Ice Hockey (Care of the Young Athlete)

Dehydration

There is a common misconception that athletes who play in cold weather do not need to drink as much as those playing in warm weather. In fact, hockey players training in cold environments wear more clothing and may be unaware they are losing body moisture. Dehydrated athletes often perform poorly in multiple game situations like tournaments and during the last period of a game.

Hydration should take place before, during, and after games and practices. In general, athletes should drink 5 to 8 ounces of water or an appropriate sports drink every 20 minutes, even if they do not feel thirsty. Players not responding well, unable to drink, or with difficulty breathing may need emergency medical attention.

Exercise-induced asthma

• Exercise-induced asthma is prevalent in hockey players who are prone to asthma because hockey is played in cold weather under dry conditions. Skaters should have a personal asthma action plan. Asthmatic skaters can prevent episodes by taking their medicines and using an inhaler before practices or games. Inhalers and spacers should always be on hand during activity. Skaters should stop skating and see a doctor if they have difficulty breathing while skating.

Frostbite

Cold weather, wet clothing, and tight-fitting skates can lead to poor circulation and frostbite. Early signs of frostbite are pale or white skin with numbness and tingling of the exposed body part. It is important to dress in layers and wear wicking, fast-drying wool or polypropylene underwear and socks. Cotton clothing is not warm when wet and can contribute to frostbite and hypothermia by lowering the body temperature. Treat frostbite by increasing circulation and warming cold body parts in a heated room or under the clothes. Change wet clothing often.

Head injuries

Concussions in hockey most often occur from a blow to the head, from falls, or from being checked into the boards. A concussion is any injury to the brain that disrupts normal brain function on a temporary or permanent basis.

The signs and symptoms of a concussion range from subtle to obvious and usually happen right after the injury but may take hours to days to show up. Athletes who have had concussions may report feeling normal before their brain has fully recovered. With most concussions, the player is not knocked out or unconscious.

Prematurely returning to play after a concussion can lead to another concussion or even death. An athlete with a history of concussion may be more susceptible to another injury than an athlete with no history of concussion.

All concussions are serious, and all athletes with suspected concussions should not return to play until they see a doctor.

Youth hockey programs in the United States and Canada have active head injury prevention programs for athletes and coaches. Safe play and properly fitting helmets can prevent concussions, as does striking the boards at an angle with the head up when a collision can't be avoided.

Arm and leg injuries

Injuries of the extremities should be treated with rest, ice, compression, and elevation (RICE). Nonsteroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and swelling, but should be taken with food. Injured athletes should see their doctor if they have pain while playing.

• Upper extremity injuries of the shoulder, arm, and wrist occur during falls or from being checked into the boards. Shoulder dislocations are very painful until put back into place. Persistent wrist or arm pain after a fall can signify a broken bone (even if there is no visible swelling or deformity) and should be iced and immobilized until it can be treated by a doctor.

• Groin strains are pulled or torn muscles or tendons of the inner thigh. Hockey players and goalies doing forced push offs or slides on skates may get this injury. Treatments that may help are ice, NSAIDs, thigh wraps, physical therapy, and modification of activity. Groin strains can be prevented by warming up properly and doing muscle stretching as a part of team practices and games.

• Knee injuries are more common in hockey than ankle injuries because the ankle and Achilles tendon are protected by a stiff boot. Knee injuries happen when the knee is forced or twisted to the side or back. If a ligament or cartilage is torn, a pop may be felt or heard, followed by visible swelling around the knee.

• Overuse injuries, such as Osgood-Schlatter disease (irritation of the growth plate causing a painful bony bump below the knee), occur in 10- to 15-year-olds who play active sports with running, jumping, or skating. In hockey, a combination of off-ice training, overtraining, and frequent practices and games may lead to Osgood-Schlatter, thus limiting or changing activity may help.

Eye injuries

In the past, blows from hockey sticks and flying pucks caused many eye injuries. Now helmets with face masks have decreased the number of eye injuries, but they still can occur. Any injury that affects vision or is associated with swelling or blood inside the eye should be evaluated by an ophthalmologist. The AAP recommends that children involved in organized sports wear appropriate protective eyewear.