Unfortunately, back pain is a common occurrence in hockey players. Hockey seems to be amongst the highest prevalence when compared to other sports. The low skating position in hockey likely plays a role in flexion-based LBP.
What’s the best way to manage flexion-based low back pain in hockey players? Most clinicians will give deadbugs, glute bridges and piriformis stretches. Not that these don’t have their place in back rehab, but I think we can do better.
Here are 5 things you should be looking at in your assessments and how I would treat them.
Let’s dive in.
#1) Modify flexion-based activity workload:
Hockey players spend most of their time on the ice in a flexed position. First thing we want to do is get them out of those positions.
I’ve know some S&C coaches who program running instead of biking in the early off-season. Their rational is that players spend the whole season flexed while skating. Stationary biking keeps them in that lumbar and hip flexed position. Running keeps them upright while biasing lumbar and hip extension.
#2) Hip flexion ROM:
A lot of hockey players I see lack hip flexion mobility. If they aren’t able to get into their hips, they will flex more through their back.
Most people will default to their players stretch their hamstrings. I rarely see hamstrings as the root cause of poor hip flexion mobility. The most common areas I find limiting hip flexion are the glutes and deep hip rotators, adductor magnus and the hip flexors
#3) Ankle dorsiflexion:
The majority of hockey players have poor ankle mobility.
Poor ankle dorsiflexion doesn’t allow them to shift their weight onto their forefoot. Keeping their weight on their heels impacts different things up the kinetic chain. This can include increasing trunk forward tilt, hip flexor and lumbar paraspinal engagement.
Don’t believe me? Try squatting with your shins blocked. Where is the weight distribution under your feet? What happens to your trunk? What do you feel engaging to keep you upright? (If you’re able to stay upright).
#4) Posterior chain strength:
I believe this is another factor influenced by a lack of ankle mobility. Nonetheless, posterior chain strength is important in reducing stress on the low back.
Training the glutes and hamstrings to better control the pelvis will put less stress on the low back. I’m a big fan of the GHR for developing posterior chain strength in players who might lack ankle mobility.
#5) Upper back strength:
Players require good upper back strength to maintain an upright posture in skating. Otherwise, they will use the muscles in the low back to keep their upper body erect.
I like using supported rows to focus on scapular and thoracic strengthening. The supported position helps to reduce lower back engagement. Progressing to bent over rows and split stance row variations will incorporate forefoot weight shift, core, posterior chain and upper back in one exercise. Talk about bang for your buck exercises!