Gary Roberts Performance

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November 27, 2023

Regardless of what level of hockey you play, if you've been lacing up the skates for any period, the chances are that you have experienced a hockey injury. It might have been acute – like a broken wrist or a chronic lingering issue such as a groin strain.

Regardless of the type of hockey injury, it can be immensely frustrating, especially if it's keeping you off the ice and away from your teammates. Unfortunately, we know all too well how a day can feel like a week and a week like a month when it comes to missed games during a season or training sessions in the summer.

It's even more frustrating when the injury occurs in training and away from the ice!

As strength coaches, we subscribe to the Hippocratic oath, first do no harm. This means that everything done off the ice is to build the athlete up, and we select exercises and methodologies with maximum upside and minimum injury risk.

Although we aren't focusing on avoiding training injuries today – we'll save that for another article – it is important to mention that if you find yourself becoming injured in training, you may need to re-evaluate the exercises, your technique, or the loads. As a general rule, err on the side of caution. For example, squatting 5 lbs lighter than you are capable of is a lot less detrimental than 5 lbs more than you can handle.

As always, look to work with a coach – either in-person or remotely – to maximize results and ensure that all of your exercises are performed correctly.

With all that said, hockey injuries are inevitable, and what can we do once they occur?

First, we'll discuss some of the more common and traditional methods and their effectiveness. You've likely heard the term RICE used before. The acronym is expanded below.

Rest

Ice

Compression

Elevation

The term RICE is not that old and first appeared in a publication in 1978 by Dr. Gabe Mirkin (1) called "Sports Medicine Book" but has become thoroughly ingrained in the academic culture since that time.

But is it effective? Does RICE after an injury actually help recovery?

The second component of Rest, and the one that RICE refers to, is Inactivity. Inactivity means precisely that, doing nothing and is highly detrimental to coming back from an injury. Not only does it not promote recovery, but it also decreases a hockey player's overall fitness. When the injury heals, the player still needs to spend additional time just getting back in shape. If they return to the Ice without the appropriate fitness level, they are highly susceptible to re-injury! Therefore, complete Inactivity is seldom the correct answer and should only be utilized for a limited period.

Starting in the mid-2000's researchers began to spend significant time analyzing the RICE method and its efficacy in promoting recovery. They paid particular benefit to Ice.

Unfortunately, the results have been less than stellar, with several publications illustrating that Ice does not provide a meaningful benefit regarding healing. The final nail in the coffin fo came in 2015 when Dr. Gabe Mirkin rescinded his 1978 statement that Icing an injury may no longer apply to long-term recovery.

Why is this? We've been told for our entire life to do so.

Anytime your body is injured, it triggers the release of different inflammatory markers (interleukins, growth factors, cytokines, etc.) that flood the area to assess the damage and begin working on the repair. Applying ice to an injury can decrease the inflammatory response, which we need to promote tissue repair. This same idea applies to ice baths immediately after hard training. We require that localized inflammation to drive adaptations in our tissue.

We use Ice and NSAIDs immediately after the injury to decrease the associated pain – 6-12 hours – but after that point, to scale back its use, especially following training. You should, of course, consult with your doctor on any treatment protocols.

Regarding the other components of RICE, it appears that Elevation and Compression have some validity in reducing the immediate swelling and aiding in blood flow. They are certainly not detrimental to the injury, so we suggest incorporating them into your routine, especially when you're at home with idle time. Even if the benefits are merely a placebo, we think it's worth implementing.

That leaves Rest.

This is another area of the Rice protocol that receives serious examination and one that we as a company realized anecdotal before the research started to support us.

Let's break Rest into two categories to define better what we mean.

The first type of Rest is what we would deem to be Recovery. These actions are hugely important for dealing with injuries and cannot be understated. Recovery encompasses your bedtime, the quality of your sleep, your mid-afternoon nap, the food you eat, and the supplements you take, and so much. It is everything but your training times, and it is more important than anything you do on the ice or in the gym for long-term success.

The quality of your sleep and a hockey player's bedtime is crucial for injury recovery. We won't get into the weeds on sleep in this article but try for at least 8 hours. As an athlete, you should be aiming for this anyway as it decreased the likelihood of an injury. (2) Be sure to power off your devices at least an hour prior and turn the temperature down to create an optimal environment.

In addition, we design a strength training program around the restrictions. We'll work with our therapy team to determine what corrective exercises to incorporate for the injury, often using pain as a feedback system. The specific corrective exercises will vary based on the injury, and your therapist and coach should be working together to decide the best options for you.

With that said, we don't want the training sessions to be purely rehabilitative. Post-injury workouts are an area that we often see player's make mistakes. Being injured doesn't mean you can't train hard!

So, what can you do post-injury?

Firstly, it's crucial to find a qualified and skilled manual therapist. This person may be a physiotherapist, chiropractor, osteopath, or TCM practitioner. These fields have all started to overlap, and you should ask your strength coach or fellow hockey players for a suggestion. Regular soft tissue treatment will be hugely beneficial in the healing process.

After you have set up a manual therapist, you can now focus on the training component.

We certainly aren't suggesting that you push through the pain and use the injured limb immediately! Instead, we advocate for a two-pronged approach and use it with all of our injured hockey players.

Globally, we prioritize Active Recovery (AR) for all of our injured hockey players. AR is well studied and reported on, with more research continuing to emerge. One of the individuals spearheading the movement is Gary Reinl, the author of ICED! The Illusionary Treatment Option. He has coined the term ARITA, Active Recovery Is The Answer, to help promote the importance of this action. In saying Active Recovery, we're referring to low-level activity through pain-free ranges of motion that promotes blood flow, clears waste products, and helps mitigate further atrophy and nerve damage.

The goal is to start the injured hockey player on this protocol as soon as possible. Of course, this is dependent on the severity of the injury and the initial Inactivity period required. What modality you use to accomplish this is less important. Cycling, walking, swimming, handbikes are all great options, and the answer depends on the injury. Light aerobic activity will promote blood flow throughout the body and aid in the recovery process, and you do not necessarily need to incorporate the injured limb into these actions.

Our goal is to make the training session as similar to an uninjured one as possible. For example, if we would usually program a Hang Clean and the player has an injured wrist, we'll replace Hang Clean with a Single-Arm Dumbbell Clean. In this way, the player is getting the maximum benefit for that movement pattern, with the least disruption. Also, they still feel like an athlete, which is crucial for keeping them mentally engaged throughout the recovery process.

Another area that every injured hockey player should take advantage of is the Crossover Effect. The Crossover Effect is the benefit that you receive from unilateral training on the uninjured limb. All neural signals travel from the brain down the spinal cord. This nerve then splits to innervate both limbs, but a component of that signal reaches the non-working limb due to crossover or spillage.

A 2006 meta-analysis (3) concluded that you receive nearly an 8% crossover benefit from training the opposing limb, which may not seem like a lot, but it can make a huge difference in the recovery process. Imagine getting an 8% strength gain in your left injured leg after performing single-leg squats with your right! That's amazing!

So, in summary, when it comes to training with an injury, there are many factors to consider. The traditional RICE model may not be as effective as we once believed. In place of that, we suggest Active Recovery with an emphasis on the appropriate corrective exercises and training sessions designed as close to optimal as possible. In Part 2, we'll examine the most important Nutrition and Lifestyle factors for hockey injuries.

If you've been injured and are looking for some guidance coming back, our Online Training App is an excellent option for working with the same coaches who have rehabbed some of the game's top players. Find out more information here.

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