Non-Surgical Treatment Of Sports Hernia In A Pro Hockey Player
Now I don’t want the title of this post to be misleading, it can be tough to diagnose a sports hernia without surgical observation and inspection of the tissues involved, so the report that I am about to share with you is a discussion of the methods used to return an NHL player with the symptoms of a sports hernia to pain free play.
If you want to read the case study in detail I will post the reference at the end of the article.
What struck me with this case was the mechanism of injury, this was an acute injury meaning there was an event on the ice which lead to the onset of symptoms. Typically I think of sports hernia as more of an insidious onset over time.
In this case a player was hit from behind while skating – so they were forced into back extension as they were going into hip extension – putting the anterior structures of the hip and abdominals on a forced rapid stretch.
The player had immediate pain and was not able to finish the game. In the post-injury period they reported pain with rolling over in bed, ambulating, navigating stairs, etc.
So the initial stage of recovery was to decrease the pain and restore the range of motion. The player also started some standing exercise in the pool to reduce the weight bearing while completing functional movements such as squatting and hip ab/adduction.
The Next Phase…
Once the player had no pain at rest and a low level of discomfort during moderate activities such as pool running and biking they moved on to the next phase of recovery.
This began by teaching the player to activate the Transversus Abdominus – (deep abdominal stabilizer) in different positions varying from supine, to quadruped, to tall kneeling, to half kneeling.
If you cannot see the video in the player above, simply click on this link…
Once the activation could be completed without a global ‘flexing’ of all the abdominal muscles, movements of the upper and lower extremities were added in through a variety of positions and patterns. I will shoot a video for another post giving you some ideas of what these movements look like. Today I just want you to get an idea of the progression and appreciate that teaching the athlete to maintain a neutral pelvis is the foundation of the rehab process.
It is not strengthening the legs, groins or rectus abdominus – it is teaching the player to use the right muscles to help maintain a neutral pelvis and then use those muscles in different planes of motion.
The Finishing Touches…
Once the player was able to maintain neutral pelvis with multi-planar movements off the ice, they began on-ice rehab with unidirectional lap skating at only 25% of their max effort for 20-minutes.
Then more layers of complexity were added such as forward cross-overs and stick-handling with a puck. Then the player increased his intensity to 50% of his maximum effort.
By the end of the first week on the ice the player was taking shots and spending 60-minutes practicing his skating and skills. During the second week they built up to 90% of max effort complete slap shots and drills with teammates.
The on-ice progression lasted 17-days. Overall, the rehabilitation lasted 7-weeks. Which sounds like a lot doesn’t it? BUT – – the player was able to return to full play after the thorough and progressive rehab program and play for at least 8-more seasons without a recurrence of symptoms.
Take it to the bank…
Injuries will happen to most athletes and as soon as you get one, you just want to make it better as fast as possible. I get emails ever week looking for the ‘fastest’ way to get over injury XYZ.
The thing I love about this case study is how the athlete and the training staff worked through a well thought out step-wise progression to get the player back on the ice and keep him healthy.
How many times do you see an athlete rush back only to be plagued by recurring injuries? Just like your training, follow the recipe and don’t look for short cuts.
Here endeth the sermon…
PS – here is the reference for the article…
Non-Surgical Treatment Of A Professional Hockey Player With The Signs And Symptoms Of Sports Hernia: A Case Report
J. Scott Woodward, Andrew Parker, Robert M. MacDonald
The International Journal Of Sports Physiotherapy. Volume 7, Number 1, February 2012, pp 85-100
PPS – Got this email a while back…
I had purchased RRGT about a year ago, and did about a month and half of the program before hitting the ice as a goalie again. This is the first time I’ve been back between the pipes in almost a year, and I have to say I was extremely impressed with my mobility and ability to play goal again! Even my friends who I was playing with said they haven’t seen me move that well in quite some time, of course my timing was way off, but I felt I did well for someone who had a year off, plus I didn’t have hip pain after! This is when I became a strong believer and supporter of your programs.