American College of
Osteopathic Pediatricians
Although Andrew Taylor Still never saw ice hockey
as we know it today, he would be able to identify with
some of the injuries sustained in ice hockey as they are
comparable to injuries Still or other young men may
have endured working on farms or hunting in the 1800’s
throughout Virginia, Tennessee, Missouri, and Kansas.
The long days of swinging sickles or scythes, used to
harvest hay and grain or to clear underbrush and
branches, plowing by hand, and digging with shovels
to turn over the land for planting crops, all can lead to
injuries that are remarkably similar to those in ice
hockey.
 The
hard work and constant bent over swinging
or digging motion used in farm field work
resemble the same body positioning, rotation
and energy release as in ice hockey players.
The foundation of Still’s studies and philosophy
are embedded in anatomy. His mastery in
structural relationships of muscles, bones, and
organs would allow Still to see how injuries in
farming can be similar to those seen in ice
hockey as well as how to treat ice hockey
injuries using manipulative therapies.
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Hockey players and goalies can be at risk for injury simply due to
the games environment, as the game is played on ice and is
enclosed by a boarded perimeter.
Body checking is an instrumental part of game strategy and game
play. High speed collisions unavoidably occur between bodies,
bodies and boards, bodies and goal posts, and bodies and pucks
at high speeds.
Many of these injuries can be acute, however, some can be severe
and dangerous.
The hockey season is long and strenuous on the body.
Some tournament weekends teams can play up to five games with
multiple games in a day.
It is also likely to have early morning games and games late into
the evening.
The body weakens over time and under such demanding
circumstances making it more susceptible to injury.
Many advances in equipment technology have been made and
help to prevent injury.
However, unfortunately, due to the nature of the sport there are still
injuries.
 Neck
and Spine
 Shoulders
 Knee, Hip, Thigh, and Groin
 Forearm, Wrist, and Hand pain
 Lower Back
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Fractures, hands and wrist
Sprains or Strains,
• medial collateral
• capsular ligaments of the knee
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Contusions, upper and lower body
Separations, AC joint separation
Skate bite, friction injury from leather of boot
Concussions, mild to severe
Lacerations, head, scalp and face
Gamekeeper’s thumb
• Tearing of the ulnar collateral ligament
 Neck, head
and spine injuries although
not as common do occur and can be
harmful. The impact at high speeds with
bodies and boards around the ice surface
are attributed to these injuries.
Muscles associated are:
 Sternohyoid muscle
Bones
 Sternocleidomastoid muscle
 Trapezius
• Cervical Vertebrae
 Splenius Capitis
-C3 responsible for
 Splenius Cervicis
diaphragm
 Scalenus Medius
(Breathing)
 Scalenus Posterior
• Brachial Plexus
 Levator Scapulae
injury
 Multifidi (deep)
-C5 to T1
 Middle Semispinalis Capitis (Superficial)
 Rectus Capitus minor and major
 Oblliquus Capitis Inferior
 The
physician will place the fingers close
to the cervical spine and bring anterior
pressure bilaterally with slight traction
through the arms of the physician.
 Place
one hand on the frontal bone, the
other hand on the lateral aspect of the
cervical spine along the articular facets.
While applying pressure on the frontal
bone away from you, the other hand
stretches the muscles of the neck toward
you.
 The
patient is supine. Place your hand on
the ramus of the mandible with fingers
extending downward toward the chin.
Apply a sudden increase in the rotation
of the neck by pressing downward
toward the table on the ramus of the
mandible.
 The
patient is supine. Rotate and
sidebend the neck. The index finger of
your hand is posterolateral to the
articular process.The patient’s head may
be flexed or extended depending on the
cervical curve and then the corrective
thrust is made with the index finger in an
arc conforming to the plane of the facets.
 Shoulders
are one of the most common
injuries in ice hockey. The most common
injury is an injury to the
Acromioclavicular (AC) joint separation.
Shoulder contusions and dislocations are
also common.
Bones Associated:
 Scapula
 Clavicle
 Humerus
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Muscles associated are:
Rhomboid Major and Rhomboid Minor
Posterior deltoid, Middle deltoid,
Anterior deltoid
Coracobrachialis muscle
Supraspinatus muscle
Pectoralis
Upper Trapezius
Biceps Brachii muscle and Brachialis
muscle
Triceps
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Rotator Cuff
Axillary Nerve- can’t abduct
-off of Brachial Plexus
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Step 1—extension with elbow flexed;
step 2—flexion with elbow
extended;
step 3—compression circumduction;
step 4—circumduction
with traction with elbow extended;
step 5a—abduction
with internal rotation with elbow
flexed;
Step 5b- adduction and external
rotation
step 6—adduction and internal
rotation with upper extremity behind
the back;
step 7—stretching tissues and
pumping fluids with the arm extended
 Forearms, wrists, and
hands are all at risk
for breaks, contusions, and sprains.
 Body checks, sticks, and collisions with
bodies and boards are all causes for
many of these injuries.
Bones and Connective Tissue:
• Ulna
• Radius
• Scaphoid- Fractured most
• Flexor Retinaculum
• Carpal Bones
Muscles associated are:
 Extensor Carpi radialis longus
 Extensor Carpi Ulnaris
 Supinator
 Palmaris Longus muscle
 Lower
back pain is a common injury as
the body is bent over and in constant
motion, initiating or receiving body
checks, rotating to generate power for a
shot or pass, hit against boards or goal
posts, or changing direction quickly.
 The lower back is susceptible to
contusions and strains.
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Multifidus
Iliopsoas
Hamstrings
Abdominals
Erecorstinae
Bones:
• Lumbar region
• 5 Vertebrae
 Patient
is prone. Place thumb onto
paraspinal muscles adjacent to the
vertebral spinous process. In a bowing
like motion stretch the muscles away
from you and release. Perform slowly.
 Patient
is supine. Have the patient lace
fingers behind head. Standing to the side
of the patient grab the patient’s contra
lateral upper arm and pull toward you
and caudally.

The patient is in the lateral recumbent position. The side that the
dysfunctional vertebra is rotated towards is up (eg, for a left
rotated lumbar, the patient is lying on their RIGHT side). The
patients upper most leg is dropped over the side of the table. The
patients upper elbow is flexed. The lower elbow is also flexed and
the arm is tucked under the head. Stand to the side of the patient
with his/her face to you. Your one arm should be placed onto the
upper elbow and the other arm placed on the upper hip. A
twisting motion is performed by moving the patients elbow
backward and the patient’s upper hip forwards, carrying the
dysfunctional vertebra into correct position
 Knee, hip, thigh
and Groin muscles are all
known to be common injuries that can be
sustained while participating in ice hockey.
 Knees frequently suffer from knee to knee
contact and impact with boards at high
speeds resulting in sprains or tears to the
medial collateral and capsular ligaments.
 Hips thighs and groin are most susceptible
to sprains, strains, and contusions.
Muscles associated are:
 Adductor Magnus (Adductor Brevis and Adductor Longus)
 Gracilis
Bones
 Rectus Femoris
Associated:
 Vastus Medialis
•Femur
 Popliteus Muscle
•Tibia
 Tibialis Anterior
• Fibula
 Gastrocnemius Muscle
 Weight Training
 Warm
up and cool downs (dynamic
warm-ups)
 Stretching and band exercises
(Flexibility)
 Nutrition and appropriate rest
 Reaching
lateral side stretch
 Kneeling quad stretch
 Kneeling heel-down Achilles stretch
 Glide
on the ice with your head and back
straight. Slide your left leg back and
point your skate away from the body.
Bend the right knee and keep the left leg
straight. Feel the stretch in the left groin
area. Hold for at least 15 seconds and
repeat on the other side.
 Hold
a hockey stick while slowly skating
forward. Raise the arms up and back with
your palms up. This stretches the
shoulders, upper back and arms.
 Lift
your hockey stick above your head
and tilt the top of your body to the right.
Keep your feet apart. You should feel the
stretch on your left side. Hold it for 10
seconds and then repeat on the opposite
side.
 Skate
forward with your feet apart and
bend forward at the hips. Keeping your
knees bent, feel a stretch in the back of
your legs. You should hold this stretch for
at least 15 seconds.
 Grasp
your hockey stick behind your
back and glide forward. Slowly raise the
stick up, keeping your arms straight. Hold
for 15 seconds. You should feel this
stretch in your upper arms.
 Lie
flat on the ice with your feet together
and knees apart. Lift your chest off of the
ice with your arms and hold for at least
15 seconds. This should be felt in the
lower back and the groin.
 Step 7
 Sit
on a stable surface with left leg bent
and right leg crossed over it. Push
against the right knee with the left elbow
and rotate your body to the right. Turn
the body by pushing the left arm and
hand. Do not jerk or pull. Feel the stretch
in your upper and lower back, as well as
the hips and ribs.
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http://www.ehow.com/how_2047720_stretch-before-playing-hockey.html
Organ/System
EENT
Parasympathetic
Sympathetic
Ant.
Chapman's
Post.
Chapman's
T1-T4
T1-4, 2nd ICS
Suboccipital
Heart
Cr Nerves (III, VII, IX,
X)
Vagus (CN X)
T1-T4
T3 sp process
Respiratory
Vagus (CN X)
T2-T7
T1-4 on L,
T2-3
3rd & 4th ICS
Esophagus
Vagus (CN X)
T2-T8
---
T3-5 sp
process
---
Foregut
Vagus (CN X)
T5-T9 (Greater Splanchnic)
---
---
Stomach
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Liver
Vagus (CN X)
Gallbladder
T6-7 on L
T5-T9 (Greater Splanchnic)
5th-6th ICS on
L
Rib 5 on R
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 6 on R
T6
Spleen
Vagus (CN X)
T5-T9 (Greater Splanchnic)
Rib 7 on L
T7
Pancreas
Vagus (CN X)
Rib 7 on R
T7
Midgut
Vagus (CN X)
T5-T9 (Greater Splanchnic), T9T12 (Lesser Splanchnic)
Thoracic Splanchnics (Lesser)
Small Intestine
Vagus (CN X)
T9-T11 (Lesser Splanchnic)
Ribs 9-11
T8-10
Tip of 12th Rib
T11-12 on R
Appendix
Hindgut
Ascending Colon
Transverse Colon
T12
Pelvic Splanchnics (S24)
Vagus (CN X)
Vagus (CN X)
Lumbar (Least) Splanchnics
T9-T11 (Lesser Splanchnic)
T5-6
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--T10-11
T9-T11 (Lesser Splanchnic)
R Femur @
hip
Near Knees
L Femur @ hip
T12-L2
Descending Colon
Pelvic Splanchnic (S2-4)
Least Splanchnic
Colon & Rectum
Pelvic Splanchnics (S24)
T8-L2
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 Question1: A, B, C, D, E.
 Question2: A, B, C, D, E.
 Question3: A, B, C, D, E.
 In
hockey injury to the leg caused by the
leather of the skate is called:
a. skate bite
b. leather burn
c. skate cut
d. boot bolt
e. lucky break
 The
most common separation injury is at
which site
 A. ac separation
 B. C1/C2
 C. Humoral tibial
 D. femoral hip
 E. L5 on sacrum

Tearing of the ulnar collateral ligament is called:
• A. gamekeeper’s thumb
• B. witlow
• C. hitch hikers thumb
• D slap thumb
• E. catch you later thumb