Sports Medicine Youth Hockey Injuries Q&A with Dr. Vyas By Sports Medicine, October 11, 2015 Youth hockey is a sport that has been growing in popularity. And because it takes a village to raise a hockey player, it’s no surprise that many parents, coaches, and family and friends have questions about their young athlete starting the sport. To help address some common questions, Dharmesh Vyas, MD, PhD, orthopaedic surgeon at UPMC Sports Medicine and Head Team Physician for the Pittsburgh Penguins, answered some of these questions during a recent Facebook Open Wall discussion. Q: Is there a limit to how much hockey a child should play? Dr. Vyas: There are no set recommendations for adolescent hockey; however, overuse injuries are probably the most common cause of time away from the sport. Most children under 14 should not play more than 3-4 times per week and should take several days off to rest between back-to-back games. Off-ice workouts on rest days are completely acceptable, though. Importantly, children should be encouraged to play other sports in addition to hockey. This would allow them to develop different muscle groups and motor skills as well as avoid burn-out from playing one sport all year round. Q: My little cousin is really eager to play hockey, but his mom is worried about potential injuries. Is there anything she can do to help him avoid getting injured? Dr. Vyas: A few tips for preventing injuries include obtaining high-quality equipment that fits well, participating in a sports-specific conditioning program to avoid overuse injuries, completing a pre-season physical exam by a physician or certified athletic trainer, and enforcement of existing rules for the appropriate level of play. That includes sportsmanship and respect for the opposing players’ health. Q: We often hear about pro athletes getting re-injured because they return to play too soon. How do we make sure we don’t let our younger players return too soon? Dr. Vyas: That’s a great question! Return to play is always a difficult concept and is highly specific to the injury or surgery. The most important aspect is to listen closely to your physician’s recommendations and try not to push the issue of returning too soon. I always tell my patients that waiting an extra 1-2 weeks may be the difference between returning safely versus needing to take an additional 1-2 months off due to a repeat injury. It is one of my biggest challenges as a team physician to keep athletes from returning back to the ice too soon. My primary role is the get them back on the ice safely and playing the sport they love at a high level! Best rule of thumb, if ever in doubt, call your physician and they’ll be more than happy to help guide you. Q: My husband’s little brother is involved in youth hockey, and we’ve heard a lot of sports do dryland training. Is this important? If so, what types of dry land conditioning is appropriate for a middle school student? Dr. Vyas: Dryland conditioning is just as important as on-ice training. Some of the most common injuries are hip, back, knee, and shoulder. Dryland conditioning that focuses on strengthening the lower back, upper body, and hip adductors may help prevent some of the more commonly seen injuries that result from improper mechanics and poor conditioning. Stretching of hip flexors and strengthening the back and abdominal muscles, strengthening of the quadriceps and hamstrings, and proper skating technique as taught and constantly monitored by a skating coach will help minimize these common youth hockey injuries. Strengthening of the upper body and neck muscles may also help decrease the severity of concussions. Also, don’t forget appropriate protective equipment by using helmets and face masks. Q: Are there recommended warm-ups for kids to do before they get on the ice? Thanks! Dr. Vyas: Yes! Some of the most common injuries are adductor strains / groin injuries and it’s very important to do both mobility and stability training for injury prevention. Warm-ups might include adductor stretching and trunk side-bending or trunk rotation. Hamstring and quadriceps stretching and upper body, shoulder, and neck mobility are recommended. Just as importantly, dynamic warmups are critical to incorporate into any warmup routine. A dynamic warmup helps to reduce injuries by coordinating joints, muscles, tendons, and ligaments. In terms of shooting, kids should start off shooting at approximately 50 percent before building up to full slap-shots during the warm up. This can help to minimize abdominal oblique injuries. Also, incorporate long and short passing drills with controlled shooting, as well. Q: What do you recommend we give our players before and during the game to stay hydrated? Is Gatorade better than water? Dr. Vyas: Water is probably the most important; however, loss of minerals is a well-known issue with dehydration and fatigue. I’d do a 3:1 combination of water to sports drink during the game. Before the game, the recommendation is 5ml per kg body weight of water, up to four hours prior to exercise. Electrolyte replacement with snacks and beverages that contain sodium after the game will help retain fluid in preparation for the next day’s practice. An important concept that is sometimes forgotten is to start the hydration process well before the practice or game (several hours prior to participation). It is difficult to catch up with water balance once the fluid loss process is underway during the activity. For more information on common hockey injuries, visit our hockey training section. To schedule an appointment with Dr. Vyas or one of UPMC’s sports medicine experts, call 1-855-93- SPORT (77678).