Low back pain can be challenging to treat. There is obviously a lot of factors that go into treating back pain, and those factors are no different with hockey players. Some lower powered studies have shown between 90%-95% of hockey players will suffer from at least one bout of low back pain during their career (Fett et al, 2016; Ball et al 2019) while higher powered studies have shown 54% of hockey players deal with low back pain (Selanne et al, 2014). In all of these studies, hockey was among the sports with the highest rates of low back pain. What makes hockey unique compared to other sports is the load mechanism on the back from skating and shooting.
Based on the mechanics of skating and shooting, here are 3 movement-related things I often look to first when players have low back pain.
#1 Hip Hinge
Hockey players spend most of their time on the ice in a forward flexed position. This forward trunk position has been shown to be a factor in forward skating speed because it brings the centre of gravity in front of the body and allows for greater hip motion. But this also creates a greater torque around the lumbopelvic complex. For players who aren’t able to hinge well, these repeated bouts of sustained spinal flexion can accumulate stress on the lumbar spine.
Baranto et al (2009) did a 15-year follow-up study comparing spinal changes on MRI in athletes from four different sports. They found that hockey players had the highest frequency of disc degeneration at follow-up. Although it has been clearly shown in the research that findings on any imaging do not necessarily correlate to pain, and the authors also found no correlation to pain in this study, I think it does demonstrate the high level of stress over time on the spine from playing hockey. This can become a contributing factor in back pain when the high levels of stress on the tissue exceeds the tissue capacity leading to irritation of the tissue and injury.
By improving a player’s ability to hinge, we can change the dominant axis of rotation from the lumbar spine to the hips and decrease the load on the spine. Additionally, improving a player’s hinge can give access to a greater range of hip motion which has been shown to be a characteristic of high caliber skaters.
#2 Hip range of motion
Hip rotation has been shown to be a factor in low back pain in many rotational sports (Van Dillen et al, 2008; Murray et al, 2009). A lack of hip rotation, in particular hip internal rotation, is thought to lead to greater lumbar spine rotation and thus greater undue stress on the bones and ligaments. Hockey players can lose hip rotation for a variety of reasons including soft tissue restriction, increased muscle tone and possibly from changes to their bony anatomy. Knowing this, it’s important to understand why someone may be lacking hip rotation in order to develop an effective treatment plan.
On top of looking at passive hip rotation, I like to look at hip separation. Do they have the ability to move the femur on the pelvis, the pelvis on the femur and the trunk on the pelvis? A player may have the range available, but do they know how to use it. Often times people aren’t able to differentiate pelvis moving on femur versus lumbar spine motion at slow speeds. When this is the case, it is unlikely they are able move the pelvis on the femur at higher speeds, like when skating or taking a shot.
#3 Thoracic motion
Finally, thoracic rotation. Hockey players often have stiff T-spines which can become problematic for the lumbar spine. Based on some shooting studies, it’s evident that thoracic rotation is important. Robbins et al (2020) showed that thoracic range of motion was a predictor of wrist shot speed. But when players lack thoracic rotation, they often find it in the lumbar spine which can lead to back problems.
In fact, Donaldson (2014) found that in a sample of 25 hockey players with low back pain, 44% were diagnosed with spondylolysis and in 73% of those players the injury occurred on the shooting side. A pars injury on the shooting side is likely to occur from a lack of thoracic extension and rotation in the opposite direction. As the player follows through on the shot, a lack of contralateral thoracic rotation would lead to more stress on the rotating and extending lumbar spine, creating greater load on the pars interarticularis. Ensuring adequate rotation in the direction away from the shooting side could help off-load the pars during shooting.
Factors Contributing to Acute Low Back Pain in Hockey Players
Like I said earlier, there are a lot of factors that contribute to low back pain. This is by no means an extensive list of factors contributing to back pain in hockey players, but I think it’s a place to start for assessing and treating movement-related factors related to low back pain.