Recently, I posted the exact program I used with a female college hockey player this season to help restore functional ability and minimize pain related to chondromalacia and patellofemoral syndrome.  If you missed it, go check it out here: The Knee Pain Program

I wouldn’t consider myself a knee expert, far from it actually.  But I would consider Mike Robertson a knee expert, and I’ve learned a lot from studying his work.

Quick Side Note: Mike and Eric Cressey put out, in my opinion, the best product in strength and conditioning to date: Building the Efficient Athlete.  It’s the only product in the industry that really addresses functional anatomy, which is crucial to understanding both performance and reasons for injury.  I highly recommend it to anyone that is serious about taking their performance (or that of their athletes) to the next level.

One of the major things I’ve picked up from him is to look at the hip for clues as to why the knee hurts.  This year I noticed a common theme in my female hockey players: Most of them had noticeably internally rotated femurs while standing.  You can tell this by having someone stand in front of you without shoes on and look at the direction their knees point from the front and back.

For those of you that aren’t functional anatomy geeks (yet!), the patella (or knee cap) sits between two bumps on the bottom of the femur called condyles.  To help you picture this, curl the knuckles of your pointer and middle finger on your right hand and then spread those fingers apart.  This is indicative of your femoral condyles (on your right leg).  Now place your pointer finger of your left hand between the groove, acting as your patella.  Now rotate your right hand inward, without changing the location of your left finger.  What you’ll find is that your left finger will pull out of that groove slightly.

This is exactly what happens when someone has an internally rotated femur.  Basically this means that anytime the athlete bends their knee, the patella won’t be tracking in the groove, but rubbing up against that lateral (or outside) femoral condyle.  You can imagine why this friction may create problems and lead to knee pain!

You can begin to address this by both stretching the internal rotators of the hip (mostly the adductors/muscles of the inner thigh), but the best thing to do is strengthen the hell out of your hip external rotators.  Referring back to the program, I address this with “isolation” and activation exercises: Side Lying Hip Abduction/External Rotation Holds, Close Stance Glute Bridge Hold w/ MiniBand and Lateral MiniBand Walk; and then lead into more functional movement patterns: Split Squat Iso-Hold w/ Toe Pull, 3-Way Squat Circuit; and Reverse Lunge.  The idea is to activate/excite the muscle, then integrate it into normal movement.  After all, being really strong on your back or side won’t help at all if you aren’t strong on your feet (or skates).

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Catch your interest?

Type II Diabetes is characterized by low insulin sensitivity and is largely the result of a diet packed full of simple sugars and a lifestyle of inactivity.

Take home message: It’s completely preventable!

Hockey-related hip injuries are usually the result of under-preparation or overuse.

Take home message: They’re almost completely preventable.  I say almost because there’s always a possibility of a collision-related injury, which are harder to protect against (on the upside-you’re unlikely to have a high-speed collision give you type II diabetes, which is more likely to kill you than a hip injury).

I’ve spent the last month outlining exactly how I screen/assess and train hockey players to prevent hip injuries on my site.  In my experience, most athletes/coaches simply don’t have the time or patience to go through an in-depth assessment of everything, which I completely understand.  There are a couple things that are easily implementable in both an individual and team setting that will definitely help prevent hip injuries:

1) A 10-minute dynamic warm-up before every practice, game, and training session. In general, most hockey players will benefit from exercises that lengthen the hip flexors, activate the glutes, and involve multi-directional movement.  Lunge variations are my favorite warm-up exercise, as they serve all the above purposes well.

2) Core stability training.  Planks and bridges are relatively easy to master, simple to coach, and do a lot in the prevention of hip, lower abdominal, and lower back injuries.  Most hockey players take several dozen shots every practice.  Think about this regarding the number of repetitions in that pattern of rotation.  This can lead to an imbalance among the anti-rotators, notably the obliques.  As a result, many athletes may find that performing a side plank is more difficult on one side than the other.  If this is the case, it’s better to perform more sets on the weaker side.  Sometimes unbalanced programming is the best way to create balance. 

As a shameless pitch, I’ve spent a lot of time and effort to detail appropriate warm-up and core training exercises and progressions in my new Off-Ice Performance Training Course.  I honestly believe it’s the best resource for youth players and coaches that are looking to take their off-ice training to the next level.  There’s no better time to invest in your development than today…

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If you haven’t yet, pick up a free copy of “Strong Hockey Core Training” on my site.  It details a few dozen equipment-free exercises and appropriate progressions.

After reading that you might be wondering two things:

1) What if I have equipment?

2) What’s next after I follow all those progressions?

My answer is similar for both: Medicine Ball Training!

I love med ball training.  It’s a great way to teach/train core stiffness and reinforce efficient force transfer from the hips to the upper body.

I think the transfer to hockey is huge, but just as importantly (especially in a team setting), it’s a lot of fun.

Three great exercises to start with are:

1) Overhead Floor Slam:

[quicktime]http://www.kevinneeld.com/videos/Overhead%20MB%20Floor%20Throw.mov[/quicktime]

2) Side-standing Shot Put:

[quicktime]http://www.kevinneeld.com/videos/Side-Standing%20MB%20Throw.mov[/quicktime]

3) Underhand Toss:

[quicktime]http://www.kevinneeld.com/videos/Underhand%20MB%20Toss.mov[/quicktime]

As a quick side note: those videos were all filmed at Cressey Performance in Hudson, MA.  You can’t tell from the video, but the white brick wall only goes up about 12 feet.  At the end of a training session there last Summer, I mustered above just enough energy to underhand toss a medicine ball as hard as I could…straight over the wall.  For safety purposes, I recommend using a wall that goes very…very high.

The next level of progression for core training is to combine explosive force transfer with reactive stability.  Take a look at these two videos:

1) Overhead Floor Slam:

[quicktime]http://www.kevinneeld.com/videos/Overhead%20MB%20Floor%20Throw.mov[/quicktime]

2) Overhead Perturbation:

[quicktime]http://www.kevinneeld.com/videos/Overhead%20MB%20Perturbation.mov[/quicktime]

Combine these two exercises so that you perform 2-3 slams, then catch the ball and hold it overhead while a partner lightly taps the ball for 5-10s while you resisted all movement.  Then immediately perform 2-3 more slams, and repeat the overhead perturbation, cycling through this process 2-4 times.  Training for periods of alternating explosive force transfer and reactive stability will have the greatest on-ice transfer, but it’s not for beginners.  Follow the progressions outlined in “Strong Hockey Core Training” before moving on to these types of exercises.

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