Hockey places specific demands on the body, which creates its own specific injury profile.
This includes soft tissue injuries such as lower back pain, ankle sprains and hamstring issues (Barboza et al., 2018; Dick et al., 2007; Murtaugh, 2009). This article aims to address how you can reduce your risk of soft tissue injury by loading the relevant tissues to keep them robust and injury free.
Interestingly, research in elite Dutch hockey has highlighted that 63% of injuries are overuse and 37% are traumatic (Barboza et al., 2017). This suggests that there is a need for players to increase their tolerance to training and match loads, in order to reduce injury risk.
The most common injury site is the lower limb (13-77% of injuries reported), followed by the head, upper limb and trunk (Barboza et al., 2018). This again highlights the need for interventions to help reduce the risk of lower limb injury, especially in the ankle (Murtaugh, 2009).
What is tissue capacity?
In its most reductive sense, tissue capacity is the ability of a tissue to withstand repeated loading. This might also be called muscular endurance. A tissue with higher capacity can tolerate more stress, and is more resilient to this. An example might be the calf muscle. If the calf’s capacity is higher, then it can perform more work and won’t fatigue as quickly. This means it can tolerate more running volume and eccentric work.
Is it related to injury risk?
Although research in the specific area of hockey is somewhat limited, we can make inferences from other sports and research areas. Research has shown that the higher the capacity of muscle tissue, the more loading it can tolerate. This is good news, as it means that you can help reduce your risk of injury and keep doing what you love - playing hockey!
Hamstring injuries
Freckleton et al. (2014) found that Aussie rules athletes who could perform more than 25 hamstring bridges had a reduced risk of subsequent hamstring injury in season. In other words, those who couldn’t perform this number, later went on to sustain an injury. Those who scored poorly also had a history of previous hamstring injury. Although the demands of the sport are different from hockey, this does not mean that they are worlds apart, and the running demands are also very high. The authors provided the following benchmarks: <20 = poor, 25 = average>30 = good.
Challenge - see if you can complete 25 hamstring bridges in one go using a 60bpm metronome (1 second up, 1 second down)
Other great preventative exercises for the hamstrings include:
- Romanian deadlifts
- Single leg back extensions
- Hamstring curls
- Slider bridges
- Single leg RDLs
- Nordic curls
Ankle injuries
The ankle is one of the most common injuries in hockey, accounting for up to 30% of all recorded injuries (Murtaugh, 2009). This is possibly due to the frequency of high-speed, unplanned changes in direction. The low positions and playing surface could also be factors here, as well as previous injury. The calf and soleus act to support this joint, keeping it stable and resisting external forces during sprinting and changes of direction. Increasing the strength and capacity of these muscles is important if you are to reduce your risk of injury. Research has also highlighted that reduced ankle dorsiflexion torque is related to increased ankle sprain injury incidence in female field hockey players (Naicker et al., 2007). If you can increase your calf capacity, then you can help to strengthen this area and offset your risk of injury.
A study by Herbert-Losier et al (2017) found the following single leg calf raise normative values (in repetitions) for male and females:
- 20-29yrs: Males 37 , Females 30
- 30-39yrs: Males 32, Females 27
- 40-49yrs: Males 28, Females 24
Challenge - see if you can complete 30 calf raises in one go using a 60bpm metronome (1 second up, 1 second down)
Other great injury prevention exercises for the ankle include:
- Double leg calf raises
- Extensive plyometric exercises (low intensity, high volume)
- Single leg balance and proprioceptive work
- Seated calf raises
- Band resisted eversions
- Band resisted dorsiflexions
Lower back
Finally, the lower back is a common injury site in hockey (Barboza et al., 2018). This is possibly related to the low positions and lumbar flexion experienced in hockey. The semi-rotated positions and frequent exposure to lunging, tackling and passing may contribute to this as well. Strengthening the muscles of the trunk including the obliques and rectus abdominis is key. They contribute to spinal stiffening, reducing shear forces and the requirement for lumbar muscle work (Willard et al., 2012).
Some great exercises to strengthen the lateral trunk muscles (obliques/transverse abdominis) include:
- Side plank pulses
- Side plank rotations
- Lateral trunk holds
- Lateral trunk pulses
- Medicine ball rotations
- Side bends
Some great exercises to strengthen the anterior trunk muscles (rectus abdominis) include:
- Double leg lowers
- Plank extensions
- Dead bugs
- Supine trunk holds
- Single leg lowers
- Hollow holds
Aim to complete 150-300 reps of a combination of anterior and lateral trunk exercises as part of a circuit. This should take you around 7-12 minutes to complete.
How often should I be doing these exercises?
A good target is to complete these exercises 2-3 times per week, aiming to spend around 30-40 minutes doing so. If you are already doing a strength programme then you incorporate them into your session after your main lifts.
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References
Barboza SD, Joseph C, Nauta J, van Mechelen W, Verhagen E. (2018) Injuries in Field Hockey Players: A Systematic Review. Sports Med. 48(4):849-866.
Barboza SD, van Mechelen W, Verhagen E. (2017) Monitoring Field Hockey Injuries: The First Step For Prevention. British Journal of Sports Medicine. 51:312.
Dick R, Hootman JM, Agel J, Vela L, Marshall SW, Messina R. (2007) Descriptive epidemiology of collegiate women's field hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2002-2003. J Athl Train. 42(2):211-20.
Freckleton G, Cook J, Pizzari T. (2014) The predictive validity of a single leg bridge test for hamstring injuries in Australian Rules Football Players. British Journal of Sports Medicine 48:713-717.
Hébert-Losier K, Wessman C, Alricsson M, Svantesson U. (2017) Updated reliability and normative values for the standing heel-rise test in healthy adults. Physiotherapy. 103(4):446-452. doi:
Murtaugh K. (2001) Injury patterns among female field hockey players. Med Sci Sports Exerc. 33(2):201-7.
Murtaugh K. (2009) Field hockey injuries. Curr Sports Med Rep. 8(5):267-72.
Naicker M, McLean M, Esterhuizen TM, Peters-Futre EM. (2007) Poor peak dorsiflexor torque associated with incidence of ankle injury in elite field female hockey players. J Sci Med Sport. 10(6):363-71.
Willard FH, Vleeming A, Schuenke MD, Danneels L, Schleip R. (2012) The thoracolumbar fascia: anatomy, function and clinical considerations. J Anat.221(6):507-36.
