Watching several NHL games in California, in San Jose and Los Angeles, means seeing up close one of the most physically demanding team sports there is. What I take from it for prevention, performance and recovery.
By Jon Iturralde
From the stands, ice hockey looks fluid. At the edge of the rink, you grasp what it demands: 40- to 50-second shifts at maximal intensity, constant accelerations and changes of direction, full-speed contact against the boards, then a few minutes on the bench before going again. Few sports combine power, speed, endurance and exposure to impact to this degree.
An intermittent, very high-intensity sport
Physiologically, each shift draws heavily on the glycolytic system, while aerobic capacity determines how fast players recover between shifts and across the three periods. The study by Quinney and colleagues, which followed one NHL team over 26 seasons and more than 700 players, shows a steady increase in players’ height, mass and aerobic and anaerobic capacities, with very different profiles by position: heavier, more powerful defencemen; younger forwards with higher relative VO2; more flexible goaltenders.
The skating stride also requires a low posture, hips and knees flexed, and a push into hip abduction, extension and external rotation. Repeated thousands of times a game, these mechanics explain many of the injuries specific to hockey.
What the injuries reveal
- The groin and adductors. In professional players, Tyler and colleagues showed that adduction strength below 80% of abduction strength was associated with a roughly seventeen-fold higher risk of adductor strain, and that injured players had 18% lower adduction strength in preseason. Flexibility, on the other hand, was not a factor.
- The hip. Cam-type morphology of femoroacetabular impingement appears more frequent in young hockey players than in young skiers of the same age, suggesting an influence of repeated loading during growth.
- The knee, especially the medial collateral ligament, stressed in collisions and valgus loading.
- The shoulder, notably the acromioclavicular joint, in body checks against the boards.
- The head and neck : concussions and neck injuries, the result of collisions and falls.
Prevention: what has been shown to work
The best-documented prevention in hockey is also the simplest. In one NHL team, a six-week adductor strengthening programme, reserved for players identified as “at risk” by a preseason strength test, brought the adductor strain rate down from 3.2 to 0.71 per 1,000 game exposures over the next two seasons. The message is clear: measure, then strengthen in a targeted way, rather than stretch more.
Beyond the groin, prevention relies on the hip’s capacity to absorb load, eccentric hamstring strength, trunk control in contact, and preparing the shoulder for impact.
Recovering between games
The NHL regular season has 82 games, often back to back, with travel and short nights. The organisations that last treat recovery as a component of performance: load monitoring, protected sleep, nutrition, care between games, and return-to-play decisions based on measured criteria rather than the calendar.
Concussion: a stepwise return
The Amsterdam international consensus (2022) changed management: prolonged strict rest is no longer recommended. After a few days, light aerobic exercise below the symptom threshold supports recovery; cervical and vestibular rehabilitation is indicated when symptoms persist; return to play follows successive stages and requires medical clearance.
What we apply in Nyon
We work with hockey players from French-speaking Switzerland using the same logic. The assessment measures what the literature identifies as decisive: adductor/abductor strength ratio, hip mobility, trunk and shoulder control, tolerance to repeated effort. Ultrasound and infrared thermography complete the picture when useful. The resulting plan is written, targeted and reassessed at every stage, in liaison with the staff when the player wishes. Amateur athletes who want to keep playing for years benefit from the same method.
This article is for information only. It does not replace a consultation.
References
- Quinney H.A. et al. A 26 year physiological description of a National Hockey League team. Applied Physiology, Nutrition, and Metabolism. 2008;33(4):753-760.
- Tyler T.F. et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. American Journal of Sports Medicine. 2001;29(2):124-128.
- Tyler T.F. et al. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. American Journal of Sports Medicine. 2002;30(5):680-683.
- Philippon M.J. et al. Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. American Journal of Sports Medicine. 2013;41(6).
- Agel J., Harvey E.J. A 7-year review of men's and women's ice hockey injuries in the NCAA. Canadian Journal of Surgery. 2010;53(5):319-323.
- Patricios J.S. et al. Consensus statement on concussion in sport: the 6th International Conference on Concussion in Sport, Amsterdam, October 2022. British Journal of Sports Medicine. 2023;57(11):695-711.