The development and implementation of a hip injury screening protocol within elite ice hockey

• Main Author: Wilcox, Christopher Richard James
• Other Authors: Vince, Rebecca V. ; White, H. S. F.
• Published: University of Hull 2015
• Subjects: 617.1; Sport science
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.691381

The primary aim of this project was to both investigate injury epidemiology and create methods to potentially reduce injuries within elite ice hockey athletes. Chapter Four assessed the injury problem within ice hockey by retrospectively collecting data from two National Collegiate Athletic Association (NCAA) division III teams across a four year period investigating the prevalence, location, severity and type of injuries sustained. Findings showed that contact injuries were more prevalent (58%) than non-contact injuries (42%), with the knee (15%), shoulder (12%) and hip (13%) being the most frequently injured locations when both contact and non-contact injuries were combined. When investigating only non- contact injuries the hip complex (hip, groin and thigh) (50%) was by far the most injured location with similar frequencies, in terms of injury severity, observed. Chapter Five analysed intrinsic risk factors of the ice hockey athlete by investigating differences of hip range of motion (ROM), strength and functional tests between ice hockey athletes, soccer athletes and control participants. Results demonstrated that ice hockey athletes had significantly weaker hip adduction (p = 0.023) and flexion in sitting (p = 0.001) strength compared to soccer athletes and less external rotation strength compared to control participants (p = 0.010). Ice hockey athletes also displayed greater strength than control participants in flexion in sitting (p = 0.005). Ice hockey athletes exhibited greater ROM in abduction (p = 0.001) than control participants and greater adduction than both soccer athletes (p = 0.003) and control participants (p = 0.004). Ice hockey athletes exhibited less hip flexion in lying (p = 0.001) and external rotation (p < 0.001) when compared to control participants. Ice hockey athletes also presented with an increased number of positive flexion, abduction and external rotation (FABER) tests compared to both soccer athletes and control participants. Chapter Six investigated the effectiveness of the newly created hip screen by comparing ice hockey athletes with and without a previous non-contact hip injury and their performance during the hip screen. Findings demonstrated that athletes who had no previous hip injury had greater internal (p = 0.004) and external rotation ROM (p = 0.022) on the dominant (Dom) limb and greater flexion in sitting (p = 0.031) and internal rotation ROM (p = 0.050) on the non-dominant (Ndom) limb. Although non-significant, previously injured athletes also displayed less ROM in all hip movements compared to previously uninjured athletes. Similar trends were found in strength measures with previously uninjured athletes showing significantly stronger abduction (p = 0.012) on the Dom limb and flexion in lying on both the Dom (p = 0.008) and Ndom limb (p < 0.001). Previously injured athletes displayed more positive FABER (Dom; 13% vs. 0%, Ndom; 13% vs. 5%), Trendelenburg (Dom; 75% vs. 58%, Ndom; 50% vs. 5%) and Ober’s (Dom; 13% vs. 5%, Ndom; 75% vs. 68%) tests with higher scores on the overall screen than uninjured athletes. Chapter Seven investigated the intra and inter-tester reliability of the hip screen finding that intra-class correlation coefficients (ICC) of intra-tester reliability of the ROM (0.49), strength (0.80) and overall screen (0.76) was moderate to near perfect. Inter-tester reliability again showed very large ICCs for ROM (0.71), strength (0.77) and overall screen scores (0.81). The minimum criterion change (MCC) (3.78 points) was also found to be small for the screen score change needed to be viewed as clinically worthwhile. These findings demonstrate that the screening procedure developed is useful, reliable and repeatable when assessing the ice hockey athlete’s hip. Chapter Eight demonstrated that all participants regardless of group improved their ROM and strength measures following the intervention period. However, it was demonstrated that the ice hockey intervention (IHI) group saw a decrease in the amount of positive FABER tests following the intervention compared to ice hockey control (IHC) and intervention control (IC) group (IHI: pre 15 vs. post 6; IHC: pre 15 vs. post 14; IC: pre 10 vs. post 9). It was also demonstrated that the IHI group improved above the MCC value presented within Chapter Seven with regards to the overall hip injury screen score (pre 48 vs. post 52) indicating that ice hockey athletes who participated in the intervention programme may be at a decreased risk of sustaining a non-contact hip injury due to the intervention exercises targeting weaknesses highlighted in the hip injury screen. In summary, the current project achieved the stated aims by demonstrating that the hip complex was the most common location for injuries of a non-contact nature and the creation of a reliable and repeatable hip injury screen that allows clinicians to potentially highlight athletes considered as ‘at risk’. To complete the injury prevention sequence, future work would be necessary to track athletes who scored low on the hip injury screen over time either following the intervention or as a control to assess if they were more or less likely to sustain a non-contact hip injury. Future work should also continue to optimise the intervention strategy to further develop and enhance its effectiveness in the prevention of non-contact hip injuries. This could be achieved either through a longer protocol that is incorporated into routine training or individualisation of the programme and as such provide a valuable tool for clinicians and medical teams wishing to reduce the risk of ice hockey athletes sustaining a non-contact hip injury.