jeffcubos.com » Hockey

Concussions 101

jcubos — Mon, 16 Jan 2012 20:28:18 +0000

NHL Concussions: Have Our Players “Outgrown” Our Sport? Has this sport gotten too big for itself?...

Related posts brought to you by Yet Another Related Posts Plugin.

Hockey Strength & Conditioning: Meeting with an NHL Strength Coach

jcubos — Tue, 27 Dec 2011 20:13:17 +0000

In December of 2010, I had the opportunity to sit down for breakfast with Anaheim Ducks strength and conditioning coach, Sean Skahan. Sean has been with the Ducks for nearly a decade and a year ago launched hockeystrengthandconditioning.com with several other high level coaches. Note: Some of you may have already read this post, but I thought I’d re-post it again seeing that the World Juniors are currently under way and to bring attention to the potential differences in hockey development between countries.

Its always a pleasure to be able to sit down with individuals who’ve “been there, done that”, but anytime I’m able to sit down with someone associated with hockey, this becomes a privilege. Rather than give you Sean’s bio, I’ll just refer you to this link.

Sean Skahan

The reason I’m writing about this rendezvous is because of some of the topics we chatted about. Here, in point form, was the jist of our conversation.

The importance of working hard to create opportunities – Sean isn’t where he is today because he spent 8 hours on the computer and one hour of training clients per day. Sean was in the trenches, interning with one of the best, and jumping on any opportunity awarded to him from his great work. He stated that sometimes these opportunities come in different and unexpected forms (he’s always wanted to work with football), but it was important that he both recognized and pursued them.

The difference between American and Canadian hockey players - One thing I shed some light on, to which he agreed, was the difference between players north and south of the border. Here, in Canada, hockey schools are a dime a dozen. Our players have a fantastic skill set and our young players spend almost as much time on the ice than they do in school. Unfortunately, this creates a problem. Many, if not most, of our players do not know how to train. In contrast, if you look at American youth, plenty of time and money is devoted to athletic development. In fact, the sporting culture down south is an industry. From full time strength coaches and athletic trainers/therapists in high schools to athletic scholarships in college and university, young American athletes know how to train. One example I provided Sean with was with regards to Olympic lifting. I asked him to compare his Canadian prospects and rookies with his American counter parts. If you’re in professional hockey, ask yourself the same question and I guarantee you’ll come to the same conclusion: Canadians spend too much time on the ice and not enough time developing themselves as athletes.

Canada - 3 : USA - 2

The contribution of track and field – Those of you in the field of strength and conditioning, regardless of sport, should spend some time working with track and field athletes and coaches. Luckily I was fortunate to work closely with the University of Toronto Track Club for a number of years. Some of the lessons I’ve taken away from this opportunity were the importance of a thorough warm up and cool down to training, the creativity utilized by coaches when cueing, and the precise form utilized when training in the weight room. Sean agreed that we can all learn a lot from spending some time working with athletes in this sport.

For more information about Sean Skahan, please visit seanskahan.com. He also posted an excellent article on Dragon Door and recently released his DVDs on Kettlebell Lifting for Ice Hockey which can be found here.

Looking at the Literature: Neck Strength and Head Impacts in Ice Hockey Mihalik, JP et al. (2011). Does cervical muscle strength in...
2011 BC Strength, Fitness and Conditioning Conference May 14, 2011 - Simon Fraser University - Burnaby, British...
Edmonton Strength & Conditioning Seminar January 14, 2012 - Foote Field, University of Alberta...

Related posts brought to you by Yet Another Related Posts Plugin.

Concussion: ThinkFirst Smart Hockey

jcubos — Mon, 19 Dec 2011 17:46:24 +0000

For more information on concussions, please check out ThinkFirst Smart Hockey’s online education program or their resource page.

Looking at the Literature: Medical Therapies in Concussion Meehan WP. (2011). Medical therapies for concussion. Clinics in Sports...
Rinkside Reading: Offseason “training” tips for ice hockey Courtesy of kraftcanada.com...
Hockey Development: 2 steps forward, 1 step back Early Specialization? Really?...

Related posts brought to you by Yet Another Related Posts Plugin.

Case of the Week # 3

jcubos — Sat, 03 Sep 2011 04:29:44 +0000

Each week, I will be presenting a “case of the week” where you, the readers, are invited to put on your thinking caps and participate. The format will be the posting of a “history” and “physical” for two days with a poll whereby you are asked for your diagnosis. You are also asked to provide your treatment plan in the comments section. 48 hours later, the actual diagnosis will be provided with a short treatment plan for said patient. Each case will be hypothetical and will in no way reflect any true patient.

History

Male, 27 years of age, 6’7″
Professional goaltender (hockey)
3 week history of severe low back pain, gradually increasing in intensity
Prior history of recurrent mild low back pain (on and off for past 12 years)
Reports no significant onset
6 hour bus ride (roadie) 4 weeks prior
Headaches 3 – 5 days per week

Physical Examination

Neurological examination (sensory, motor, DTR) within normal limits
Upper chest breathing
Toe touch (lumbar flexion) – 50% ROM with sharp pain upon rising
Lumbar extension with arms overhead – < 5 degrees with pain
Active straight leg raise – 40 degrees with low back pain
Passive straight leg raise – 55 degrees with no pain
Passive straight leg raise with resisted bilateral shoulder extension at 90 degrees of shoulder – 70 degrees with no pain
Prone posterior-anterior spinous challenge L2-4 – painful
Quadratus lumborum hypertonicity bilaterally with palpable tenderness

Radiographic Findings

None ordered

Diagnosis

View This Poll

Treatment Plan

Please state your answer in the “comments section” and provide a recommended plan of management

..**Concluding Diagnosis**

Just a quick little note to Josh and Michael before I continue. I refrained from commenting simply to not give away the “best” answer. So my apologies.

Anyway, the key physical exam findings for this case were the sharp pain upon rising, the increased range of motion in passive straight leg raise with resistance and the spinous process pain upon challenge. Often sharp pain upon rising indicates an “instability catch” pointing in the direction of poor motor control. Because of this poor motor control, other structures tend to become overactive resulting in poor or limited extension patters for example, as well as global musculature (quadratus lumborum) hypertonicity. This is the “high threshold strategy” or as Lund calls it, the “pain adaptation model.” I also refrained from providing a full description of the test that demonstrated pain on spinous process challenge. In this case, the athlete was positioned with his upper body (proximal to pelvis) over the table with his feet on the ground. This is the prone instability test. Should this be positive (produce pain), one can check to see if pain decreases with active bilateral hip extension. This would increase core muscular activity and often, provide lumbar stability. Not much different to the resisted passive straight leg raise.

With respect to the plan of management, one of the top priorities would be to achieve proper motor control of the lumbar musculature. This can go hand in hand with facilitating proper breathing patterns to subsequently, dim down the neck muscle tension. Following this, progress as you see fit. There’s no right answer!

Case of the Week # 2 What's your diagnosis?...
Case of the Week #1 What's your diagnosis?...

Related posts brought to you by Yet Another Related Posts Plugin.

Hockey Development: 2 steps forward, 1 step back

jcubos — Fri, 26 Aug 2011 17:31:53 +0000

Several months ago, I wrote a short piece on off-season training tips for parents and their young athletes on the Kraft Hockey Centre site.

Rinkside Reading: Off-Season Training Tips

Unfortunately, many people still aren’t getting the message. Last night, I was watching the local news and perked up when a segment about the Edmonton Oil Kings‘ fitness testing day was aired…until I heard a message about Early Specialization. Go directly to 35:35 for the segment.

I think we’re still missing the boat. How is it that the message of healthy, long term athlete development is being completely forgotten? Is it Hockey Canada? I doubt it. Is it the media? Perhaps. Or is it the trainers? Maybe, maybe not. I know Body By Bennet has plenty of room in their facility for fundamental skill development and I know they’re doing the right things, but somewhere, somehow some parents are getting the wrong message. I really don’t know what’s going on in other, less established facilities. At least here in Canada anyway. Read this discussion I had with Sean Skahan early in 2011.

One of my graduate supervisors, Dr. Joe Baker, recently released his new book “Talent Identification and Development in Sport” and in a recent article in the Toronto Star he states,

“Playing many sports…is a sign of general athletic prowess and a source of useful skills for the one a youngster will eventually choose.”

Anyway, young Canadian children need to be children first. They need to be athletes second. It’s okay to be a “hockey player” and I encourage young children to get out on the ice and play, but most importantly, they need to participate in a wide range of athletic and playful activities.

Because mark my words, 10 years from now the U.S. will be a power house in international and professional hockey.

Video streaming by Ustream

Rinkside Reading: Offseason “training” tips for ice hockey Courtesy of kraftcanada.com...

Related posts brought to you by Yet Another Related Posts Plugin.

So your athlete has FAI, now what?

jcubos — Wed, 03 Aug 2011 05:29:15 +0000

Recently Kevin Neeld posted an excellent blog on FAI or Femoroacetabular Impingement as a follow up to his webinar on strengthandconditioningwebinars.com and sportsrehabexpert.com

If you're not a member, you're missing out!

For those of you unfamiliar with FAI, make sure you read Kevin’s post before reading any further. But for those of you who are, you’ll know that there are a million orthopaedic tests that all look the same.

So what do you do when these tests are positive? We already know that many professionals who suffer from FAI also have labral tears, but what about those young athletes who have no labral pathology? And what about those who do have labral pathology but for some reason or other, may not be candidates for surgery?

Well some of you soft tissue the heck out of it on a weekly basis but do you truly get the results you’re after? Maybe, maybe not. And if not, why not?

To answer that question, we have to ask ourselves what, from a non-osteological perspective, may be contributing to this presentation in the first place? Well Shirley Sahrmann may have the answer to this one. And her likely answer will probably fall somewhere along the lines of the anterofemoral glide syndrome (check out Eric Cressey’s post for some info on this presentation).

But back to my question, as a manual and rehabilitation therapist what can you do about it?

We know that the deep posterior hip structures are often stiff and shortened, so the first thing I would do is mobilize these structures.

We also may notice that the adductor musculature likely need some soft tissue work as well, so I would pistol (perhaps a simultaneous and combined ART / contract relax strategy – using the elbow as resistance) my way through these structures as well.

Personally, I prefer a more gentler and slow approach than his technique.

I’d also probably use a foam roller as well to save my hands.

I would likely then do some trigger point work in the anterior portion of the gluteus medius region at this point. Sorry I don’t have a video recorded for this one but only because its my secret weapon . Actually, you can do some needling here (and the TFL) as well, if you want even faster results.

Hit 'em RIGHT behind the ASIS.

But next I’d get them to do some self mobilizations, again for the deep posterior hip structures:

Then I’d throw down some “Sister Kenny” action (but more for the glute max rather than the glute med). Take a gander through Craig Liebenson’s ROS to see what I’m talking about (just click on the image).

And finally, I’d lock it down with the most appropriate, glute-dominant hip extension pattern that their exercise progression continuum calls for. This can be the lumbar-locked glute bridge:

It can be the hip extension portion (12:00 direction) of the Valslide Quadruped Hip Stability Clock Slide:

Or it can be the hip airplane:

As always, you’re free to choose whatever exercise you wish, just make sure its appropriate!

Happy treating!

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Looking at the Literature: The effect of A.R.T on pain thresholds

jcubos — Tue, 04 Jan 2011 04:07:59 +0000

Study Title: Immediate effect on pain thresholds using active release technique on adductor strains: Pilot study.

Authors: A. Robb & J. Pajaczkowski

Journal: Journal of Bodywork & Movement Therapies

Date: January 2011

Summary:

Here is a nice little pilot study by two of my colleagues from Toronto on the effect of Active Release Techniques on immediate pain thresholds in elite ice hockey players. Using 9 players from AAA to the major junior level, they studied the influence of this popular manual therapy technique on its ability to modulate reported pain pressure thresholds (PPT) in acute adductor muscle strains. Up until now, the majority of the current literature on this technique had looked at the beneficial application of ART through case studies, however, few if any have looked deeper into the therapeutic effect of such protocols. PPT, “the minimal amount of pressure applied to the tissue to change the pressure sensation to discomfort or pain”, was assessed both pre- and post-treatment via a hand-held mechanical pressure algometer. A significant improvement in PPT was demonstrated in this study. Since the painful experience involves both a bottom-up and top-down process, this study sheds some light into the potential positive effects manual therapy may have in acute pain patients. While the authors disclose that it is still difficult to conclude with certainty the exact pathophysiological and histological mechanisms responsible for these outcomes, they do provide some potential mechanisms for such reduction of pain. Certainly this study lacked a large sample size and randomization (hence a pilot study), however, the work of Drs. Robb and Pajaczkowski do pave the way for further research to validate a therapy that carries with it an extreme wealth of anecdotal evidence.

Robb, A. & Pajaczkowski, J. (2011). Immediate effect on pain thresholds using active release technique on adductor strains: Pilot study. Journal of Bodywork and Movement Therapies, 15, 57-62

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Concussion Updates

jcubos — Tue, 10 Aug 2010 15:00:40 +0000

As many of you know, my graduate work focused on hockey related concussions. For those of you who have followed my blog from day one, you’ll know that my very first post reviewed the developments from the most symposium on concussion in sport. To read my summary, click on this link.

Joe Przytula recently posted some highlights from the Athletic Trainers’ Society of New Jersey’s (ATSNJ) concussion summit of which Dr. Robert Cantu was the keynote speaker. Here are his notes (as taken directly from his blog):

VERY important the athlete is permitted appropriate time for healing to take place.
There is no set number of concussions that is a disqualification for further participation in contact sports.
2 man wedge tackling, blindside hits rule changes in American football are in order.
No way to predict CTE in a live person; lawyers should not be driving decision making.
Concussion accounts for 6-10% of all athletic injuries. The reported ones are just the tip of the iceberg. Subconcussive blows and their effect is an unknown factor.
Loss of consciousness is not a good indicator of degree of brain injury.
You don’t need to grade a concussion to manage them efficiently.
Time to recovery is a good indicator for risk in subsequent concussions.
When a player shows any symptoms of concussion, they should discontinue participation at least for that day.
The cornerstone of concussion management is physical and cognitive rest until symptoms resolve.
Prolonged post concussion syndrome (1m+) is usually associated with playing with a pevious head injury prior to the concussion.
Concussion Research- Journal of Neural Trauma: http://www.liebertonline.com/toc/neu/27/7
Many concussions occur at lower force, 60G’s and below. The new NFL helmet recommendations are suspect because they involved testing at higher G’s. Head and spine biomechanist specialists were not used in the study.
Since every concussion is different, is legislating concussion guidelines a good idea?

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Hockey Conditioning and Development

jcubos — Mon, 02 Aug 2010 15:57:12 +0000

This weekend I had the privilege of traveling to Hockey Canada headquarters to say hello to several of my former athletes and catch a glimpse as they participate in the Under 18 selection camp.

Quick update: The team roster was just announced and all three WILL represent our country!

As many of you know, athletic development is paramount when it comes to hockey and so I’d like to direct you to several good reads from my collegue, Kevin Neeld.

Long-Term Hockey Development and Injury Prevention

A New Look at Hockey Conditioning

Enjoy!

Photo source

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Ultimate Hockey Development

jcubos — Wed, 19 May 2010 16:11:53 +0000

Just wanted to give you all a heads up on Hockey Develepment Program, a new website by professional strength and conditioning coach, Kevin Neeld. Along with such professionals as Eric Cressey, Nick Tumminello, Chris Boyko, and Kim McCullough, I was asked to do an interview for this site.

Some of the topics I talk about are:

The #1 injury in men’s and women’s hockey and the long-term implications no one is talking about

Preventing the injury that can end your career

Pain vs. healing: How returning too quick can put you right back in the stands

Assessments that you can use to identify performance limitations and injury risk factors

How to minimize your risk of hip flexor and groin strains and what to do if you do suffer one of these injuries

How to minimize your risk of suffering a hip labral tear and sports hernia

If you are a hockey coach, strength and conditioning specialist, medical professional, or hockey dad, I highly suggest you visit The Hockey Development Coaching Program!

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.

Play It Cool

jcubos — Wed, 20 Jan 2010 02:28:16 +0000

The Problem:

Recent events in ice hockey that display a complete lack of respect not only for the opponent, but the game itself. The following are direct examples of such disrespect from two “highly ranked” players in Canadian major junior hockey within the last 2 weeks.

One Possible Solution:

Widespread and mandatory implementation of user friendly, evidence-based skill development and education programs such as “Play it Cool“

*Adapted from the “Play it Cool” website:

What Is Play It Cool™?

A skill enhancement program that aims to reduce the incidence of neurotrauma (concussion and spine) injuries in hockey.

An online platform to promote safe hockey as skill enhancement and education are the keys to injury prevention.

What components of Play It Cool™ separate it from other programs?

Play It Cool™ is supported by proven scientific research (the production of the Practice Playing Games Manual and the Online Learning Management Modules)

The development of the Play It Cool ™ project used a stage-gate model consisting of three major stages:
- The development of a program of safe hockey preparation,
- The delivery of the program, and
- The assessment of the methods of implementation and perceived effectiveness of the program.

Online Safety Platform

The website is the central hub for information surrounding the prevention, detection and management of concussions and spinal injuries in hockey for parents, coaches and players

Information is pooled from a variety of partners within the community to provide a wide range of information sources for users

The website is also player friendly so that young athletes can log on and participate in interactive activities that encourage a safer, more effective brand of hockey.

Online Learning Management Modules

An 8-week e-learning course for coaches: They are guided through the curriculum by expert facilitators and supported through a community of online learning with fellow coaches.

The Envoy Program

A Play It Cool™ ambassador (who has sustained a spinal cord injury while playing hockey) visits minor league teams and hockey camps to speak about their injury, how it could have been prevented, and the Play It Cool™ program.
The goal of this is to provide the audience with useful on-ice safety tips and strategies.

No related posts.

Related posts brought to you by Yet Another Related Posts Plugin.