessary to both prevent and treat low back pain and you should always consult a professional but these tips could help you stay in the game, or get back on the ice. They require 20-30 minutes extra per day, which seems like a small price to pay for confidence in your body.

Remember that consistency is key! You can't just perform the exercise for a couple of days and expect results. Trust in the process and stay consistent.