Perceived Barriers to and Facilitators of an Injury Prevention Program Among Professional Male Ice Hockey Players and Staff Members.

CONTEXT: Injury prevention programs for the lower extremities are effective in team-sport athletes. OBJECTIVE: To identify barriers and facilitators among professional ice hockey players and staff members for adhering to an injury prevention program. DESIGN: Cross-sectional survey. SETTING AND PARTICIPANTS: A questionnaire about barriers and facilitators related to knowledge/perceptions, beliefs, adoption, and habits about injury prevention was filled out by Swiss professional male ice hockey players and staff members. MAIN OUTCOME MEASURES: Frequencies of ratings were calculated and binary logistic regression analysis was applied to predict a relationship between a high/low perceived benefit of an injury prevention program and player characteristics. RESULTS: Knowledge, perceived benefit, and relevance of injury prevention as well as awareness of high risk of injuries in ice hockey were identified as important facilitators. Players' habit of exercise performance was identified as a barrier. Program understanding of staff members was identified as a facilitator and barrier. No significant relationships were observed between a high/low perceived benefit of an injury prevention program and age (P = .85), nationality (P = .53), level of education (P = .63), National League experience (P = .50), or occurrence of lower-extremity injuries in the previous season (P = .10). CONCLUSIONS: Players and staff members clearly rated perceived benefits of an injury prevention program, which can be considered an important facilitator of the uptake and adoption of such a program in ice hockey teams. Players should be educated about well-performed injury prevention exercises. Staff members should be educated about the aim of a regular injury prevention program. An injury prevention program might be implemented in players of all ages, levels of education, and experience in the National League, irrespective of previous injuries. Identified barriers and facilitators should be addressed when implementing an injury prevention program in a setting of professional ice hockey teams in the future.

Effectiveness of multicomponent lower extremity injury prevention programmes in team-sport athletes: an umbrella review.

OBJECTIVE: To identify which exercise combinations are most effective as part of a lower extremity injury prevention programme for team-sport athletes. DESIGN: Umbrella review. DATA SOURCES: A comprehensive literature search was performed in PubMed, Scopus, Cochrane Library and PEDro databases. Studies published between January 2000 and March 2017 were included in this umbrella review. STUDY ELIGIBILITY CRITERIA: Moderate to high-quality systematic reviews that investigated the effectiveness of a combination of two or more exercise components, that is, strength, agility, plyometrics, balance, stretching, technique, warm-up and functional activity, regarding injury incidence/rate of lower extremity injuries in team-sport athletes. The methodological quality of the included systematic reviews was independently assessed by two reviewers using the Assessing the Methodological Quality of Systematic Reviews measurement tool and the Grading of Recommendations Assessment, Development and Evaluation guidelines were used to assess the overall quality of evidence for particular outcomes. RESULTS: Twenty-four systematic reviews met the inclusion criteria. Multicomponent exercise interventions were effective in reducing the injury incidence/rate of lower extremity, knee, ACL and ankle injuries, but not groin injuries. Strength and balance exercise components were included in 10 of 11 effective injury prevention programmes for the lower extremity, knee, ACL and ankle injuries. SUMMARY/CONCLUSION: Lower extremity injury prevention programmes in team sports are effective in preventing lower extremity, knee, ACL and ankle injuries. Lower extremity muscle strength and balance exercises should be prioritised in lower extremity injury prevention programmes for team-sport athletes.

Epidemiology of Traumatic and Overuse Injuries in Swiss Professional Male Ice Hockey Players.

BACKGROUND: Ice hockey injury patterns in Europe were last evaluated in the 1990s. PURPOSE: The aim of this study was to assess the frequency, type, location, and incidence of traumatic injuries, as well as the prevalence and relative effect of overuse injuries in professional male ice hockey players. STUDY DESIGN: Descriptive epidemiology study. METHODS: Traumatic injuries were assessed using a standardized injury report form over a 1-year period (including the preparatory phase and season). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire was used to determine overall and substantial overuse injuries and their relative effect on ice hockey players. RESULTS: Five Swiss National League teams participated in the study. From a total of 321 recorded injuries, 179 led to time loss from sport. The game-related time-loss injury incidence during the season was 88.6/1000 player-game hours.Time-loss injuries affected mainly the hip/groin/thigh region (23%), followed by the head (17%). Most time-loss injuries were classified as muscle strains (24%), followed by concussions (18%). The most common injury mechanism involved collision with an opponent's body (31%), and right forward players (23%) were most likely to report a game-related injury. Most injuries (27%) occurred within the defending zone along the boards. The average prevalence rates of all overuse and substantial overuse injuries were 49% and 13%, respectively. The hip/groin displayed the highest average prevalence for all overuse problems (16%), translating to the highest relative effect. CONCLUSION: Muscle strains and concussions were the most frequent time-loss injuries in Swiss professional ice hockey players. The hip/groin was the most affected region for both traumatic and overuse injuries.

Field-based evaluation of hip adductor and abductor strength in professional male ice hockey players: Reference values and influencing factors.

OBJECTIVES: To provide reference values and examine the influence of hip/groin pain on hip adductor and abductor strength in professional male ice hockey players, by using a straightforward 5-min procedure. DESIGN: Cross-sectional study. SETTING: On-field assessment of hip/groin muscle strength with dynamometry, together with the concomitant level of hip/groin pain with a visual analogue scale. PARTICIPANTS: Professional male ice hockey players competing in the Swiss National League (n = 187). MAIN OUTCOME MEASURES: Hip abductor strength, hip adductor strength and hip adductor:abductor ratio. RESULTS: Reference values by playing position (goalkeepers, defenders and forwards) are provided for asymptomatic athletes. Players with hip/groin pain during adduction displayed lower hip adductor strength (p = 0.001) and hip adductor:abductor ratio (p = 0.012) than their symptom-free peers. CONCLUSIONS: The presence of hip/groin pain during adductor testing may contribute to selective hip adductor weakness, whose cause-effect relation with possible groin problems remains to be demonstrated.

The FADIR test accuracy for screening cam and pincer morphology in youth ice hockey players.

OBJECTIVES: Aim of this study was to evaluate the flexion-adduction-internal rotation (FADIR) test accuracy for screening cam and pincer morphology in youth male ice hockey players without diagnosed hip disorders. DESIGN: Cross-sectional study. METHODS: Seventy-four ice hockey players with a mean age of 16 years (range: 13-20 years) were assessed unilaterally. The presence of cam and pincer morphology was evaluated using the FADIR test and magnetic resonance imaging (MRI) (reference standard). Positive FADIR test consisted of groin pain during the maneuver, while positive MRI findings consisted of (1) pure cam, pure pincer or combined morphology and acetabular labral alterations, or (2) pure cam or combined morphology and acetabular labral alterations. Sensitivity, specificity, positive and negative likelihood ratios, and positive and negative predictive values were calculated. RESULTS: For pure cam, pure pincer or combined morphology as positive MRI findings, the FADIR test demonstrated a sensitivity of 41%, specificity of 47%, positive likelihood ratio of 0.78, negative likelihood ratio of 1.24, positive predictive value of 19% and negative predictive value of 73%. For pure cam or combined morphology as positive MRI findings, the FADIR test showed a sensitivity of 60%, specificity of 52%, positive likelihood ratio of 1.24, negative likelihood ratio of 0.78, positive predictive value of 16% and negative predictive value of 89%. CONCLUSIONS: The FADIR test is inadequate for screening cam and pincer morphology in youth ice hockey players without diagnosed hip disorders because of the large number of false positive test outcomes.

Clinical Rating of Movement-Pattern Quality in Patients With Femoroacetabular Impingement Syndrome: A Methodological Study.

Study Design Cross-sectional study. Objectives To evaluate intrarater and interrater agreement among physical therapists with different clinical experience in performing a visual rating of movement-pattern quality of patients with femoroacetabular impingement (FAI) syndrome using a semi-quantitative scale. Background Visual rating of movement patterns in patients with FAI syndrome is of interest, because poor control of dynamic hip motion is frequently noted. Methods A video camera was used to record the performance of 34 patients with FAI syndrome performing single-limb standing, squat, frontal lunge, hop lunge, bridge, and plank. Visual rating of movement, as recorded on video, was performed by a highly experienced, a moderately experienced, and a novice physical therapist on 2 occasions using a semi-quantitative scale. Hip abductor strength was assessed using dynamometry, and hip pain and function were assessed with a patient-reported questionnaire. Intrarater and interrater agreement among physical therapists was evaluated using Gwet's agreement coefficient 1. Construct validity was evaluated as the association between physical therapists' rating and patients' hip abductor strength, pain, and function. Results Good intrarater and interrater agreement was observed in the highly experienced and moderately experienced physical therapists when rating single-limb standing, bridge, and plank. Poor to moderate intrarater and interrater agreement was found when they rated squat, frontal lunge, and hop lunge. Poor performers, as rated by the highly experienced physical therapist only, demonstrated lower hip abductor strength (P<.05), and similar hip pain and hip function compared to those of good performers. Conclusion Movement-pattern quality of patients with FAI syndrome should be rated by a highly experienced physical therapist. J Orthop Sports Phys Ther 2018;48(4):260-269. doi:10.2519/jospt.2018.7840.

Prevalence and Functional Consequences of Femoroacetabular Impingement in Young Male Ice Hockey Players.

BACKGROUND: Femoroacetabular impingement (FAI), which is highly prevalent in adult ice hockey players, is often associated with negative clinical and functional outcomes. It is unclear, however, whether FAI-related bony deformities and symptoms may lead to functional alterations as reflected in hip muscle strength, range of motion (ROM), and on-ice physical performance in youth ice hockey players. HYPOTHESIS: Compared with players with neither structural signs nor symptoms related to FAI, players with symptomatic FAI would show hip muscle weakness and reduced hip ROM, which would in turn affect ice hockey physical performance. STUDY DESIGN: Controlled laboratory study. METHODS: A total of 74 young male ice hockey players were evaluated bilaterally for passive hip internal rotation ROM by use of a hip examination chair. Only the side with less internal rotation ROM was further investigated. FAI-related bony deformities were evaluated with magnetic resonance imaging (MRI). The involved hip was classified as symptomatic or asymptomatic based on the presence of hip pain during exercise and results from the flexion/adduction/internal rotation (FADIR) provocation test. Hip muscle strength, passive hip ROM, and on-ice physical performance were compared between players with no FAI, players with asymptomatic MRI-positive FAI, and players with symptomatic FAI. RESULTS: Fifty of 74 players (68%) had FAI-related bony deformities, of whom 16 (22%) were symptomatic. Hip muscle strength, hip ROM, and on-ice physical performance did not differ significantly between players with no FAI and those with asymptomatic or symptomatic FAI. CONCLUSION: Despite a high prevalence of FAI-related bony deformities, youth ice hockey players with asymptomatic or symptomatic FAI did not show functional impairments in terms of hip muscle strength, hip ROM, or on-ice physical performance. CLINICAL RELEVANCE: Hip muscle strength, passive hip ROM, and on-ice physical performance do not seem to discriminate for FAI-related signs and symptoms in young male ice hockey players.