Prevention and recovery strategies in field hockey by NAQI Belgium

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PREVENTION & RECOVERY STRATEGY Hockey Issue 1 2021

CONTENTS EDITOR’ S LETTER ED GARD GE YSKENS,

E D I T O R N A Q I F O U N D AT I O N

INJURIES IN FIELD HOCKEY PLAYERS: A SYSTEMATIC REVIEW Cover photo: Philippe De Putter

MAGAZINE BOARD GREET CLAES M S c ( D e n t i s t r y), D D s ( D e r m a t o - Co s m e t i c S c i e n c e s) H e a d o f R & D N AQ I ® nv, B e l g i u m

DELPHINE VERBEKE M S c (S c i e n c e B i o c h e m i e), R & D N AQ I ® nv, B e l g i u m

PAU L VA N LO O N M S c ( P hy s i c a l T h e r a p y) P a u l Va n L o o n S p o r t s c l i n i c s , St a b r o e k & A n t w e r p N AQ I ® M a i n I n s t r u c t o r

EDITOR EDGARD GEYSKENS M S c (E c o n o my), M S c ( A p p l i e d E c o n o my & H e a l t h E c o n o my), M S c (B u s i n e s s A d m i n i s t r a t i o n), M S c (F i n a n c e) C E O N AQ I ® nv, B e l g i u m

SAULO DELFINO BARBOZA, COREY JOSEPH, JOSKE NAUTA, WILLEM VAN MECHELEN & EVERT VERHAGEN

YOUNG ATHLETES SPECIALISE FAR TOO EARLY, AND LITTLE VARIATION INEVITABLY LEADS TO INJURY DAMIEN VAN TIGGELEN, PR O FE SSO R /R EHAB I L I TAT I O N SCI EN T IS T

WESLEY MUYLDERMANS Sports Journalist & writer

ART DIRECTOR ISABEL VERELLEN Master of Arts A r t D i r e c t o r N AQ I ® nv, B e l g i u m

JO VERSCHUEREN,

CO O R D I N AT O R O F R E H A B I L I TAT I O N S C I E N C E S A N D P H Y S I O T H E R A P Y

THE MOST IMPORTANT THINGS FOR A GOOD RECOVERY ARE SLEEP, HYDRATION AND NUTRITION X AVIER TROESSAERT, 22

S P O R T S P H Y S I O T H E R A P I S T AT R O YA L R A C I N G C LU B D E B R U X E L L E S

ATHLETES NEED TO BE MADE MORE AWARE OF THE IMPORTANCE OF INJURY PREVENTION FR ANCIS WE Y TS, PHYSIOTHERAPIST-OSTEOPATH OF ROYAL VICTORY HOCKEY CLUB FANION TEAM D1/H1

I ALWAYS TRY TO BE ON THE TOP OF MY GAME F O R WA R D A N D C A P TA I N O F T H E R E D L I O N S

THE RIGHT BALANCE OF RECOVERY AND PERFORMANCE CAN TAKE YOUR BODY TO A HIGHER LEVEL JULIEN RYSMAN,

M E D I C A L S TA F F R E D L I O N S / O S T E O PAT H

MOST INJURIES RECORDED BY DOCTORS ARE SPORTS INJURIES SANDR A LIE VROUW,

PROJEC T MANAGER INJURY PREVENTION GE T FIT 2 SPORT

SUBSCRIPTIONS

INJURIES DUE TO OVERUSE ARE OFTEN THE BIGGEST CHALLENGE

THOMAS BRIELS,

WRITER

PREVENTION AND SPORTS SHOES

I N FO @ N AQ I FO U N DAT I O N .CO M

PAUL GRIFFIN,

ADDRESS NAQI FOUNDATION - NICHOLAS HOUSE - RIVER FRONT

GOOD CIRCULATION IS CRUCIAL FOR INJURY PREVENTION AND RECOVERY

ENFIELD, MIDDLESEX EN1 3FG - UNITED KINGDOM

GREE T CL AES & DELPHINE VERBEKE,

S P O R T P O D I AT R I S T

R&D TEAM NAQI®

Hockey issue 1 2021

THERAPEUTIC MAGAZINE

EDITOR’ S LETTER PREVENTION & RECOVERY STRATEGY

EDGARD GEYSKENS Editor NAQI ® Foundation

he sport of hockey has seen a tremendous surge in Belgium in recent years. Whereas the hockey federation now has more than 50,000 members, this was just half of it a decade ago. An increasing number of new clubs are being founded, bringing the total to close to 100 now. Of course, the successes of the national hockey teams at the major tournaments have a lot to do with this. Hockey has also become more widely accessible. As a sport, hockey is also an example of good management. It requires a sense of creativity and entrepreneurship. Promotional channels are even addressed, offering a solid product which may attract potential sponsors. In this way, everything can be gradually built up. In the NAQI Therapeutic Magazine we always try to establish a link between physiotherapy and skin therapy. In this edition, that’s what we will do for hockey, while also taking a closer look at the aspects of recovery and cooling. Additionally, special attention will be dedicated to injury prevention and treatment. As usual, a scientific publication is the basis to start from and we take it from there to check out experiences in practice. The inspiration for this issue came from the fascinating systematic review “Injuries in Field Hockey” by Saulo Delfino Barboza, Corey Joseph, Joske Nauta, Willem van Mechelen and Evert Verhagen. In our aim to present a complete picture on this topic, we talked to a number of ‘specialists in the field’. For example, Thomas Briels, the captain of the national hockey team, who gives us an interesting insight into the ins and outs of professional hockey. We spoke to Julie Rysman, an osteopath and member of the Red Lions’ medical staff, who gives us an insight into the various recovery and cooling techniques used in hockey. We also have Xavier Troessaert, sports physiotherapist, who is involved in the medical supervision of hockey club Racing Club de Bruxelles. He is convinced that an efficient framework is necessary to deliver a top performance. Francis Weyts, physiotherapist-osteopath of Royal Victory Hockey Club Fanion Team D1/H1, is the right specialist to ask some questions about injury prevention and treatment in hockey. This is a topic of outspoken expertise of Professor Damien Van Tiggelen, who is known for his research in the field of prevention of lower limb injuries. Doctoral student and independent sports physiotherapist Jo Verschueren, who built up practical experience in top-level sports, will also guide us through this very interesting subject like no other. We listened to Sandra Lievrouw, project manager for injury prevention at Gezond Sporten Vlaanderen. She explains what exactly the Get Fit 2 Sport programme is and what impact it can have on injury prevention and treatment. We also travelled, figuratively speaking, to the other side of the world, where we had an interesting conversation with the Australian sports podiatrist Paul Griffin. Together with a colleague, he developed an innovative sports shoe for the Belgium-based hockey brand Osaka, which actively helps to prevent injuries. Finally, we also talked to Greet Claes, head of the R&D department and Delphine Verbeke, assistant R&D at NAQI®, who explained how NAQI® can contribute to better recovery in hockey.

Enjoy your reading!

NAQI® Belgium nv/sa, supplier of Team Belgium & Belgian National Fieldhockey Teams

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Hockey issue 1 2021

SPORTS MEDICINE

Injuries in Field Hockey Players: A Systematic Review – Saulo Delfino Barboza1 • Corey Joseph2 • Joske Nauta1 •

Willem van Mechelen1,3,4,5 • Evert Verhagen1,2,4 –

1. Amsterdam Collaboration on Health and Safety in Sports, Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands 2. Australian Collaboration for Research into Injury in Sport and its Prevention, Federation University Australia, Lydird Street South, Ballarat, VIC 3350, Australia 3. School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, QLD 4072, Australia 4 Division of Exercise Science and Sports Medicine, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory 7925, Cape Town, South Africa 5 School of Public Health, Physiotherapy and Population Sciences, University College Dublin, Belfield, Dublin 4, Ireland

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IN JUR IE S IN FIELD H O CK E Y PL AY ER S

ABSTRACT Background To commence injury prevention efforts, it is necessary to understand the magnitude of the injury problem. No systematic reviews have yet investigated the extent of injuries in field hockey, despite the popularity of the sport worldwide.

Objective Our objective was to describe the rate and severity of injuries in field hockey and investigate their characteristics.

INTRODUCTION

ield hockey is an Olympic sport played by men and women at both recreational and professional levels. The five continental and 132 national associations that are members of the International Hockey Federation [1] demonstrate the high level of popularity of field hockey worldwide. Field hockey participation may contribute to players’ health through the well-known benefits of regular exercise. However, participation in field hockey also entails a risk of injury [2].

Methods We conducted electronic searches in PubMed, Embase, SPORTDiscus, and CINAHL. Prospective cohort studies were included if they were published in English in a peer-reviewed journal and observed all possible injuries sustained by field hockey players during the period of the study.

Results The risk of bias score of the 22 studies included ranged from three to nine of a possible ten. In total, 12 studies (55%) reported injuries normalized by field hockey exposure. Injury rates ranged from 0.1 injuries (in school- aged players) to 90.9 injuries (in Africa Cup of Nations) per 1000 player-hours and from one injury (in high-school women) to 70 injuries (in under-21 age women) per 1000 player-sessions. Studies used different classifications for injury severity, but—within studies—injuries were included mostly in the less severe category. The lower limbs were most affected, and contusions/hematomas and abrasions were common types of injury. Contact injuries are common, but non-contact injuries are also a cause for concern.

Conclusions Considerable heterogeneity meant it was not possible to draw conclusive findings on the extent of the rate and severity of injuries. Establishing the extent of sports injury is considered the first step towards prevention, so there is a need for a consensus on injury surveillance in field hockey. (For tables see appendix).

In general, sports injuries result in individual and societal costs [3], hamper performance, and compromise a teams’ success over the sporting season [4,5]. Therefore, injury prevention strategies are of great importance for teams at both recreational and professional levels. Establishing the extent of the injury problem is considered the first step towards effective prevention [6]. In field hockey, as well as in other sports, this information can aid researchers and health professionals in developing appropriate strategies to reduce and control injuries [6]. To the best of our knowledge, no systematic reviews have provided a synthesis of information on injuries sustained by field hockey players. Systematic reviews involve gathering evidence from different sources to enable a synthesis of what is currently known about a specific topic (e.g., injuries) and may facilitate the link between research evidence and optimal strategies for healthcare [7]. Therefore, the aim of this study was to systematically review the literature on injuries sustained by field hockey players, in order to describe the extent of such injuries in terms of rate and severity as well as to identify injury characteristics according to body location, type, and mechanism of injury.

KEY POINTS •

•

Substantial heterogeneity between studies prevents conclusive findings on the extent of the rate and severity of injuries in field hockey.

• Injury prevention efforts in field hockey may benefit from consensus on the methodology of injury surveillance.

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HOCKEY Injuries

“ ...participation in field hockey also entails a risk of injury ”

METHODS

2.1 Information Sources and Search Strategy Electronic searches were conducted in PubMed, Exerpta Medical Database (Embase), SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases with no limits on the publication date. The search strategy combined keywords for injury, field hockey, and study design: (injur*) OR traum*) OR risk*) OR overuse) OR overload) OR acute) OR odds) OR incidence) OR prevalence) OR hazard)) AND (field AND hockey) OR (hockey NOT ice) AND (prosp*) OR retrosp*) OR case*). The detailed search strategy for each database can be found Appendix S1 in the Electronic Supplementary Material (ESM). The last search was conducted on 31 May 2017.

2.2

Eligibility Criteria

Studies were eligible for inclusion if they were published in the English language in a peer-reviewed academic journal, were prospective cohort studies, and observed all possible injuries sustained by field hockey players during the period of the study (i.e., studies that looked only at specific injuries were not included). To minimize the possibility of recall bias, only prospective cohort studies were included [8, 9]. Studies were not included if they described field hockey injuries together with those from other sports, and specific data on field hockey could not be distinguished. Conference abstracts were not included.

2.3

The number of injuries normalized by exposure to field hockey (i.e., injury rate) was also extracted. In addition, information on injury according to body location, type of injury, mechanism, and player position was gathered whenever possible. When different studies used the same dataset (Table 1), the results of such studies were combined in one row in all other tables for simplicity.

2.4

Risk of Bias Assessment

Two independent reviewers (SDB and CJ) assessed the risk of bias in the included studies using ten criteria previously used in systematic reviews on sports injury [9, 10]. All criteria were rated as 1 (i.e., low risk of bias) or 0 (i.e., high risk of bias). When insufficient information was presented in a study to rate a specific criterion as 1 or 0, the rating was categorized as ‘unable to determine’ (UD) and counted as 0. The assessment of each reviewer was compared, and conflicts were resolved through discussion. The ten criteria are described in Table 2.

Study Selection and Data Collection

Two reviewers (SDB and CJ) independently screened all records identified in the search strategy in two steps: title and abstract screening, and full-text screening. References of full texts were also screened for possible additional studies not identified in the four databases. Conflicts between reviewers’ decisions were resolved through discussion. A third reviewer (EV) was consulted for consensus rating when needed. One reviewer (SDB) extracted the following information from the included studies: first author, publication year, country in which the study was conducted, primary objective, setting, follow-up period, number and description of field hockey players, injury definition, injury data collection procedure, number of injured players, number of injuries sustained by players during the study, and severity of injuries (Table 1).

HOCKEY Injuries

R E S U LT S

3.1 Search Results We retrieved 810 records from the four databases. Of those, 193 were duplicates. After screening 617 titles and abstracts and 21 full texts, ten studies matched the inclusion criteria. Screening the references of the full texts resulted in 12 additional records. In the end, 22 studies were included in the review. The flowchart of the inclusion process is presented in Fig. 1.

403

157

177

records identified in PubMed

records identified in EMBASE

records identified in SPORTDiscus

records identified in CINAHL

810

193

potential records

duplicates removal

617

596

records screened by title and abstract

not included after title and abstract screening

studies identified in the references list and other sources

studies assessed for eligibility

11 studies not ncluded: 4 2 2 2 1

non-English ice hockey non-identifiable data full texts not available conference abstract

studies included in the review

Fig 1: Flowchart of the studies during the inclusion process. Electronic searches were conducted in PubMed, Exerpta Medical Database (Embase), SPORTDiscus, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) databases with no limits on the publication date.

3.2

Description of the Included Studies

The characteristics of the 22 studies included in this review are presented in Table 1. Studies included in this review were published between 1975 and 2016, with 12(55%) published before 2000 [11–22] and ten (45%) published from 2000 onwards [23–32]. Two studies used the same dataset from the National Athletic Trainers’ Association (NATA) High School Injury database [21, 27], and two used the same dataset from the National Collegiate Athletic Association (NCAA) Injury Surveillance System [26, 28].

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Hockey issue 1 2021 One study [24] was the follow-up of a previous study [23]. Six studies (27%) focused on describing field hockey injuries only [14, 18, 19, 28, 29, 32]. The other 16 studies (73%) described the epidemiology of injuries in field hockey together with those in other sports [11–13, 15–17, 20–27, 30, 31]. The period of follow-up varied between studies from a 6-day championship tournament [20] to 15 consecutive seasons of field hockey [28]. The sample size varied between 26 [22] and 5385 participants [28].

However, seven studies (32%) did not report the number of field hockey players studied [11, 13, 14, 19, 21, 25, 27]. The definition of injury varied across the studies. Common criteria to define an injury as recordable were a musculoskeletal condition requiring medical attention and/ or leading to field hockey time loss (Table 1). The proportion (%) of injured players varied from 6% (in 7 months of high school) to 33% (in 6 days of university games). Twelve studies (55%) did not report the number or proportion of players who had sustained an injury over the study period [11–15, 18, 19, 25, 26, 28, 29, 32].

3.3

Risk-of-Bias Assessment

Table 2 shows the risk- of-bias assessment for the 22 included studies. The total score ranged from three to nine of a possible ten points. The studies published during and since 2000 scored higher (range 7–9) [23–31]. Three studies (14%) did not provide a clear definition of injur y [11, 15, 18], and three did not describe any charac teristics of the players studied [11, 15, 19]. These studies were published before the year 2000. Nine studies (41%) included a random sample of players or studied the entire target population [12, 16, 20, 23–25, 30 –32]. Eighteen studies (82%) collec ted injur y data direc tly from players or medical professionals, 17 studies (77%) used only one method (i.e., not multiple methods) to collec t injur y data during the study [11, 13, 15–20, 23–26, 28–32], and one study (5%) did not describe the data collec tion procedure at all [14]. Twelve studies (55%) employed a medical professional to diagnose injuries [13, 16, 17, 21, 25–32]. The follow-up period of 13 studies (59%) was over 6 months [11–14,17–19, 21, 24, 26 –29], and 12 studies (55%) expressed ratios that represented both the number of injuries and the expo - sure to field hockey [11–13, 21, 23–29, 32].

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3.4

Injury Extent in Field Hockey

3.5

Injury Characteristics in Field Hockey

3.4.1

Injury Rates

3.5.1

Body Location and Types of Injury

In total, 12 studies (55%) reported the number of injuries normalized by player exposure (i.e., injury rate). The injury rates reported in each of these studies are presented in Table 3, and were divided into two categories: (1) number of injuries per 1000 player-hours of field hockey exposure (i.e., time at risk) [11, 12, 23–25, 32] and (2) number of injuries per 1000 player-sessions (i.e., sessions at risk) [13, 21, 25–29]. One study reported the number of injuries according to both player-hours and player-sessions at risk [25]. In the studies describing injuries according to players’ time at risk, injury rates ranged from 0.1 injuries (in school-aged players) [12] to 90.9 injuries (in Africa Cup of Nations) [32] per 1000 player-hours of field hockey (Table 3). The injury rate in the studies describing injuries according to players’ sessions at risk varied from one injury (in high-school women) [13] to 70 injuries (in under- 21 age women) [29] per 1000 player-sessions. The injury rates were higher in games than in training sessions in two [21, 28] of the three studies that investigated this outcome [21, 28, 29]. In major tournaments, injury rates were higher in men [25, 32].

Fifteen studies (68%) described injuries according to the affected body location [12–16, 18, 19, 21, 24, 25, 27–29, 31, 32]. Table 4 presents the proportion (%) of injuries according to body location reported in these studies. The most common site of injury was the lower limbs (ranging from 13% [25] to 77% [18] of all injuries), followed by head (2% [13] to 50% [25]), upper limbs (0% [16] to 44% [12]), and trunk (0% [18] to 16% [28]). In the lower limbs, injuries were more frequent in the knee, ankle, lower leg, and thigh (Table 4). In total, 13 studies (59%) described the types of injury sustained by field hockey players [13–16, 18, 20, 21, 24, 25, 27–29, 31]. Table 5 presents the proportion (%) of injuries according to their type. Contu- sions and hematomas were the most common types of injury (ranging from 14% [31] to 64% [18] of all injuries), followed by abrasions and lacerations (5% [14] to 51% [15]), sprains (2% [18] to 37% [13]) and strains (0% [25] to 50% [28]). Concussions ranged from 0% [25] to 25% [25].

3.4.2

3.5.2

Injury Severity

Table 1 presents the classification of injuries according to severity. Most of the studies (55%) used field hockey time loss to report the severity of injuries [11, 13, 17, 19, 21, 25–31], but reported the days of time loss differently. Some studies reported the average days of time loss [11, 17] and others used diverse cut-off points to report injury-related days of time loss, such as two days [19], eight days [21, 27], and ten days [26, 28]. The majority of injuries were in the less severe category in all studies reporting days of time loss due to injury, regardless of the cut-off points used [13, 14, 19, 21, 25, 28, 29, 31]. Six studies (27%) included severity measures in the methodology but did not specify the number or proportion of injuries according to severity in the results [12, 16, 20, 23, 24, 32]. Three studies (14%) did not mention severity of injury at all [15, 18, 22].

Injury According to Mechanism and Player Position

Eight studies (36%) described injuries according to their mechanism [18–20, 25, 28, 29, 31, 32]. Table 6 presents the proportion (%) of injuries according to their mechanism. Non-contact injuries ranged from 12% [18] to 64% [28]. Contact with the ball (range: 2% [29] to 52% [32]) and stick (9% [29] to 27% [18]) were also common mechanisms, as was contact with another player (2% [19] to 45% [20]) or with the ground (9% [28] to 15% [20]). Three studies (14%) reported injuries according to the injured player’s position [19, 28, 29]. Goalkeepers sustained fewer injuries in all three studies that reported injuries by playing position (4% [19] to 19% [28]). Defenders sustained 16% [19] to 36% [29] of injuries, while midfielders and forwards sustained 22% [28] to 37% [19] (Table 7).

DISCUSSION

To the best of our knowledge, the present study is the first systematic review to summarize the descriptive evidence of injuries sustained by field hockey players. We included only prospective studies to ensure we gathered the most reliable information available on the extent of injuries in field hockey in terms of rate and severity as well as injury characteristics according to body location, type, and mechanism of injury. To reduce and control field hockey injuries, as for all sports, we must first establish the extent of the injury problem [6]. The substantial heterogeneity between studies included in this review prevented conclusive findings on the extent of the rate and severity of injuries in field hockey (Tables 1, 2). Such heterogeneity may be caused by the different definitions and methods employed to record and report injuries and the different characteristics and levels of players studied.

Hockey issue 1 2021

HOCKEY Injuries

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This systematic review shows that, despite the long history of field hockey and its popularity worldwide, prospective studies focusing on overall field hockey injuries are still lacking. The majority of the studies investigated field hockey injuries together with injuries in other sports [11–13, 15–17, 20–27, 30, 31]. Within such studies, injury rates in field hockey were comparable to those in other team sports, such as basketball [23, 24, 26], netball [23, 24], lacrosse [26], and softball [21, 27]. The injury rate in field hockey can be considered low compared with football (soccer) [21, 25–27]. However, in major tournaments, the rate of time loss injuries in field hockey [32] can be considered higher than that in football (soccer) [4]. These findings confirm that the risk of sustaining an injury in field hockey should not be neglected. Despite the considerable heterogeneity between studies, it is still possible to observe similar characteristics of injuries with regard to body location, type, and mechanism of injury. Most of the injuries described in the studies included in this review were to the lower limbs (Table 4), affecting mainly the knee and the ankle. This is in line with previous studies on team sports involving running and stepping maneuvers, such as football (soccer) [33] and lacrosse [34], and justifies a focus on preventive efforts in this body area. Interestingly, the majority of injuries sustained by women during major tournaments were to the head [25, 32]. A specific analysis of head injuries in collegiate women’s field hockey showed that 48% of these injuries occurred due to contact with an elevated ball [35]. Most (39%) of the concussions were due to direct contact with another player, and 25% were due to contact with an elevated ball [35]. Contusions and hematomas were common types of injury, as were abrasions and lacerations, which might be due to players’ contact with the ball, stick, and playing surface [2, 28]. A specific analysis of ball-contact injuries in 11 collegiate sports showed that injury rates were the highest in women’s softball, followed by women’s field hockey and men’s baseball [36]. In field hockey, the common activities associated with ball-contact injuries were defending, general play, and blocking shots [36]. To reduce the injury burden, the International Hockey Federation stated that goalkeepers must wear protective equipment comprising at least headgear, leg guards, and kickers [37]. Field players are recommended to use shin, ankle, and mouth protection [37], and other research suggested that the use of such equipment should be mandatory [2]. Accordingly, some national associations have updated their rules to make shin, ankle, and mouth protection obligatory [38, 39]. It is important to note that non-contact injuries are also a cause for concern in field hockey (Table 6). Although protective equipment has a fundamental role in injury prevention, it may not prevent most of the non-contact injuries. During the last decades, different studies have shown that it is possible to prevent injuries in team sports with structured exercise [40–44]. Yet, to our knowledge, evidence showing the implementation of such programs in field hockey is lacking. Nevertheless, exercise programs that have proven effective in preventing sports injury can be introduced as part of the regular training schedule of the field hockey team, especially programs focusing on the prevention of lower limb injuries [40–42]. While there is no structured exercise program for field hockey, stakeholders can also use open source resources for overall and specific injury prevention that are supported by the Inter- national Olympic Committee, such as exercise programs and guidelines on load management and youth athletic development [45–47].

4.1 Future Recommendations The present systematic review shows that studies have used different definitions and methods to record and classify injuries and their severity, and this prevents conclusive findings on the extent of the injury problem in field hockey. As establishing the extent of sports injury is considered the first step toward effective prevention [6], one of the main findings of this review is the recognition of the need for a consensus on the methodology of injury surveillance in field hockey. Consensus statements on the methodology of injury surveillance have been made available for a variety of sports [8, 48–54]. A consensus statement represents the result of a comprehensive collective analysis, evaluation, and opinion of a panel of experts regarding a specific subject (e.g., methodology of injury surveillance in field hockey) [55]. Consequently, consensus statements enable investigators from different settings to access and employ the same definitions and methods to collect and report injury data. Comparisons among different studies as well as data pooling for meta-analyses are then facilitated. The common goal in field hockey is to promote players’ safety while maintaining the traditions of the sport [35]. Protecting the health of the athletes is also a priority of the International Olympic Committee [56], and resources for injury prevention have been made available for the public in general [45–47]. The field hockey community would benefit from studies investigating the implementation of such resources and from strategies that have been proven to be effective in other sports [40–44]. Until there is consensus on the methodology of injury surveillance in field hockey, investigators may use consensus from other team sports in future studies as an example [8, 52, 53]. Based on the gaps identified in the studies included in this review, the authors also suggest that future studies adhere to the reporting guidelines from the Enhancing the Quality and Transparency of Health Research (EQUATOR) Network. The EQUATOR Network provides comprehensive documentation on what information needs to be reported in scientific manuscripts depending on the study design [57]. By following an appropriate guideline such as that of the EQUATOR Network, future investigators will facilitate assessment of the generalizability, strengths, and limitations of studies on field hockey injuries.

4.2

Limitations

Electronic searches were conducted in four databases that were considered relevant for this systematic review. This does not rule out the possibility of eligible articles published in journals that were not indexed in any of these databases. To minimize this limitation, we screened the references of the full texts assessed for eligibility and included additional studies that were not identified in the database search. In addition, this systematic review included only scientific manuscripts published in English, although studies on field hockey injuries have been published in other languages. These were not included because the authors were unable to translate the papers accurately enough to extract their data.

Hockey issue 1 2021

photo: Philippe De Putter

Conclusion

•

• The present systematic review shows that, despite the long history and the popularity of field hockey worldwide, few prospective studies have investigated the overall injury problem in field hockey. •

Most of the information on field hockey injuries registered prospectively comes from studies conducted in multi-sport settings.

•

The range of definitions, methods, and reporting employed by studies prevents conclusive findings on the rate and severity of injuries in field hockey.

•

To facilitate the development of evidence-based strategies for injury-prevention, field hockey may benefit from a consensus on the methodology of injury surveillance.

•

While no specific consensus is available for field hockey, future studies may use widely accepted consensus from other sports, such as football (soccer).

•

In addition, future studies on field hockey injuries are encouraged to adhere to the reporting guidelines from the EQUATOR Network.

• Despite the considerable heterogeneity, it is clear that most of the injuries sustained by field hockey players affect the lower limbs, justifying efforts to develop preventive strategies for this body area. •

Contact injuries, such as contusions/hematomas, and abrasions, are frequent, and the use of protective equipment for the ankle, skin, hand, mouth, and eye/face has been recommended. Nevertheless, non-contact injuries are also common in field hockey, and most of these may not be prevented by protective gear.

• To reduce the burden of injuries, field hockey stakeholders may implement exercise-based injury- prevention programs and guidelines on load management and youth athletic development that have been supported by the International Olympic Committee.

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P R O F E S S O R / R E H A B I L I TAT I O N S C I E N T I S T

“Young athletes specialise far too early, and little variation inevitably leads to injury.” – Damien Van Tiggelen –

Damien Van Tiggelen is a rehabilitation scientist and head

of the Centre for Physical Medicine & Rehabilitation at the Queen Astrid Military Hospital (Brussels). Moreover, he has been a visiting professor at the Faculty of Medicine & Health Sciences (UGent) since 2013. He earned his doctorate in Motor Rehabilitation & Kinesitherapy in 2009 with the thesis “Prevention of Patellofemoral Pain in Military Recruits”. Prevention of sports injuries of the lower limb is his field of research. He is leading this research both among military staff and hockey players.

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Hockey issue 1 2021

Professor Van Tiggelen, does sport, and hockey in particular, pay sufficient attention to injury prevention? A thletes and coaches are becoming increasingly aware of the importance of prevention, but still not enough attention is paid to it. Prevention is of course not ‘sexy’ and often comes down to boring exercises with no connection to the athlete’s preferred sport. Moreover, the athlete does not see any immediate effect. Injury prevention is not a goal in itself, better performance is. And those two aspects are obviously linked. Therefore, the link with performance should be made clearer. Preventive exercises also put the athlete in situations which often lead to acute injuries, which will allow the athlete to anticipate the movement. In hockey, for example, changes of direction and sprints when the athlete is already tired are a risk of ligament or muscle injuries. This is what we refer to as “graded exposure”. In this treatment strategy painful movements are performed and built up step by step. This approach is based on the fact that pain and pain increase do not automatically result in damage the body.

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What could be improved in terms of injury prevention and at what level? A lack of infrastructure in Belgian hockey is certainly an issue. You need both the space and the time for appropriate preventive exercises. And there is certainly also room for improvement in terms of awareness-raising. The federation has been keeping a record of injuries since 2013, but unfortunately many still remain under the radar. Insurance companies have a very good picture of sports accidents, but injuries due to overexertion do not feature in claims. Most sports injuries have a ‘dormant’ origin and do not, or only rarely, appear in these tables. However, they are no less important for the sport and the athlete himself, who will sometimes end up in a slump for years. At club level, I also see some changes happening in the coming years. We have been researching injuries in hockey for about five years and have a good idea of the sport-specific adaptations in the athletes. Together with Dorothée Gaeremynck - Medical-Paramedical Coordinator of the Belgian Hockey Federation - we screen the young athletes of the BeGold programme every year. Covid-19 did put a stop to it this year, but if the financial resources can be found, we will certainly continue. Once we can roll out customised programmes, this will also have an impact at the club level.

What injuries are most common among (young) hockey players and to what extent do they differ from other sports? Every sport has its typical injuries and hockey is no different. Hockey is what we call an ‘invasive game’, short sprints, pivoting and intensive movements. The rotations of the trunk and limbs in deep flexion are typical for hockey. I think young athletes specialise in a certain sport too early. They sometimes play hockey three or four times, without making time for other sports. Little variation inevitably leads to injuries. In some sports we see that the federation intervenes, like in baseball. The number of pitches per week is limited for young children. However, it is still premature to introduce something similar for hockey. The data to substantiate this is simply not available yet. In hockey, we see two types of injuries: acute and overuse injuries. The former include muscle tears and sprains, while overuse injuries are chronic and gradual in nature. A distinction can also be made between men and women (or boys and girls). Men often suffer from injuries to the hamstrings, as in football, and other muscle injuries. They typically occur during the preparation or at the end of the season, when fatigue starts to affect athletes. Ankle injuries are common in both sexes, while traumatic injuries to the knee (anterior cruciate ligament) are more of a problem in girls. However, this is not typical for hockey alone. Acute injuries also include traumatic injuries caused by the ball or the stick. Most accidents happen in ‘D’, where the ball may be hit upwards towards the goal and where the concentration of players in certain phases of play is high. These include injuries to the face (including teeth) and to the fingers. As far as overuse is concerned, there are also differences between the two sexes. Boys are more likely to suffer from femoroacetabular impingement (FAI) - where there is an entrapment at the level of the hip joint between the edge of the femoral head and the hip socket. They are also more likely to be affected by Sever’s disease. The calf muscles at the back of the lower leg consist of two large muscles. Both muscles attach to the heel bone via the Achilles tendon. In persons whose skeleton is not yet fully developed, there is a growth disk where the Achilles tendon attaches to the bone. Every time the calf muscles tighten, the muscles pull on the Achilles tendon. It cannot stretch much, which puts a great deal of strain on the growth plate of the heel. If the tension is too great/strong or is carried out repeatedly for a long time, the growth plate can become irritated. This can result in pain and sometimes a bone-like protrusion at the back of the heel. Girls are more likely to suffer from patellofemoral problems, i.e. pain around the kneecap. A combination of (partly unknown) factors, with overloading as an important component, causes this symptom. Treatment is often long-term and consists of rest and exercise therapy. Girls are also more prone to shin splints, a collective term for various irritations of the shin. The most common variant is an inflammation of the bone membrane near the shinbone. You can get it through overexertion or bad shoes, for instance.

A generic or individual approach, that is often the key question... Which do you prefer? The generic approach is good for athletes who have no history of injury, which is so-called primary prevention. The advantage of a generic programme is that it does not require much preparation, it is easy to learn and easy to apply. But even in this generic approach, it is necessary to differentiate between the sexes. In addition, certain age groups also have certain needs. Our research has shown, for example, that hip mobility decreases significantly in boys in the U18 age group compared to the U16, something we do not see in girls at all. There again, strength of the quadriceps and core (back and abdominal muscles) appear to be more important. With these scientific findings, ‘semi-tailored’ programmes based on gender and age can be created. This is already a step in the right direction.

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A n individual programme is better but requires a lot of time and resources. It requires thorough anamnesis (feedback from the athlete) and examination. Moreover, adequate follow-up is necessary, because today’s needs are not necessarily the same as next season or even next month. Therefore, the screening we have been able to conduct so far also has its limitations. You could compare it with a photo. You may look good in the photo, while the photo is not exactly what you want it to be. This is also true of screening and testing. It is a snapshot. The very striking deviations are significant, but the subtle ones are much less so. An individual programme must take into account previous injuries and, in particular, their underlying cause. We know that the most significant risk factor for an injury is a prior injury.

What role does good monitoring play in all this? Constant monitoring of an athlete is a vital step in injury prevention. Injuries are caused by an imbalance between the imposed load and the athlete’s capacity. Both of these factors vary constantly, which makes it all very complex. Sports performance is largely dependent on four pillars: physical fitness, mental resilience, nutrition and hydration, and - last but not least - rest and recovery. These four pillars fluctuate constantly: a bad night’s sleep, stress at work, a bad meal, and so on. Scientific literature speaks of internal load and external load. The latter is measured using, for example, GPS systems (total distance walked, metres per minute, etc.). The internal load is indicated by the athlete by subjectively evaluating internal load. The body does not like acute peaks in load. Many or high peaks often lead to injuries. If you run an untrained marathon, chances are that, in addition to a medal, you will also be taking home an injury as a souvenir. We are currently working on developing a system where this monitoring is not only reserved for the top athletes of the premier league or national team. A pilot project is now underway in a Belgian club.

Are athletes sufficiently aware of the importance of injury prevention ? I think that the awareness is growing. Unfortunately, injury prevention is still too often limited to a warm-up and some dynamic stretching. The coaches should be the ambassadors of awareness-raising in the first place, because players just do what they are asked to do. Coaches and parents should encourage youth players to play (totally) different sports in the off-season, so that they are exposed to a variety of movement. This will not only enhance their skills and game intelligence, but will also prevent injury.

What are common ‘mistakes’ in injury prevention ? A thletes often do the exercises they are good at, not the ones that are necessary for them. In addition, I regularly see programmes which are too analytical and have not much to do with the sport. This is not actually wrong, but if it does not translate into something functional, it makes little sense and compliance is not great. Hockey is a running sport, where the majority of the time is spent standing on one leg and where stability of the lumbopelvic region is important for efficient running (and less injuries). However, the transfer to functional movement is not obvious. Hamstring injuries are often sustained when the athlete is accelerating or reaching maximum speed. So part of the prevention will also have to consist of these incentives. If, for example, you constantly train on half a hockey pitch, you will never reach the maximum speed you can achieve during a match.

You mentioned recurring injuries earlier. What can be done to avoid these ? A s I said, the greatest risk of injury is a previous injury. If the rehabilitation is only symptomatic, the risk of relapse is real. We have not yet discovered the secret formula to completely avoid recurring injuries, but it is important to identify the cause of the initial injury. Why does the biceps femoris always rupture in the preparation, why always in November or in February? Why do girls always suffer from those annoying patellofemoral problems? Identifying all the contributing factors requires not only a good scientific knowledge of the injury, but also a thorough knowledge of sport and the athlete’s environment. Proper monitoring of the athlete also allows timely identification of when the load/capacity balance is about to get out of control. You see, all this is a very interesting, but also a complex process. A real challenge!

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CO O R D I N AT O R O F R E H A B I L I TAT I O N S C I E N C E S A N D PHYSIOTHERAPY

“Injuries due to overuse are often the biggest challenge.” – Jo Verschueren –

o Verschueren is a doctoral student at the Human

Physiology research group, Faculty of LK at the Vrije Universiteit Brussel and is also coordinator of Rehabilitation Sciences and Physiotherapy - Sports Physiotherapy option. In addition, he has gained experience as a physiotherapist in top-level sports with the national volleyball and hockey teams. His research focuses on (1) the effects of fatigue on the injury risk profile in the context of sports injury prevention; and (2) the effects of (sports) injuries on the brain and the interactions with fatigue in the context of rehabilitation and return-to-sport. He also still works as a self-employed sport physiotherapist to stay in touch with the clinical practice side of it. He is definitely the right man to introduce us to the world of injury treatment and prevention.

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Mr Verschueren, hockey is not classified as a contact sport. Does this mean that there are fewer injuries than in other sports ? C ertainly not, hockey players are also confronted with sports injuries, although this is a very broad concept. It includes grazes, back injuries, muscle injuries or more serious injuries such as shoulder dislocation or head injuries. You could say that hockey is a dangerous sport because of the high number of injuries, but the injuries are generally not serious and often the player can return to the sport quickly. Skin injuries and ankle sprains are frequent occurrences in hockey, but the nature of the injury varies greatly between age groups.

What injuries are most common among young hockey players? A t a young age, hockey is taught in a playful manner and we see few sports injuries. Because children play a lot, also outside of hockey, they may occasionally have some pain after training, often due to a slight overload. From the growth spurt onwards, the number of injuries due to overloading increases. The body changes very quickly and the muscles and tendons need time to adapt. This translates into tendon problems, often in the groin, knee or foot.

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Do other injuries appear after that growth spurt ? A fter the growth spurt, the intensity of the game goes up and we see more acute muscle injuries and ankle sprains. Back pain is also a characteristic feature of hockey players, especially those who practise the sport as a hobby and who also have to manage the combination of family and work. Hockey is not a contact sport per se, as pushing with hands or shoulders, for example, is not allowed. However, other types of contact are possible. During the game, a ball or stick can hit you or the opponent. This leads to bruising, where - after an initial pain reaction - the player can usually resume play quickly. Sometimes, however, a crack or break can cause the player to be out for some time.

And then, of course, good treatment is vital. I n the case of acute sports injuries, such as muscle injuries or ankle sprains, it will be necessary to administer good initial care. We swear by the acronym “POLICE” (Protect, Optimal Load, Ice, Compression & Elevation). The player is taken out of the match or training session to protect him from further injury, to apply ice and provide support using crutches where necessary. After this, the doctor will decide on the treatment, often prescribing physical therapy to accompany the rehabilitation. Injuries due to overuse are often the biggest challenge. Because players will often have the feeling they can continue playing, although in pain, and often deny themselves the care that the injury needs from the start. Open and clear communication within the team is very important. It is important to be on the ball and, in consultation with the doctor and sports physiotherapist, to start an appropriate care programme. The rehabilitation team can determine when the sport can be resumed, possibly with some adjustments and guidelines, and still in combination with appropriate care.

Athletes obviously want to be back in action as soon as possible. How long do they ideally rehabilitate? T he ideal rehabilitation period does not exist for sports injuries. Whereas in the past a certain period of time was often linked to a particular injury (e.g. three weeks out after an ankle injury), scientific literature shows that functional recovery can vary greatly over time. This is also seen daily in the practice of the sport physiotherapist. One athlete recovers faster than the other. This is also highly dependent on the type of sports injury and any other injuries it may have caused. However, there is usually a minimum recovery time that must be respected. It is all about finding the right balance between recovery time from the injury and the recovery of strength, stability and coordination in the body. One overarching insight, however, is that resuming the sport too soon only increases the risk of a new injury. Therefore, you have to give yourself the time to recover: if in doubt, hold out!

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Prevention is the best cure, as the saying goes. Do you agree with this statement? Of

course, I do. Injury prevention is very important in sports in general, so also in hockey. Injuries can be prevented by proper preparation and preventive exercises. Two strategies are generally recognised. On the one hand, you have the schemes where the entire team follows the prevention programme, often as part of the regular training or warm-up. On the other hand, you have the individual approach, which involves training typical movement patterns and risk factors in a more targeted manner. However, you should not forget that good physical preparation and targeted training are also very important in terms of injury prevention. A person in good physical condition can handle the strain that hockey puts on them better and also has a lower risk of injury.

How is injury prevention addressed in hockey? There

is no standard protocol for hockey players on injury prevention. Inspiration can be drawn from, for example, the prevention programmes for ankle sprains and muscle injuries that exist in other sports. Performing balance and stability exercises during the warm-up helps to reduce the number of ankle sprains. This can be combined with hockey-technical games to make it more fun. For example, keeping the ball high on the stick or certain technical skills and types of dribbling. The prevention of muscle injuries can be achieved through proper physical preparation and warming up, but also through targeted strength training. Integrating certain forms of training (e.g. Nordic Hamstring Curl) into the warm-up can also reduce the number of hamstring injuries. However, these are tough muscle exercises that are best learnt and performed under supervision within the limits of each individual’s abilities.

What about stretching? Some people swear by it, others don't see the point ... S tretching has no effect on the prevention of muscle injuries - quite the contrary. Static stretching of a muscle before an effort reduces the capacity of the muscle to deliver force and is more likely to be disadvantageous. However, these insights have not yet reached practice in the field, where many athletes still do static stretches before the sports activity. Dynamic stretching can be part of a good warm-up, but it has no direct effect on injury prevention.

What do you think the ideal ‘medical setting’ looks like at a hockey club? A t a recreational level, I strongly recommend looking at the local network for a suitable sports physiotherapist and sports doctor who can advise the club and players where necessary. There are all kinds of platforms / websites where you can look for recognised specialists in the field. At a professional level, a permanent sports physiotherapist who can work together with a doctor is a minimum, but a permanent team doctor is of course recommended. The physiotherapist and doctor must work well together and consult with the technical staff, with respect for each other’s qualities and knowledge. This is the only way to achieve good physical preparation and injury prevention. Physical coaching, but also mental coaching by a sports psychologist and professional dietary advice have also clearly proven their value in my experience. If further additional expertise is required, Belgium can also fall back on the expertise present in its universities.

Hockey is clearly on the rise, not least due to the performance of the Red Lions ... H ockey is also simply a fantastic sport that can contribute enormously to children’s motor development. It is a game sport in which running technique, skilful footwork, strength, endurance and eye-hand coordination come together in a unique way. So don’t be put off by this story about sports injuries, but discover the fun that hockey can offer for yourself.

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S P O R T S P H Y S I O T H E R A P I S T AT R O YA L R A C I N G C L U B D E BRUXELLES

“The most important things for a good recovery are sleep, hydration and nutrition.” – Xavier Troessaert –

Holder of a sports physical therapy diploma awarded by ULB in 2011, Xavier Troessaert quickly became involved in the medical supervision of hockey club Royal Racing Club de Bruxelles. This team plays at the highest Belgian level with players from various national teams (Belgium, Canada, France, Ireland, etc.). Due to his sporting past in volleyball, Troessaert always felt particularly attracted to competitive sports. Setting up the most efficient framework possible is his way of contributing to the team’s performance. His motto is: players must be at their best every day, so we should try to do the same! Mr Troessaert, how do you deal with the recovery aspect within the club where you work? First of all, it is important to clarify exactly what we mean by recovery. The work and performance of an athlete is a continuous effort. Truly empty moments between matches, training sessions, sessions in the gym, and so on are extremely rare. So I prefer to speak of ‘load management’. Indeed, depending on the work being done, the body will be challenged in some way to generate a benefit at the end of the period required for this adjustment. And this certainly includes the mental aspect. It is therefore necessary to clearly indicate which structure (nervous system, cardiovascular system, joints, muscles, etc.) is to be addressed and in what way (volume, intensity, aggressiveness) in each of the scheduled working sessions. Depending on this, we can estimate/ monitor the time the body needs to adapt. This is where the concept of ‘optimal loading’ comes into play, which we try to put into practice every day in physical development but also in rehabilitation.

So, adequate monitoring is very important? That’s right. And we use various tools to monitor all this, because we want to know how the athlete reacts to the different applied stresses (physical or even mental). First and foremost we have the ‘Daily Morning Report’, a daily collection of data relating to sleep (quality/quantity), pain, fatigue, stress, etc

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We compare these data with the usual values of the athletes (because they are different for each person). In addition, there is a report of ‘internal load’, i.e. a collection of the intensity felt by an athlete at the end of a training session. These data can vary greatly between two athletes doing the same training, because one of them may have greater difficulty adapting to the total load his body is exposed to (e.g. related to a problem of sleep, diet, stress, insufficient recovery, ...). And finally, there is an analysis of the external load, i.e. the load to which the athlete is exposed. By using GPS, heart rate monitors or others, we can collect a considerable amount of information. This information sometimes enables us to identify variations in performance, which may be caused by a workload problem or poor recovery.

So what is the result of combining these three approaches? Together, these three approaches allow us to oversee the load an athlete is exposed to and how he adapts to it. However, this only makes sense if a link is made to the planning, which has been made in view of the required performance peaks. Close cooperation between the physical coach, the coach and the medical staff is therefore essential. However, a big difference complicates our task. Every athlete is different in his adaptation to training. Monitoring and adjusting training is therefore not so easy to manage for a team of twenty or more athletes. Moreover, the available resources and people are limited.

And that is when you can really get to work ... O nce the various working sessions have been planned, we can indeed look at the content and draw up the appropriate management strategies. If we assume a ‘normal’ competition, we know that it will take 48 to 72 hours for the athlete to regain all his performance capacity (strength, speed, etc.). This is unrelated to any recovery strategies. If we do not repeatedly respect this time frame, we increase the risk of injury. The same applies to certain types of specific training, such as maximum running speed and plyometrics, which require the affected structures to be relieved for a certain period of time. The strategies for recovery, for facilitating adaptation, must be worked out individually and in accordance with the work done. The management of a hockey team is organised around one game a week (or even two). The development of certain physical parameters is adjusted accordingly and we prepare a weekly schedule. This is clearly different from a national team which works towards one match or one tournament. In those circumstances, the periods between matches are almost exclusively devoted to maintaining performance and therefore to the maximum recovery of all these parameters over a short period of time.

What techniques are used to promote recovery ? O ur approach can be broken down into two strategies. First of all, there is a greater need for recovery between two efforts that come in close succession. For example, when two matches are played in the same weekend (often Friday evening and Sunday). As already indicated, it is not possible to speed up the ‘natural’ recovery period of 48 to 72 hours. But we can use different strategies/techniques to make the athlete feel better. There is the ‘cold strategy’, for example an ice bath or cooling-compression devices. This is how we manage the inflammatory response related to muscle damage. We can also apply the compression technique (e.g. compression stockings), which facilitates venous return and counteracts the intra-tissue pressure/stasis of fluid, which causes discomfort especially in the lower limbs. Active recovery is of course also a possibility. In that case we use low-impact activity performed 24 hours after training. This may include cycling, elliptical trainer or swimming. It allows the body’s own regulatory systems (cardiovascular, hormonal, nervous, etc.) to ‘function’.

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Finally, we also use myofascial release therapy and mobilisation. Through stretching exercises, slow mobilisation and large amplitudes, we work on releasing muscular hypertonicity caused by the inflammatory processes that arise from muscle breakdown (DOMS mechanism). This also allows a mobilisation at the articular and other levels that allow a return to metabolic balance (homeostasis). And there’s also what we call the ‘Time Line’ approach, which is important for ‘natural’ recovery. Emphasis is placed on myofascial release and amplitudes (same technique) and the implementation of preventive strategies (mobility/stability/quality of movement). An enhanced recovery strategy can be implemented individually if the monitoring parameters are not good enough. Hence the importance of monitoring. Active recovery is also part of this accompanying process of natural adaptation. Apart from all these elements, which represent a specific strategy, it is important to note that the most important components of a good recovery are sleep, hydration and nutrition. The latter can be achieved in particular by integrating post-exercise recovery shakes and specific supplements (amino acids, antioxidants, creatine, caffeine, vitamins, etc.).

Are some recovery techniques specifically used in hockey ? There are different techniques used across different sports. However, hockey generates a fairly heavy load on the lower limbs. This is particularly illustrated by the number of injuries to these parts of the body. If we look at the GPS information with regard to the efforts made, we can easily compare hockey with football. However, given the small size of the stick and the large number of movements where the stick has to be placed completely on the ground, we see an even greater strain on the thighs and buttocks. Therefore, the development of these muscles is very important to ensure that they are adapted to the workload. In addition, braking for basic movements (push, flat, flick, etc.) is carried out with the left leg forward. So there is an increased tax on this limb. It is therefore necessary to pay special attention to the gluteal and quadriceps muscles. The adductors and hamstrings are also particularly well looked after, as they are the most commonly injured muscles in hockey. Finally, certain movements, such as the “DragFlick”, are only practised by a few athletes. But when practised intensively, it is a movement that can be very taxing on the body, especially in the hips. We must therefore pay particular attention to these athletes.

Do you also use cooling ? C ooling

strategies are regularly used to help manage the inflammatory processes associated with muscle breakdown. However, scientific studies have shown that the chronic use of these strategies hinders the muscle adaptation we strive for. The inflammatory process that follows the muscle breakdown of the work is what comes before reaching the strengthening we aim for. It is also for this reason that anti-inflammatory drugs (NSAID) are not recommended in the 72 hours after a muscle injury. In efforts that follow in close succession, and where we are looking for ‘comfort’ for the athlete, we use local strategies coolingcompression devices or more global strategies (ice bath or GR Full Leg). The development of whole-body cryotherapy is also an interesting strategy. However, it is more of a systemic approach that focuses less on the lower limbs.

In hockey, unlike in football for example, the players are not constantly at the club. What is the biggest challenge for the medical staff in this regard? I t is rare for clubs to have all the equipment within their infrastructure to organise all the possible care, collective recovery or physical preparation. Therefore, partnerships with local fitness centres are set up, which sometimes causes logistical problems. All the more so because, although more and more players are professionals, many hockey players are still students or have a job in addition to their sport. Strength training therefore often comes down to a programme that the athlete carries out according to his or her individual schedule. As far as the medical/paramedical follow-up is concerned, someone is stand-by during the training sessions. But as far as I am concerned, the most essential care is best carried out in a private practice. Ideally, it should not be far from the club. As for the preventive and other monitoring, outside the testing periods (screening and others), this will be communicated to the athlete in the form of a programme, to be executed individually by each athlete. This will obviously create problems in terms of follow-up, quality, etc. So this approach still involves a lot of compromise. But the gradual integration of professionalism will make it possible to improve all this in the near future. That is for sure.

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photo: Colas Lefevre

Given the limited medical staff within a hockey club, how are injury prevention and recovery programmes developed ? It is clear that in hockey we are still a long way from the number of staff that the big football clubs have at their service. Many football clubs have at least four to seven therapists (doctors, physiotherapists, osteopaths, etc.) to look after one team of thirty players. We are often alone to fulfil all these roles. In our team, we have twenty-seven players and we don’t have a lot of resources for medical assistance. We do this work in addition to our jobs where we really earn our living, and especially because we love the ‘fieldwork’. What particularly appeals to me are all the elements of team assistance that you don’t find in traditional physiotherapy consultations. A more professional framework in hockey is necessary in the near future, especially if we want to further develop performance in the Belgian league. But for that to happen, it is important that clubs can spend more of their budget on high level medical and paramedical support.

In an ideal world, how would you develop the medical environment ? H ockey clubs can rarely count on the significant presence of a doctor. The physical therapist will usually be the front line, often for problems or concerns that are not directly within his field of expertise. A greater ‘medical presence’ is therefore required. In addition, every club should be able to employ at least someone part-time to ensure the adequate follow-up of injuries, but also to be proactive in developing strategies for control and prevention. Subsequently, this professionalism should also be developed in the national youth teams as well. A professional framework often comes too late, when the athletes are already between 19 and 21 years old. This should actually be three or four years earlier. In this way, young talented hockey players will arrive at the national senior teams much better prepared. Finally, the infrastructures within the clubs (areas for physical preparation and rehabilitation) must be such that they allow us to gradually recover from an injury until we return to action. This is a great challenge for clubs that currently do not have the financial means or the space to realise this.

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PH YSI OT H ER APIS T- OS T EO PAT H O F R OYAL V I C TO RY H O CK E Y CLU B FA N I O N T E A M D1/ H1

“Athletes need to be made more aware of the importance of injury prevention” – Francis Weyts –

After graduating in 1984, Francis Weyts specialised in sports medicine, manual therapy and movement analysis. Over the years, many more specialisations and diplomas were added: Oriental medicine, osteopathy, endermology and psychosomatics. Weyts has twentyfive years of experience in gymnastics and acrobatics under his belt. In addition, he has been working with dancers and various sportsmen and women in the field of anatomical assistance for about 30 years. Today he is also the physiotherapistosteopath of Royal Victory Hockey Club Fanion Team D1/H1. The right specialist, therefore, to ask a few questions about injury prevention and treatment in hockey.

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Mr Weyts, in your experience, what are the most common injuries among hockey players? I n the first place, strains in the groin or adductor muscles, whether or not in combination with an injury to the hamstrings (remarkably more on the left than on the right). Back problems are also frequent, more specifically at vertebrae D12-L1, the rotation point of the spine and the place where the blood flow to the hips starts, as well as the nerve endings of the oblique abdominal muscles and adductors at the pubis. There are also frequent problems in the lower back, with discopathy L4-5-S1 and SIG problems. This is mainly due to the hunched posture of hockey players and not always the right technique on the ball when running and dribbling. It is very important to learn this in time, so that this is mastered well during growth. Ankle distortion and sagging feet are also common among hockey players. The latter also causes problems at knee level due to torsion between the calf bone and the tibia. Finally, we are also often confronted with wrist instability due to the many wrist movements and other impacts. This leads to a strain of the ligaments of the wrist, which in time will result in a cyst, tendonitis or instability.

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How are these injuries treated ? We

treat acute problems locally, often opting for ‘microcurrent’ (Bioenergetic-Stimulation or B-E-St), classic massage techniques, mobilisations or dry-needling. We also like to work with Normatec’s recovery pants, Hyperice’s massage shotgun, massage ointment or andullation therapy, an alternative healing method that uses mechanical vibrations in combination with red and infra-red light to stimulate the body’s cells and thus bring about pain relief and relaxation. Of course, everything starts with injury prevention, which includes a good recovery. We want athletes to be aware of this, because prevention is still the best cure! The specific exercises we will apply in that context are in function of the cause of the injury and individual need. The combination of agility, coordination, flexibility, strength and reaction speed is what is aimed for with this.

What is a normal rehabilitation period for this kind of injury ? The rehabilitation period obviously depends on the type of Injury. In case of muscle tears, we talk about one week per centimetre of tear and this up to three centimetres, after that it is about five to six weeks. This period is also used to work on other ‘weaknesses’, provided that the injury is not compromised. Keeping the athlete engaged during rehabilitation optimises the healing process and creates an active process in which the athlete becomes more aware of his own body. Another important fact: the better the basic condition, the easier rehabilitation will be.

You mentioned that injury prevention is very important. How does this go in practice? A gility, coordination, flexibility, strength and reaction speed are, so to speak, the building blocks of a healthy athletic person. At our club we have started a screening / basic check of the youth players who are in their puberty. This age group is in the danger zone when it comes to injuries. During puberty, the body is constantly changing, both in terms of growth and strength, and this can cause various injuries. The screening of these youth players gives us a kind of passport with possible weaknesses, or ‘risks’ if you want. On this basis, we can draw up a work schedule. B-Gold, the programme that prepares youth players for integration into the Senior National team, also uses this method for the selected players. In my humble opinion, it would not be bad to collect all this information, also with the cooperation of other clubs. This will allow us to identify the different injuries and gain a better understanding of the strain of this sport. And if I may give you one last tip: visiting an osteopath three to four times a year can also prevent a lot of trouble, especially in the back and pelvic area.

Do you have a standard protocol for treating hockey players ? We use a basic SpartaNova protocol, which is a spin-off of UGent and VUB and specialised in prevention, rehabilitation and training. It is based on the following pillars: lower limb strength, hip and pelvic flexibility, core/leg stability, dynamic balance and alignment. As mentioned earlier, cooperation between the clubs and B-Gold could provide a broader platform. We could work with different physiotherapists to draw up exercise schedules that we could give to the athletes, as well as make appointments and exchange thoughts on rehabilitation and so on.

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When is a player ready to play again after an injury, and who decides ? I

think a player should be able to train fully with the team for at least two training sessions. After that, if we are talking about someone who plays in the first team, he or she can play a match with the second team. A number of aspects are then monitored which may tell us whether or not they are ready. The physio, together with the rest of the medical staff, can then decide whether the player is ready for the real thing again. If there are still minimal risks or problems, a decision about the number of playing minutes can be made in consultation with the coach. The physiotherapist and the rest of the medical staff are there to make and keep the players fit to play. They identify possible risks and try to take preventive action. For example, we can help the players with taping, manipulation of the back or limbs and loosening of the muscles. We also insist on a good warm-up and cool-down, as well as dynamic stretching before the game and static stretching afterwards. As you can see, injury prevention is always the focus!

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FO RWAR D AND C AP TAIN O F T HE R ED LI O NS

“I always try to be on the top of my game.” – Thomas Briels –

homas Briels has been valuable asset on the Red Lions, the Belgian national hockey

team, for several years. The forward and captain of the Red Lions already has some nice trophies to put on display: silver at the Olympics in 2016, gold at the World Cup in 2018 and gold at the European Championship in 2019. In a club context, Briels defends the colours of the Dutch Orange-Red. Thomas: How did you get into hockey ? M y grandmother started playing hockey at Royal Antwerp Hockey and she won the Belgian championship with them. Afterwards, she founded the first women’s team at KHC Dragons. My mother and my uncles also played hockey. So you could say that it is in my blood. At the age of four, I started playing hockey with my brother and sister - we are triplets - at KHC Dragons. I played for all the youth teams there and played in the first team for the first time at the age of 17. I was also selected for the national U18 and U21 teams and at the age of 19 I was in the Red Lions’ selection for the first time. Since then, I have always played for my country with great pride.

Injuries and lesions are of course part of every sport, especially at top level. How do you cope with that ? A fter the training sessions, there is always a physio present who we can turn for minor and major ailments, such as stiffness. I always try to be on the top of my game. If I feel anything at all, I seek professional help as soon as possible. Touch wood, but I have never been very badly injured myself. What I also find very important is injury prevention. There are weeks when we have eight or even more training sessions to digest, and that is of course taxing, but there is also a real risk of injury. So the strength and stretching exercises we do are not just there to make us stronger and more flexible. They are also very important for injury prevention. As we travel across the continent, we also regularly encounter extreme temperatures. Drinking plenty of fluids is the first order of business, but good cooling is also essential. We do this mainly by using cooling vests, primarily when we are sitting on the bench during a match. In this way, we keep our body temperature more or less under control.

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What do you consider an ideal recovery after training or competition ? When we play a tournament, the matches follow each other in rapid succession. In that case, adequate and correct recovery is of great importance. After we have talked to the press, if necessary, we drink a recovery shake. Some players also wear compression socks or take an ice bath. Many studies have been conducted on ice baths, which either confirm or reject its usefulness. An ice bath is often a mental issue, which is why not all players are fans of it. Electrostimulation is another thing, not everyone wants it. For me, the ‘old method’ also still works: walking out and stretching. Recovery is actually something that players cope with in a very individual way. Above all, I swear by a good diet and a good night’s sleep. I try to be as fit as possible and stay mentally fresh. Very important! We often train twice a day. Sleep is of great importance for recovering after strenuous exercise and also for being able to perform again the next day.

What do you think the perfect medical environment looks like and can it be improved ? We certainly cannot complain about that at the moment. We are very well looked after! Of course, hockey does not have the same financial resources as, say, football. Often there is only one physiotherapist for 18 players, which I think is not enough. But this is purely about money, not the know-how of the medical staff at our disposal. I play in clubs in the Netherlands and people sometimes ask me if there are differences between the two countries in this respect. Not very much, I have to say. You can compare it somewhat. Playing for a club or for the national team are, of course, two different things. We are together at different times, more or less, for different periods of time, we peak in a different way and there is a different staff. I just think it is important that there is good communication between the medical staff and the players. Players must quickly indicate how they are feeling or what they are feeling, and the staff must communicate openly about this. In addition to peaking more towards a particular match moment, everything in the national team also happens more as a team. That makes sense, because we are together for a longer period of time, especially during tournaments. For example, we go together to the weight room or the gym. At the club, the approach is more individual. Players spend more time individually with a trainer or physio. For example, strength training may be facilitated.

Sports in times of corona. How did you train at times when contact with team mates was not possible ? During the lockdown, the federation very quickly decided to strictly follow the government guidelines. This is only natural, as our health comes first. There were no more group training sessions, only individual running sessions where we did not come into contact with other people. Fitness materials were also sent to the players so that we could do strength training at home. We tried to deal with the situation in a creative way. Still, we hope that a real lockdown will never happen again! Do you know that we have even done our bit in the fight against the virus? Several hockey players worked as telephone volunteers for the citizens’ platform Covid-Solidarity.org. In this way, we helped people who live in social isolation. I got a man on the phone who was lonely and wanted to tell his story. I did not say who I was, but let him tell his story. I liked that very much.

As a top athlete, you often have to live like a priest. Have you ever thought to yourself: “ This is far too big a sacrifice, I want to be a normal guy! ” ? I’ ve had that feeling from time to time, especially when I’m in a heavy training period and need to be ultra-disciplined for a long period of time. But eventually it becomes a kind of routine for me. I know I cannot go out with friends very often because I need to rest and recover properly. This is the only way I can continue to play hockey at the same level. That makes the choice easy! A long holiday is not always an option for me, as we regularly have training camps and tournaments with the national team. On the other hand, of course, I get a lot in return. I do what I love to do and I also travel around the world. A top-class sporting career is just a small part of your whole life, so I try to enjoy it as much as I can. And if, in the end, I reach a big goal together with my team mates, then all those sacrifices were well worth it.

Finally, do you have any advice for young talented hockey players ? First of all, you must have the right mindset: always want to be better! However, you should never set your expectations unrealistically high. Keep realistic goals in mind and take things one step at a time. I also told you that I had few or no injuries myself. I think this is because I always take the best care of my body, including a healthy diet. From the age of eighteen I was often in the gym and that certainly helped too. Moreover, you have to realise that as a professional hockey player, you can earn a nice salary, but above all, there is a life after hockey. Retirement is not yet on the cards for most of us. Combine your favourite sport with studies, even if it takes you longer than usual. Think well in advance about your life after hockey!

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M E D I C A L S TA F F R E D L I O N S / O S T E O P AT H

“The right balance of recovery and performance can take your body to a higher level.” – Julien Rysman –

J ulien Rysman (45) is an osteopath with a lot of hockey

expertise. From an early age, he has had an outspoken preference for all things medical and scientific. The choice of his studies and career was always guided by finding a balance between sport and his professional activities. In 2000 - with a recently earned degree from ULB in hand - he joined the medical staff of football club RSC Anderlecht, where he stayed for four years. He left because he wanted to focus more on his family life and because he wanted to start his own practice. Rysman became an assistant in osteopathy at ULB and signed a contract with the Royal Hockey Club Leuven, where he remained until 2016. Then he joined the staff of the Red Lions, who had just won a silver medal at the Rio Olympics.

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Mr Rysman, you are treating players from different clubs, with each club having its own training techniques and medical staff. How do you build a physiotherapy protocol that can be applied to everyone or is everything worked out individually? G ood cooperation and communication is very important.” That is why we have regular contacts with colleagues at the various clubs during the season. Meetings are organised, where we try to develop common therapeutic strategies. Players with injuries receive specific treatment, depending on the particular injury, of course. The club’s physiotherapist and I then alternate treatment, depending on where the player concerned is at the time. This is the only way we will be able to deal with it properly. If a player suffers an injury during a game or tournament with the Red Lions, it is of course my responsibility. I am always with the group, no matter where in the world. When a player is injured, my hands immediately spring into action. And I will not take my hands off until the injury is completely resolved!

Are recovery techniques after an international match significantly different from those at national matches and what is your protocol ? T here will be differences, of course, but by and large everything is about the same. In tournaments, of course, the sequence of matches and the limited time between matches must be taken into account. During a world championship or at the Olympic Games, the last matches - e.g. the semi-final and final - are often played in quick succession. So quick recovery is the message here. The right balance of recovery and performance can take your body to a higher level. We have a very precise and individualised rehabilitation protocol for each player according to his habits and preferences. Active, passive and also nutritional techniques are used to recover as quickly as possible.

Passive and active techniques, you say... A ctive

recovery is best achieved with an activity in which you use the same muscles as during the activity in which you experienced muscle fatigue or soreness. This means that you should do a cooling down, preferably in a related form of the sport in which you have been training. In addition, several scientific studies show that training the muscles in the upper limbs in the gym (with appropriate loading) helps recovery in the lower limbs (through the hormonal boost). Passive recovery is, of course, resting and allowing your body to recover. And then, of course, you have the fuels and building materials that need to be replenished. Proteins, responsible for fast recovery, and carbohydrates - the energy supplier should be taken soon enough after exercise for the recovery process to begin. And meanwhile not forgetting to keep the fluid intake at the required level.

“ Active recovery is best achieved with an activity in which you use the same muscles as during the activity in which you experienced muscle fatigue or soreness ”

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What is your experience with cooling as a recovery tool ? T hese techniques are very useful. We know that immersion baths have proven their worth in scientific literature, but ice baths are also used (a cold bath in the hotel room also works very well, by the way). Cooling compression devices are also used for more localised applications in case of tissue damage. A cooling-compression device combines ice therapy and compression therapy in one user-friendly device. The ice water circulates quickly through the bandages and combines with compression. This combination provides a better therapy for musculoskeletal disorders. Besides relieving symptoms such as pain and swelling, Game Ready stimulates natural tissue healing and actually speeds up recovery.

The players of the Red Lions regularly play matches in regions where the temperatures are very high. How do you ensure that they (literally) keep their cool? T here are different methods and through our partners Sport Vlaanderen and Adeps we have the latest technologies at our disposal. We also exchange a lot of information with the other therapists of Team Belgium of the Belgian Interfederal Olympic Committee during our webinars. Vincent Callewaert always presents us with the latest scientific publications and recovery techniques. I will keep our methods as secret as possible. What I can say is that we use cooling clothes, cooling vests and ice water tanks to put towels in during games or training sessions to cool down the most important areas such as the neck, the hollows of the knees, the groin area and especially the inside of the elbow.

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PROJECT MANAGER INJURY PREVENTION GET FIT 2 SPORT

“Most injuries recorded by doctors are sports injuries” – Sandra Lievrouw –

Sandra

Lievrouw - Master of Rehabilitation Sciences and Physiotherapy - has been active as a sports physiotherapist at various sports clubs and associations for many years. With the wisdom of 'Our bodies are built to move' in mind, she specialised further in manual therapy, myofascial therapy and in injury prevention. As a practical assistant in the programme of Rehabilitation Sciences and Physiotherapy at the University of Ghent, she developed an interest in communication and education. Since 2019, Lievrouw has been working at Gezond Sporten Vlaanderen as a project manager for injury prevention (Get Fit 2 Sport). For example, she supports the policy of healthy sports at sports federations and clubs.

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Mrs Lievrouw, could you please explain exactly what the 'Get Fit 2 Sport' project is ? This programme is a primary injury prevention programme, developed by the Movement and Sports Sciences department at UGent, under the direction of Professor Dirk De Clercq. It aims to improve the implementation of primary sports injury prevention among young athletes in Flanders. Gezond Sporten Vlaanderen has taken the initiative to provide the various federations and clubs with support in this programme and to organise the necessary training courses. All this aimed at a continuous focus on the implementation of injury prevention.

What is the importance of this programme for the sport of hockey ? M ost injuries recorded by sports physicians and General practitioners in Flanders are sports injuries. On average, one hundred Flemish athletes suffer 12.9 injuries annually, according to an estimate. The total annual cost of sports injuries in Flanders is estimated at more than EUR 125 million. Injuries should therefore be avoided as much as possible and the creation of a safe and responsible sporting context is one of the basic tasks of the sports trainer/teacher. This can be done by implementing injury prevention. As a sports trainer/teacher you can set a good example so that (young) athletes adopt the right attitude for the rest of their sports career. Moreover, a previous injury is the most important risk factor for further sports injuries. Therefore, if we can prevent sports injuries in the present, we also ensure that there will be less risk of sports injuries in the future. You can imagine that all this also has an impact on the performance of the athlete and the team. The ‘Get Fit 2 Sport’ programme - developed by order of the Flemish Minister of Sport - is tailored to nineteen sports, including hockey. For its application in the field, a top-down waterfall structure was set up. Get Fit 2 Sport is a two-time three-hour refresher course for trainers or sports coaches, organised by the relevant sports federation and a trained mediator.

What can hockey (trainers, players, assistants ...) and possibly physiotherapists rely on ? G et Fit 2 sport is, as mentioned, a primary injury prevention programme. So we are going to take preventive action before there is an injury. In most sports, this is considered a task for the trainer. After all, he or she accompanies the athletes on a regular basis - sometimes daily. The dissemination of the knowledge takes place through two important channels: the future trainers and sports coaches get acquainted with the Get Fit 2 Sport programme during their training trajectory through, for instance, the Flemish Trainers School and, in addition, certified trainers or interested sports coaches (including physiotherapists) can follow an additional training. These people are taught how to integrate sports injury prevention in their training sessions or lessons in a scientifically based manner.

Is the response from the different sports sufficient ? Unfortunately, I cannot give you the exact figures. The in-service training for qualified trainers is organised by the sports federations. It is also true that the Get Fit 2 Sport programme is part of various courses (V TS, UGent, ...) so that there is no real ‘response’, because the knowledge is offered in the course. During the project at UGent, however, research was carried out into the implementation of the programme in the period 2016-2018. By the end of 2018, it is estimated that more than 75,000 young athletes have been reached through the 3354 mediators trained by Get Fit 2 Sport. The implementation of sports injury prevention strategies among these young athletes by the mediators was high (application in more than half of the sports activities). Moreover, not only did this application increase significantly after the mediators had attended the in-service training, it also remained at such a high level for months afterwards.

How do you see this initiative evolving in the future ? A t Gezond Sporten Vlaanderen, we want to continue to encourage and support the implementation of primary injury prevention. At the moment, Healthy Sports Flanders is busy developing a tool to make the knowledge on primary injury prevention interactively accessible to all trainers and sports coaches, regardless of their level of training and sports discipline. We are still in the design phase, so unfortunately I cannot communicate very concrete information yet. But as you can see, we are certainly not standing still!

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THERAPEUTIC MAGAZINE

SPOR T PODIAT R IS T

“Above all, we want to make sure that the hockey player feels connected to the ground.” – Paul Griffin –

Australian podiatrists Simon Barthold and Paul Griffin developed an innovative shoe tailored to the sport of hockey for the Belgian-based hockey brand Osaka: the Ido Mk1. Tests in the Belgian Runners' Lab showed that this shoe offers numerous advantages for hockey players. We caught up with Paul Griffin, who explains what makes the Ido Mk1 so special.

Hockey issue 1 2021

Mr Griffin, why is a good sports shoe so important ? A thletic footwear is an essential part of sports equipment that can have an impact on a number of areas, such as player comfort, performance and possible injury prevention. The ‘holy grail’ is conceptualising and developing for better performance, reducing the risk of injuries and increasing the athlete’s self-confidence. However, we should not blindly and exclusively link sports shoes to injury prevention. After all, injuries are a very complex matter, with various influencing factors.

In what ways does the hockey shoe you have designed differ from other sports shoes ? D eveloping

sports shoes requires a very good knowledge of the mechanics of the foot and the lower limbs, combined with an understanding of the game of hockey and the unique movement patterns involved. Hockey has never received the attention it deserves in terms of footwear. Players often resort to using ‘trail running shoes’, mainly because of some common features such as grip. Behind these shoes, however, is a completely different idea. For example, they are specifically designed for undulating terrain with varying density, where hockey is played on a flat, consistent surface. Hockey also requires more attention to dexterity patterns, such as sharp changes of direction when moving at speed or running backwards. We make the difference by putting these nuances into design, engineering and material science. The Ido is the very first hockey shoe to have a durable anatomic structure. The shoe is built around the shape of the foot. The impact on the athlete’s comfort and performance is considerable. In hockey we want to make sure that the hockey player feels connected to the ground. We can significantly increase performance and reduce the risk of injury by reducing related joint moments. This, combined with a strategic decoupling of the midsole, ensures that the foot can work optimally. This conclusion was confirmed during our tests at Runners’ Lab, where we compared competitors’ hockey shoes with the Ido. The results were very positive!

And what is the feedback you get from the users ? T here are other features that subtly alter shoe behaviour, such as rounded outsole edges and smart midsole geometry that affect joint kinematics. Recently I had contact with the chairman of a big club in Australia, who also used to play hockey at a high level and is still active today. He told me that thanks to the Ido, he had been able to play without knee pain for the first time in three years. The light weight and exceptional grip are also strong assets, according to him. All users note that the shoe feels different, but in a good way. And to be honest, we would be disappointed if it felt the same as any other ‘hockey shoe’. This reflects our efforts to build the 1% factors into the shoe.

What future plans are there on the work table ? T here is no doubt about it: we have set the new benchmark! Other brands will take up to two years to catch up with us and we already have some interesting things in the pipeline for next year. Our mantra ‘the athlete comes first’ still carries the most weight in our design, concept and development decisions, and we will work closely with our users to ensure that we maintain our lead over the rest of the pack.

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R&D TEAM NAQI®

“Good circulation is crucial for injury prevention and recovery.” – Greet Claes, MSc (Dentistry), DDs (Dermato-Cosmetic Sciences) Head of R&D NAQI® & Delphine Verbeke, MSc (Science Biochemie), Assistent R&D NAQI® –

Can NAQI® contribute to injury prevention ? E specially

Delphine Verbeke

when it is cold, we can play an important role here. In cold weather, we want to keep our core temperature constant and constrict the blood vessels to lose as little heat as possible. Heat loss depends on the exposed body surface, speed (including wind: the more there is, the more heat is lost) and humidity (wet skin loses 25% more heat than dry skin). The delayed circulation in arms and legs is disadvantageous during sports, as less oxygen is supplied. Muscles warm up more slowly and are less supple, which reduces performance and increases the risk of injury. Warming products counteract this vasoconstriction but without a protective film they increase the heat release. Our warming up and protective ‘Warming Up Competition’ lipogels help with this. As soon as rain or mud hits the skin, it will draw extra heat away from the body. If you use a heating product that contains water, this will also improve heat conduction and you will have an even greater release of heat. NAQI lipogels do not contain water, making them the ideal protection against heat loss and passive warming up of the muscles for outdoor sports in low temperatures and damp weather conditions. A protective oil film on the skin slows down cooling.

Hockey issue 1 2021

Good blood circulation is what matters most ... T hat’s right. And blood flow plays an important role again after the exercise. Good circulation means a faster supply of nutrients and better elimination of waste products. This will speed up recovery. Micro-trauma in the muscles always occurs during intensive exercise. These are microscopic damages in your muscles when you strain them. Usually you will start to feel the beginning of that muscle pain 24 to 48 hours after an effort. These micro-traumas need to be repaired by, among other things, a good blood circulation, so that the reconstruction of the muscles is faster. ‘NAQI Recovery Gel’ can certainly be a help for this. It reduces muscle fatigue and stiffness after exertion. The gel relaxes tired muscles after exercise, improves blood circulation and thus increases the supply of oxygen and nutrients to the muscles. As a result, the waste products in the muscles are removed faster and you recover faster after an intense workout.

Can cooling also contribute to this process ? D efinitely, but especially after sports, and especially in hockey. Hockey is a sport that often involves bruises, sprains and swelling. In those cases, cooling can relieve the pain

What problems can arise when using products that help prevent injuries and recover ? T he greatest danger, of course, is using the wrong product. As I said, heating products that contain water will cause even more heat loss in cold conditions. So they are going to have the opposite effect and be anything but protective. Using too many warming products is not ideal either. It can lead to skin irritations, to which some people are more sensitive than others. That is why we work with three numbers at the NAQI® Warming Up Competition: 1, 2 and 3. The intensity of the product increases with a higher number.

RECOVERY GEL FOR A QUICK RECOVERY ✔ Reduces muscle fatigue, stiffness and cramps ✔ Improves the circulation and reduces waste materials ✔ Lightens heavy legs ✔ Cooling and analgesic effect

NAQI® RECOVERY GEL helps reduce muscle fatigue and stiffness after physical activity! While exercising, the muscles are put under great pressure. This can result in a feeling of heaviness and fatigue, and even muscle pain. The NAQI® Recovery Gel has been developed to alleviate this heaviness and discomfort, a cream with a unique effect on recovery after a sporting effort. NAQI® Recovery Gel promotes good blood circulation, which, in turn, boosts the supply of nutrients, the removal of waste products and muscle relaxation. Rubbing in Recovery Gel relaxes the muscles and stimulates the blood flow In addition, NAQI® Recovery Gel contains various ingredients which have a positive influence on blood circulation and a calming effect on the muscles. By combining these ingredients into a cream that is applied to the skin, this product has a direct effect on the muscles. NAQI® Recovery Gel thus relieves the heavy, tired feeling that follows exertion. THERAPEUTIC MAGAZINE 44

SPORTS LOTIONS

EXPERIENCE THE EXCEPTIONAL

✔ apply after sports

Airless Bottle

easy-to-use

Use: Rub into the skin immediately after sports. NAQI® Recovery Gel is easily absorbed, nongreasy and has an intense and prolonged effect. Stimulates blood flow & increases the supply of nutrients and oxygen to tired muscles.

Packaging: 100 ml • 500 ml www.naqifoundation.com 45

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Appendix

Table 1 CHARACTERISTICS OF PROSPECTIVE STUDIES ON FIELD HOCKEY INJURIES: Study (country) Weightman and Browne 1975 (UK) [11] Clarke and Buckley 1980 (USA) [13]

Setting and follow-up period

Description of field hockey players

Survey injuries in 11 selected sports

Season (8 months)

Men (25 clubs) and women (36 clubs). Number, age, and level NR

Preliminary overview of injury experiences among collegiate women athletes reported to the National Athletic Injury/ Illness Reporting System during its first 3 operational years

Season (3 years)

High-school women from annual average of 16 teams. Number and age NR

Zaricznyj et al. 1980 (USA) [12]

Analyze causes and severity of sports injuries in a total school-aged population

School season (1 year)

65a school-aged players (5–17 years)b. Number and sex NR

Mathur et al. 1981 (Nigeria) [15]

Determine sites and types of common injuries associated with competitive sports popular in Nigeria

Season (8 weeks)

212 players. Sex, level, and age NR

Rose 1981 (USA) [14]

Describe women’s field hockey injuries at the California State University in Long Beach

Season (4 years)

University women. Number and age NR

Martin et al. 1987 (USA) [16]

Detail injury experiences of 1985 Junior Olympics

1985 Junior Olympic games (7 days)

53 women. Age NR

Jamison and Lee 1989 (Australia) [18]

Compare injuries during Australian Women’s Hockey Championships, 1984 (on grass) and 1985 (on Astroturf)

Championship (2 years)

110 women playing at Australians’ state teams. Age NR.

McLain and Reynolds 1989 (USA) [17]

Investigate sports injuries at a large high-school

School season (7 months)

46 high-school women. Age NR

Competitive season (2 years)

Women. Number, level, and age NR

Fuller 1990 (Country NR) [19]

Primary objective

Study whether a characteristic pattern of injuries and their causation existed at county and territorial competition levels in women’s field hockey on synthetic turf pitches

Cunningham and Cunningham 1996 (Australia) [20 ]

Obtain data relating to frequency, type, mechanism, severity of sports injuries incurred during or related to competition

1994 Australian University Games (6 days)

466c university players, aged 17–47 years. Sex NRb

Fawkner et al. 1999 (Australia) [22]

Examine relationship between hassles and athletic injury

Season (13 weeks)

26 professional women aged 26 years on averageb

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ARRANGED BY YEAR OF PUBLICATION (LEAST RECENT TO MOST RECENT) Injury definition (summary)

Injury data collection

Sport clubs’ secretaries form

117

Average TL. Women: 1.5 days; Men: 6.5 days

An injury causing the athlete to miss at least 1 week of participation (≥ 1 week TL)

Athletic trainer injury report form

TL and consequences: [3 weeks: 23%; Surgery: 5%

Any traumatic act against the body sufficiently serious to have required first aid, school and insurance accident reports, or medical treatment (MA)

Principals, coaches, sport supervisors, ERs, school insurance company, local physician’s injury form

Injury type and consequences (NR)

Athlete self- report questionnaire

641

Minor injury: required MA of team physician in some cases but handled mainly by the trainer and produced no or limited disability. Major injury: required MA of team physician and produced definite disability needing follow-up care (medical/trainer attention)

Injury type and consequences. Minor: 82.7%c; Major: 17.3%c

Injuries severe enough to withhold athlete from competition, at least temporarily, and to require formal medical evaluation by the trainer (medical/trainer attention and TL)

Medical staff report form

15.1% (8)

Tissue damage. Outcome NR

Athletes self- report questionnaires

178

Athletic trainer injury evaluation sheet

6%(3)

Average TL: 3.3 days

Any incident resulting from athletic participation that keeps athletes from completing a practice or game or causes athlete to miss a subsequent practice or game (TL)

Injured players

Number of injuries

Severity of injury

Presence of pain, discomfort, or disability arising during or as consequence of playing in a hockey match and for which physiotherapy treatment, advice, or handling was given (MA)

Researcher observation and contact with athletes

135

TL. ≤ 2 days: 90%; >2 days: 10%

Any incident during warm-up or competition that required MA, on-field management to enable continued participation, or removal from the playing field (MA)

Attending officer injury surveillance form

33.5% (156)

181

Required treatment and injury outcome (NR)

Medical problem resulting from either participation in training or competition, required MA, and restricted further participation in either training or a competition for at least 1 day post occurrence (MA and≥ 1day TL)

Coach recording form

23% (6)

THERAPEUTIC MAGAZINE

Table 1 CHARACTERISTICS OF PROSPECTIVE STUDIES ON FIELD HOCKEY INJURIES: Study (country)

Primary objective

Powell and Barber-Foss 1999d (USA) [21]

Describe injury patterns in ten high school sports

Setting and follow-up period

Description of field hockey players

Season (2 years)

High-school women, number, age NR

393 non- professional men (170) and women (223) aged 25 years on average

Stevenson et al. 2000 (Australia) [23]

Describe trends in recreational sports injury in Perth, Western Australia

Winter season (5 months)

Finch et al. 2002e (Australia) [24]

Describe incidence of injury over two consecutive sporting seasons in a prospective cohort of community-level sporting participants within Australian football, hockey, basketball, netball

Two consecutive winter seasons (10 months)

280 non- professional men (116)c and women (164)c aged 25 years on average

Junge et al. 2006 (Greece) [25]

Analyze and compare incidence, characteristics, and causes of injuries in all team sport tournaments during 2004 Olympic Games

2004 Olympic Games (19 days)

Olympic men and women. Number and age NR

Dick et al. 2007f (USA) [28]

Review 15 years of NCAA injury surveillance data for women’s field hockey

Season (15 years)

5385 high- school women. Age NR

Hootman et al. 2007f (USA) [26]

Summarize 16 years of NCAA injury surveillance data for 15 sports

Season (15 years for field hockey)

5385 high- school women. Age NR

Rauh et al. 2007d (USA) [27]

Determine patterns of new and subsequent injuries among female athletes participating in interscholastic sport

Season (2 years)

High-school women. Number and age NR

Junge et al. 2009 (China) [30]

Analyze frequency, characteristics, and causes of injuries incurred in competitions and/or training during 2008 Olympic Games

2008 Olympic Games (16 days)

382 Olympic men and women aged 26 years on averageb

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ARRANGED BY YEAR OF PUBLICATION (LEAST RECENT TO MOST RECENT) Injury definition (summary)

Injury data collection

(1) injury causing cessation of participation in current game or practice and prevented player’s return to that session, (2) injury causing cessation of a player’s customary participation on the day following the day of onset, (3) any fracture, even though athlete did not miss any regularly scheduled session, (4) any dental injury, including fillings, luxations, and fractures, and (5) any mild brain injury requiring cessation of player’s participation for observation before returning, either in current or next session (MA or ≥1 day TL)

Athletic trainer injury form

(445)

510

TL. <8 days: 79.6%; 8–21 days: 13.3%; >21 days: 7.1%

Assisted telephone interviewing with athletes

28% (198)

279

Injury treatment (NR)

One that occurred while participating in sport and that led to reduction in the amount or level of sport activity and/or need for advice or treatment and/or adverse economic or social effects (TL or MA and/or adverse economic/social effects)

Assisted telephone interviewing with athletes

31% (87)

445

Injury treatment (NR)

Any physical complaint incurred during the match that received MA from the team physician, regardless of the consequences with respect to absence from the match or training (MA)

Physician injury report form

Estimated TL. None: 50%c; 1–3 days: 27.3%c; 4–7 days: 9.1%c; [1 month: 2.3%c; Unspecified: 2.3%c; Missing: 9.1%c

Injury occurring while participating in sport and leading to one of the following consequences: reduction in amount or level of sports activity, need for advice or treatment, and/or adverse economic or social effects (TL or MA and/or adverse economic/social effects)

One that (1) occurred due to participation in an organized intercollegiate practice or competition and (2) required MA by a team-certified athletic trainer or physician and (3) resulted in restriction of the student athlete’s participation or performance for 1 or more calendar days beyond the day of injury (MA and ≥ 1 day TL)

One that (1) occurred as a result of participation in an organized intercollegiate practice or competition and (2) required MA by team-certified athletic trainer or physician and (3) resulted in restriction of the student athlete’s participation or performance for C 1 calendar days beyond the day of injury (MA and C 1 day TL) (1) Any injury causing cessation of participation in current game or practice and prevented player’s return to that session; (2) any injury causing cessation of player’s customary participation on the day following the day of onset; (3) any fracture, even though the athlete did not miss any regularly scheduled session; (4) any dental injury, including fillings, luxations, and fractures, (5) any mild brain injury requiring cessation of player’s participation for observation before returning, either in the current or next session (MA or ≥ 1 day TL) Any musculoskeletal complaint newly incurred due to competition and/or training during the XXIXth Olympiad in Beijing that received MA regardless of consequences with respect to absence from competition or training (MA)

Injured players

Number of injuries

Severity of injury

Athletic trainer injury report form

3286

>10 TL days. Game injuries: 15%; Practice injuries: 13%

Athletic trainer injury report form

3286

>10 TL days. Game injuries: 15%; Practice injuries: 13%

Athletic trainer injury form

(445)

510

TL.< 8 days: 79.6%; 8–21 days: 13.3%; > 21 days: 7.1%

Physician injury report form

20.4% (78)

Estimated TL: 3.5% of players

THERAPEUTIC MAGAZINE

Table 1 CHARACTERISTICS OF PROSPECTIVE STUDIES ON FIELD HOCKEY INJURIES: Primary objective

Study (country) Rishiraj et al. 2009 (Canada) [29]

Description of field hockey players

Setting and follow-up period Season (5 years)

Identify rates, profiles, and severity of injuries associated with participating in under-21 age representative field hockey team

75 women aged 18 years on average representing BC Women’s Field Hockey Federation

Engebretsen et al. 2013 (UK) [31]

Analyze injuries and illnesses during 2012 Olympic Games

2012 Olympic games (19 days)

388 Olympic men (196) and women (192). Age NR

Theilen et al. 2016 [multiple countries (Table 3)] [32]

Investigate incidence and severity of injuries during international field hockey tournaments in 2013

16 International Hockey Federation tournamentsg

Professional men and women. Number and age NR

Table 2 Study

RISK-OF-BIAS ASSESSMENT OF STUDIES ON FIELD HOCKEY INJURIES ACCORDING TO TEN CRITERIA Criteria

Score 2

Weightman and Browne 1975 [11] 0 1 0 0 1 0 1 0 1 1 5 Clarke and Buckley 1980 [13] 1 1 1 0 UD 1 1 1 1 1 8 Zaricznyj et al. 1980 [12] 1 1 1 1 1 0 0 0 1 1 7 Mathur et al. 1981 [15] 0 1 0 0 UD 1 1 0 0 0 3 Rose 1981 [14] 1 1 1 0 UD UD UD 0 1 0 4 Martin et al. 1987 [16] 1 1 1 1 1 1 1 1 0 0 8 Jamison and Lee 1989 [18] 0 1 1 0 1 1 1 0 1 0 6 McLain and Reynolds 1989 [17] 1 1 1 0 1 1 1 1 1 0 8 Fuller 1990 [19] 1 1 0 0 UD 1 1 0 1 0 5 Cunningham and Cunningham 1996 [20] 1 1 1 1 UD 1 1 0 0 0 6 Fawkner et al. 1999 [22] 1 1 1 0 1 0 0 0 0 0 4 Powell and Barber-Foss 1999 [21] 1 1 1 0 UD 1 0 1 1 1 7 Stevenson et al. 2000 [23] 1 1 1 1 0 1 1 0 0 1 7 Finch et al. 2002 [24] 1 1 1 1 0 1 1 0 1 1 8 Junge et al. 2006 [25] 1 1 1 1 0 1 1 1 0 1 8 Dick et al. 2007 [28] 1 1 1 0 UD 1 1 1 1 1 8 Hootman et al. 2007 [26] 1 1 1 0 UD 1 1 1 1 1 8 Rauh et al. 2007 [27] 1 1 1 0 UD 1 0 1 1 1 7 Junge et al. 2009 [30] 1 1 1 1 1 1 1 1 0 0 8 Rishiraj et al. 2009 [29] 1 1 1 0 UD 1 1 1 1 1 8 Engebretsen et al. 2013 [31] 1 1 1 1 1 1 1 1 0 0 8 Theilen et al. 2016 [32] 1 1 1 1 1 1 1 1 0 1 9 Total, n(%) of studies 50

19 (86)

22 (100)

19 (86)

9 (41)

18 (82)

17 (77)

12 (55)

13 (59)

12 (55)

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ARRANGED BY YEAR OF PUBLICATION (LEAST RECENT TO MOST RECENT) Injury definition (summary)

Injury data collection

Any event during team or team- related game, practice, or activity (on or off the playing surface) requiring attention by team’s therapist or physician and subsequent game/ practice TL (MA and≥ 1 day TL)

Athletic therapist injury reporting system

198

Physician injury report form

17% (66)

TL. ≥ 1 day: 37.9%; ≥ 7 days: 15.2%

236c

New or recurring musculoskeletal complaints or concussions (injuries) incurred during competition or training during London Olympic Games receiving MA, regardless of consequences regarding absence from competition or training (MA)

A new musculoskeletal symptom or concussion that led to time stoppage when player was unable to continue playing during competition (TL)

Medical officer injury form

Injured players

Number of injuries

Severity of injury TL.<7 days: 81%; 8–12 days: 17%; >21 days: 2%

BC British Columbia, MA medical attention, ERs Emergency rooms, NATA National Athletic Trainers’ Association, NCAA National Collegiate Athletic Association, NR not reported, TL time loss a Players participating in school teams. Does not include physical education, non-organized, and community practice (that are reported in the study) b Data from the whole cohort (not only from field hockey players) c Calculated from presented data d Studies using the same data from 1995–1997 NATA High School Injury database e Finch et al. [24] is a follow-up study of Stevenson et al. [23] f Studies using the same data from 1988–2003 NCAA Injury Surveillance System g Tournament durations in 2013 ranged from 3 to 10 days. The specific duration of each tournament can be found at https://tms.fih.ch/fih/home/

Table 2:

SCORE - RISK-OF-BIAS ASSESSMENT OF STUDIES ON FIELD HOCKEY INJURIES ACCORDING TO TEN CRITERIA

Risk of bias: low = 1, high = 0. Unable to determine fields (UD) were counted as zero in the score 1 definition of injury clearly described 2 prospective design that presents incidence or prevalence data 3 description of field hockey players (e.g., recreational or professional level) 4 the process of inclusion of athletes in the study was at random (i.e., not by convenience) or the data collection was performed with the entire target population

5 data analysis performed with at least 80% of the athletes included in the study 6 injury data reported by players or by a healthcare professional 7 same mode of injury data collection used 8 injury diagnosis conducted by medical professional 9 follow-up period of at least 6 months 10 incidence or prevalence rates of injury expressed by a ratio that represents both the number of injuries as well as the exposure to field hockey (i.e., number of injuries/hours of field hockey exposure, or number of injuries/ sessions of field hockey exposure)

THERAPEUTIC MAGAZINE

Table 3 Study

NUMBER OF FIELD HOCKEY INJURIES (AND 95% CONFIDENCE INTERVALS) PER Players’ characteristics

Setting

Injury definition summary

Weightman and Browne 1975 Unspecified Season NR 11] Men Woman Zaricznyj et al. 1980 School players aged 5–17 years, [12] sex NR

Season

Clarke and Buckley High-school women, age NR 1980 [13]

Season ≥ 1 week TL

Powell and BarberFoss High-school women, age NR 1999c [21]

Season MA or ≥ 1 week TL Game Practice

Dick et al. 2007d High-school women, age NR [28]

Rishiraj et al. 2009 [29]

Under-21 aged women from the British Columbia Women’s Field Hockey Federation

Season MA or ≥ 1 week TL Game Practice

Finch et al. 2002e Non-professional men and women, Winter season TL or MA and/or adverse economic/social effects [24] average age 25 years

Junge et al. 2006 Olympic players, age NR 2004 Olympic Games MA [25] Men Woman Theilen et al. 2016 [32] Professional players, age NR 2013 FIH tournaments TL Men Africa Cup of Nations (Kenya) East Asia Games (China) Junior World Cup (India) Oceania Cup (NZ) Sultan of Johor Cup (Malaysia) World League Round 2 (India) World League Round 2 (Russia) World League Round 2 (France) World League Round 2 (Brazil) World League Semi-final (Malaysia) World League Semi-final (The Netherlands) Women 4 Nations Tournament (NZ) East Asia Games (China) World League Final (Argentina) World League Round 2 (India) World League Round 2 (Brazil) FIH International Hockey Federation, MA medical attention, NR not reported, NZ New Zealand, TL time loss a

Calculated according to presented data

Impossible to calculate 95% confidence interval

Same data as Rauh et al. 2007 [27]

Hockey issue 1 2021

1000 PLAYER-HOURS AND PLAYER-SESSIONS ARRANGED BY PLAYERS’ CHARACTERISTICS Players’ exposure (hours)

Number of injuries per 1000 player-hours

122,074a 70,874a 51,200a

1.0 (0.8–1.1)a 1.0 (0.8–1.3)a 1.3 (0.9–1.6)a

14,286a

0.1 (0.0–1.4)a

Players’ exposure (sessions)

Number of injuries per 1000 player-sessions

1.0b

138,073 3.7(3.4-4.0)a 66,122 a 4.9 (4.4-5.4)a 58,125 a 3.2(2.7-3.7)a

716,910a 4.6 (4.4–4.7)a 155,370 a 7.9 (7.4–8.3) 561,540 a 3.7 (3.5–3.9)

2828 70.0 (30.2–79.8)a 578 67,5 (45,6-89,3)a 2250 68.0 (57,1-78,9)a

29,276a 15.2 (13.8–16.7)

1322a 33 (23–43)a 1133 a 770 47 (35-2-62) 660 552 14 (4-24) 473

39 (27–50) 55 (37–72) 17 (5–29)

6519a 36.2 (31.6–40.8)a 4825 48.3 (30.9–68.8) 154 90.9 (38.4–143.4)a 154 90.9 (38.4–143.4)a 1129 27.4 (17.4–37.5)a 154 77.9 (28.4–127.4)a 462 28.1 (11.1–45.1)a 385 44.2 (21.5–66.9)a 385 44.2 (21.5–66.9)a 385 26.0 (7.4–44.6)a 385 20.8 (3.4–38.2)a 616 42.2 (25.2–59.3)a 616 39.0 (22.5–55.4)a 1694 29.1 (18.6–39.7) 154 26.0 (0.0–67.3)a 154 26.0 (0.0–67.3)a 616 26.0 (12.1–39.8)a 385 44.2 (21.5–66.9)a 385 23.4 (5.4–41.4)a

Same data as Hootman et al. 2007 [26]

A follow-up study of Stevenson et al. 2000 [23]

THERAPEUTIC MAGAZINE

Table 4

PROPORTION (%) OF FIELD HOCKEY INJURIES BY BODY LOCATION

Study

Head, Neck, Face

Upper Limbs Hand, finger, wrist

Upper arm,

forearm

Elbow

Shoulder

Total upper limbs

Trunk, upper and lower back

Mathur et al. 1981 [15]

2 12 40 4 44 5 17 4 2 1 24 14

Rose 1981 [14]

11 1 5 4

Martin et al. 1987 [16]

22 0

Jamison and Lee 1989 (astroturf) [18]

Fuller 1990 [19]

15 16 2 1 1 21 5 9 9 2 1 1 13 1 10 18 2 20 9

Powell and Barber- Foss 1999a [21]

Finch et al. 2002b [24]

31 4 22 6 9 3 3 16 8 50 25 0 0 0 25 13 25 10 21 7

Clarke and Buckley 1980 [13] Zaricznyj et al. 1980 [12]

Jamison and Lee 1989 (grass) [18]

Junge et al. 2006 (men) [25] Junge et al. 2006 (women) [25] Dick et al. 2007 (game)c [28]

13 3 16 5

8 2 8 16 7 23 6 29 14

Dick et al. 2007 (practice) [28] Rishiraj et al. 2009 [29]

20 16 3 5 23 11 27 19 19 4 40 14 14 0

Engebretsen et al. 2013 [31] Theilen et al. 2016 (men) [32] Theilen et al. 2016 (women) [32]

Bold formatting indicates the highest values for the main body areas in each study aSame data as Rauh et al. 2007 [27] bValues represent percentages of injured players (i.e., not injuries) and do not add

Table 5

PROPORTION (%) OF FIELD HOCKEY INJURIES BY INJURY TYPE

Study

Sprains

Strains

Dislocation

Fracture

Abrasion, laceration

Contusion, hematoma

Clarke and Buckley 1980 [13]

37 21 7

Mathur et al. 1981 [15]

20a 6b 51

Rose 1981 [14] 32 16 1 1 5 33

Martin et al. 1987 [16] 11 11 33

Jamison and Lee 1989 (astroturf) [18] 2 12 26 49

Jamison and Lee 1989 (grass) [18] 2 5 16 64

Cunningham and Cunningham 1996 [20] 15 19 2 22 28

Powell and Barber-Foss 1999c [21] 26 20 6 37

Finch et al. 2002d [24] 28 55 2 14 15 80 Junge et al. 2006 (men) [25]

Junge et al. 2006 (women) [25]

Dick et al. 2007 (game)e [28]

24 13 15 11 20

Dick et al. 2007 (practice)e [28]

50 5

Rishiraj 2009 [29]

40 1 1 8 17

Engebretsen 2013 [31] 18 14 6 8 21 14 54

Hockey issue 1 2021

Lower Limbs Ankle

Foot, toes

Lower leg

Thigh

Knee

Hip, groin, pelvis

Total lower limbs

Other, unspecified

32 72 26 16 12 8 8 44 12 11 46 2 6 58

27 15 9 11 11 2 75 5

44 33

23 14 22 59 3

28 12 19 30 31

14 3 3 8 22 0 50 13 0 0 0 0 0 13 15 3 3 10 18 3 43 4

15 2 8 27 17 12 60 7 14 10 13 15 53

8 8 5 9 11 8 47 13 28 31 9 16 12 28 18 to 100% as some players sustained more than one injury

Swelling, blistering

Concussion

cSame data as Hootman et al. 2007 [26]

Tendinopathy

Other, unspecified

4 32

22 1

4 2 5

2 3 6

7 1 5

3 4 9

3 8

1 2

0 8 3

25 0 0

9 4 3

3f 3 7 8

Bold formatting indicates the highest values for each study aSprains and strains reported together bFractures and dislocations reported together cSame data as Rauh et al. 2007 [27] dValues represent percentages of injured players

(i.e. not injuries) and do not add to 100% as some players sustained more than one injury

eSame data as Hootman et al. 2007 [26]

3 18

fReported as inflammation

THERAPEUTIC MAGAZINE

Table 6

PROPORTION (%) OF FIELD HOCKEY INJURIES BY INJURY MECHANISM

First author, year

Ball Stick contact contact

Player contact

Ground contact

Object contact

Unspecified Non Unspecified contact contact

Jamison and Lee 1989 (astroturf) [18]

32 27 11 12 18

Jamison and Lee 1989 (grass) [18]

42 23 9 14 12

Fuller 1990 [19] 30 17 2 10 41 45 15 36 4

Cunningham and Cunningham 1996 [20]

Junge et al. 2006 (men) [25] 58 36 6 Junge et al. 2006 (women) [25] 75 13 13 Dick et al. 2007 (game)a [28]

29 18 14 9 28 2

Dick et al. 2007 (practice)a [28] 5 26 64 5 Rishiraj et al. 2009 [29]

Engebretsen et al. 2013 [31]

3b 62 44c 41 7

Theilen et al. 2016 (men) [32]

37 25 23 15

Theilen et al. 2016 (women) [32]

52 14 12 20 2

Bold formatting indicates the highest values for each study aSame data as Hootman et al. 2007 [26] bContact with the goal cContact with unspecified moving or stagnant object

Table 7

PROPORTION (%) OF FIELD HOCKEY INJURIES BY PLAYER POSITION

Study Forwards Midfielders Defenders Goalkeepers Other, unknown 22

36 10

Rishiraj et al. 2009 [29]

Fuller 1990 [19]

37 37 16 4 6

Dick et al. 2007 (game)a [28]

28 24 19 7

Bold formatting indicates the highest values for each study aPlayer position at time of injury. Same data as Hootman et al. 2007 [26]

Acknowledgements Saulo Delfino Barboza is a PhD candidate supported by CAPES (Coordenação de Aperfeiçoamento de Pessoal de Nível Superior), Brazilian Ministry of Education (process number 0832/14-6). Compliance with Ethical Standards Funding This study had no funding sources. Conflict of interest Saulo Delfino Barboza, Corey Joseph, Joske Nauta, and Evert Verhagen have no conflicts of interest. Willem van Mechelen is the editor and chapter coauthor of the Oxford Textbook of Children’s Sport and Exercise Medicine (Armstrong N, van Mechelen W. Oxford: Oxford University Press; 2017. ISBN 9780198757672).

Hockey issue 1 2021

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