Overview
Knees and hips are two joints that are put under great strain by the nature of the game of hockey. By nature, hockey is a quick and dynamic game involving rapid movements, intense speeds, stops and starts, and body contact.
The combinations of these factors can lead to knee injuries. Knee injuries can range from very mild to career-endingPlayers who have played for many years tend to experience overuse or trauma pain or injury associated with either one or both of these joints Structural abnormalities can make the problem worse. This blog focuses on knee pain and knee injuries.
How general knee pain happens
The knee is an intricate joint consisting of multiple structures that have to distribute forces from the ground up through the body, as well as from the upper body down through the leg. As a result, there are many different reasons and causes of knee pain, and the pain can be in several different places throughout the knee.
Most knee pain results not because of the knee itself, but from some other part of the body. For instance, a tight iliotibial band, hip flexors, or quadriceps muscles, dominant hamstrings or quads, or weak hip rotators can all contribute to excessive stress and strain being transferred to your knees. Also, if your core is unstable, your body will try to gain that stability somewhere else—often times at the knees.
Where does it hurt?
Front of the knee
- Above the knee – pain from quadriceps muscle strain and quad tendon inflammation, often from activities where the knees come past the toes, as with poor squatting technique.
- Below the kneecap – the source of pain is the patellar tendon, which connects the knee cap to the top of the lower leg.
- Under the knee cap – pain from excessive compression of the knee cap and from arthritic changes underneath the knee cap.
Back of the knee
- Pain can be to the inside, middle, or outside, often due to hamstring or calf muscle tendon involvement or poor joint mobility, especially when bending the knee.
Inside of the knee
- Pain can be due to tendinitis from the groin muscles and where the tendon inserts. It also can be due to ligament strain of the medial collateral ligament (MCL) or irritation to the medial (inside) meniscus.
Outside of the knee
- Pain can be due to tendinitis, often from a tight iliotibial (IT) band. It also can be due to ligament strain of the LCL or irritation of the lateral (outside) meniscus.
Symptoms
- Intense pain, inflammation, or bruising at the site of the injury
- Pain when walking or getting up and down, and with stairs
- Reduced and/or painful range of motion
- Feeling of locking, catching, giving out or buckling with weight-bearing
Initial Treatment
- Apply ice applications for 15-20 minutes, 3-4 times a day.
- Aspirin, acetaminophen, ibuprofen and naproxen may relieve pain and reduce inflammation.
- Compress the knee joint with an elastic wrap if inflammation and swelling are present.
- Use a pillow to elevate the knee while at rest and during the night.
- Rest until symptoms diminish, which could take several days or several weeks.
- See a doctor if the pain is severe or if the pain persists for two weeks.
Knee injuries
Knee injuries in hockey can be acute or chronic and include:
- Strains and Sprains
- Over-use Injuries
- Contusion Injuries
- Ligament Injuries
- Meniscus Injuries
- Tendonitis and Bursitis
Diagnosing a knee injury can be tricky; however, swelling of any kind can indicate trouble and needs to be investigated.
Other signs and symptoms include:
- Pain – mild to acute
- Deformity
- Popping or snapping sound
- Creaking sensation
- Inability to weight bear
- A loose sensation or instability
Any of these symptoms or a combination of these symptoms should not be ignored and an accurate examination and diagnosis of your knee injury is essential for correct treatment.
Depending on the nature and duration the knee injury, further examination may be necessary, such as Diagnostic Ultrasound, X-ray and MRI. Once the diagnosis has been established treatment and rehabilitation can begin.
Treatment protocols can include:
- Rest
- Ice
- Compression
- Laser
- Ultrasound
- Kinesiological taping and bracing [see video]
- Active Release/Graston
- Crutches/Non-weight bearing
- Surgery ( in severe cases)
- Non-steroidal anti-inflammatory medication – Over-the-counter drugs like ibuprofen and naproxen, or prescription anti-inflammatory medication can reduce pain and swelling
Two of the most common knee injuries experienced by hockey players are;
ACL (anterior cruciate ligament) rupture
The ACL is an important ligament as it helps to stabilise the knee. ACL ruptures are common field hockey injuries, especially in women and can occur when the knee is twisted during a change in direction. This type of injury causes knee pain, swelling, instability and difficulty walking. A loud pop may be heard at the time of injury. If this happens you should stop play immediately, apply the RICE formula (Rest, Ice, Compression and Elevation) and seek medical attention as soon as possible. Rehabilitation with physiotherapy is always needed to help return to the hockey field.
Meniscus tears
The menisci are made up of two rings of cartilage – the medial meniscus and the lateral meniscus. Their function is to absorb shock in the knee. Constant twisting of the knee can cause pain, swelling, difficulty bearing weight and inability to bend the knee. When this happens you should stop play and apply the RICE formula as above. Physiotherapy will be needed to help you return to future games, but in severe cases surgery may be necessary, followed by rehabilitation
Exercises for bad knees
Exercise may be the best medicine for chronic achy knees. “Strengthening the muscles around the joint protects you from injury by decreasing stress on the knee,” says Willibald Nagler, MD, chairman of rehabilitation medicine at New York Presbyterian Hospital-Cornell Campus in New York City. But you must use good form and technique when doing exercises for knee pain.
The first commandment when exercising knees is to never bend your legs to a point where your knees stick out past your toes. That puts a lot of pressure under the kneecap.
Best Exercises for Knee Pain
Except where stated, do 10 to 12 repetitions of each of the following, two or three times a week.
Partial Squats Stand about 12 inches away from the front of a chair with your feet about hip width apart and your toes forward. Bending at the hips, slowly lower yourself halfway down to the chair. Keep your abs tight, and check that your knees stay behind your toes.
Stepups Using an aerobic step bench or a staircase, step up onto the step with your right foot. Tap your left foot on the top of the step, and then lower. As you step up, your knee should be directly over your ankle. Repeat with your left foot.
Side-lying Leg Lifts Wearing ankle weights above the knee, lie on your left side, legs straight and together, with your left arm supporting your head. Keeping your right foot flexed and your body straight, slowly lift your right leg to about shoulder height, then slowly lower. Repeat with your left leg.
Inner-thigh Leg Lifts Wearing ankle weights above the knee, lie on your left side, slightly back on your butt. Bend your right leg and place it behind your left leg with your right foot flat on the floor and your left leg straight. Support your head with your left arm. Slowly lift your left leg about 3 to 5 inches, then lower. Repeat with your right leg.
Calf Raises Using a chair or wall for balance, stand with your feet about hip width apart, toes straight ahead. Slowly lift your heels off the floor, rising up onto your toes. Hold, then slowly lower.
Straight-leg Raises Sit with your back against a wall, left leg straight and right leg bent with your foot flat on the floor. Slowly raise your left leg straight up about 12 inches off the floor. Hold, then slowly lower. Repeat with your right leg.
Short-arc Knee Extensions In the same starting position as the straight-leg raises, put a ball (about the size of a basketball) under your left knee so that your leg is bent. Slowly straighten your leg. Hold, then slowly lower. Repeat with your right leg.
Hamstring Stretch Lie on your back with your left leg flat on the floor. Loop a towel or rope around your right foot and pull your leg as far as comfortable toward your chest, while keeping a slight bend at the knee. Keep your back pressed to the floor throughout the stretch. Hold for 10 to 30 seconds and then release. Repeat three or four times with each leg. Do this stretch five or six times a week.
OTHER CONSIDERATIONS;
Ease Pain with a Foam Roll
Work out kinks in your muscles, ease pain, and recover faster with a foam roll. See previous go Hockey blog on using a foam roller.
Prophylactic Taping and Bracing
There is increasing interest in prophylactic taping and bracing as a means of protecting players against knee injury and for rehab of knee injuries. The concept of taping and bracing implies that where the knee joint is inherently ‘weak’, and requires added support to sustain the forces involved in hockey play. The use of KT tape and the methods in which KT tape is applied are widely becoming accepted as an excellent way of reducing knee injury. Go to the KT website www.kttape.com.au for further information. KT tape can be purchased from Just Hockey.
