Sub-Clinical Hockey Injuries?

Last week, Eric Cressey put up a few great posts on an issue that I think everyone working in the human performance arena should be aware of. You can check them out here:

Preventing Lower Back Pain: Assuming is Okay

Healthy Shoulders with Terrible MRIs?

Who Kneeds Normal Knees?

Despite the last title, these three posts contain a lot of great information. The big take home message from all these posts is that many people (athletes and non-athletes alike) have positive MRI findings (positive MRIs means something is wrong), despite not having ANY symptoms. This is most profound in the lower back area, where one study found that 82% of the 98 MRIs taken of asymptomatic individuals came back showing a spinal disc abnormality (Jensen et al, 1994). Eric points on in these posts that similar (although not QUITE as profound) findings have been found in the knees and shoulders of various athletic and non-athletic populations.

More specific to ice hockey players, recall from my post Off-Season Hockey Leads You to Surgery? that similar findings have been found in the hips of elite level hockey players. To refresh your memory, the article found that MRIs of 39 NHL and NCAA Division 1 players, twenty-one (54%) had labral tears, twelve (31%) had muscle strains, and 2 (5%) had tendinosis (degeneration of the tendon). Overall, 70% of these hockey players, who otherwise present as “healthy”, had irregular findings on their MRIs.

We could have a very lengthy discussion about how to interpret all this information, but one major question arises: “If they’re asymptomatic, do the positive MRI findings matter?”

The answer is yes. While positive MRI findings shouldn’t be taken as an instant justification for surgery, they still shouldn’t be overlooked. It’s likely that many of these individuals are just “sub-clinical”, meaning they have a pathology that isn’t normal, but hasn’t yet advanced to the point of pain or disability…yet.

A major take home from these studies is that many hockey players that appear fine probably have some pretty serious injury predispositions. Any injury (even subclinical) can cause neural alterations to the timing and strength of signals sent to various muscles, and therefore have a profound impact on movement.

This latter point was the main message in Proprioception and Neuromuscular Control in Joint Stability, the awesome text book I’ve spent the last 9 months reading.

When I read stuff like this it just reinforces how important it is to teach and emphasize proper movement patterns. It makes me wonder if my half dozen left shoulder injuries, bilateral hamstring tears, 5+ year groin pain, and double hernia surgery could have been prevented had I worked with a quality Strength and Conditioning Coach when I was younger. It also makes me nervous for the countless young players out there that think they can “do it on their own”.

Exercise isn’t as simple as people think it is. Injuries don’t happen by accident. Coaching isn’t a commodity; it’s a necessity. Hopefully hockey players will hear this message from a decent strength coach before they hear it from a physician.

To your uninjured success,

Kevin Neeld

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