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American College of Osteopathic Pediatricians Slide 2 Although Andrew Taylor Still never saw ice hockey as we know it today, he would be able to identify with some of the injuries sustained in ice hockey as they are comparable to injuries Still or other young men may have endured working on farms or hunting in the 1800s throughout Virginia, Tennessee, Missouri, and Kansas. The long days of swinging sickles or scythes, used to harvest hay and grain or to clear underbrush and branches, plowing by hand, and digging with shovels to turn over the land for planting crops, all can lead to injuries that are remarkably similar to those in ice hockey. Slide 3 The hard work and constant bent over swinging or digging motion used in farm field work resemble the same body positioning, rotation and energy release as in ice hockey players. The foundation of Stills studies and philosophy are embedded in anatomy. His mastery in structural relationships of muscles, bones, and organs would allow Still to see how injuries in farming can be similar to those seen in ice hockey as well as how to treat ice hockey injuries using manipulative therapies. Slide 4 Slide 5 Hockey players and goalies can be at risk for injury simply due to the games environment, as the game is played on ice and is enclosed by a boarded perimeter. Body checking is an instrumental part of game strategy and game play. High speed collisions unavoidably occur between bodies, bodies and boards, bodies and goal posts, and bodies and pucks at high speeds. Many of these injuries can be acute, however, some can be severe and dangerous. The hockey season is long and strenuous on the body. Some tournament weekends teams can play up to five games with multiple games in a day. It is also likely to have early morning games and games late into the evening. The body weakens over time and under such demanding circumstances making it more susceptible to injury. Many advances in equipment technology have been made and help to prevent injury. However, unfortunately, due to the nature of the sport there are still injuries. Slide 6 Neck and Spine Shoulders Knee, Hip, Thigh, and Groin Forearm, Wrist, and Hand pain Lower Back Slide 7 Fractures, hands and wrist Sprains or Strains, medial collateral capsular ligaments of the knee Contusions, upper and lower body Separations, AC joint separation Skate bite, friction injury from leather of boot Concussions, mild to severe Lacerations, head, scalp and face Gamekeepers thumb Tearing of the ulnar collateral ligament Slide 8 Neck, head and spine injuries although not as common do occur and can be harmful. The impact at high speeds with bodies and boards around the ice surface are attributed to these injuries. Slide 9 Muscles associated are: Sternohyoid muscle Bones Sternocleidomastoid muscle Trapezius Splenius Capitis Splenius Cervicis Scalenus Medius Scalenus Posterior Levator Scapulae Multifidi (deep) Middle Semispinalis Capitis (Superficial) Rectus Capitus minor and major Oblliquus Capitis Inferior Cervical Vertebrae -C3 responsible for diaphragm (Breathing) Brachial Plexus injury -C5 to T1 Slide 10 Slide 11 Slide 12 Slide 13 Slide 14 Slide 15 The physician will place the fingers close to the cervical spine and bring anterior pressure bilaterally with slight traction through the arms of the physician. Slide 16 Slide 17 Place one hand on the frontal bone, the other hand on the lateral aspect of the cervical spine along the articular facets. While applying pressure on the frontal bone away from you, the other hand stretches the muscles of the neck toward you. Slide 18 Slide 19 The patient is supine. Place your hand on the ramus of the mandible with fingers extending downward toward the chin. Apply a sudden increase in the rotation of the neck by pressing downward toward the table on the ramus of the mandible. Slide 20 Slide 21 The patient is supine. Rotate and sidebend the neck. The index finger of your hand is posterolateral to the articular process.The patients head may be flexed or extended depending on the cervical curve and then the corrective thrust is made with the index finger in an arc conforming to the plane of the facets. Slide 22 Slide 23 Shoulders are one of the most common injuries in ice hockey. The most common injury is an injury to the Acromioclavicular (AC) joint separation. Shoulder contusions and dislocations are also common. Slide 24 Bones Associated: Scapula Clavicle Humerus Slide 25 Slide 26 Muscles associated are: Rhomboid Major and Rhomboid Minor Posterior deltoid, Middle deltoid, Anterior deltoid Coracobrachialis muscle Supraspinatus muscle Pectoralis Upper Trapezius Biceps Brachii muscle and Brachialis muscle Triceps Slide 27 Slide 28 Rotator Cuff Axillary Nerve- cant abduct -off of Brachial Plexus Slide 29 Slide 30 Slide 31 Step 1extension with elbow flexed; step 2flexion with elbow extended; step 3compression circumduction; step 4circumduction with traction with elbow extended; step 5aabduction with internal rotation with elbow flexed; Step 5b- adduction and external rotation step 6adduction and internal rotation with upper extremity behind the back; step 7stretching tissues and pumping fluids with the arm extended Slide 32 Forearms, wrists, and hands are all at risk for breaks, contusions, and sprains. Body checks, sticks, and collisions with bodies and boards are all causes for many of these injuries. Slide 33 Bones and Connective Tissue: Ulna Radius Scaphoid- Fractured most Flexor Retinaculum Carpal Bones Slide 34 Slide 35 Muscles associated are: Extensor Carpi radialis longus Extensor Carpi Ulnaris Supinator Palmaris Longus muscle Slide 36 Slide 37 Lower back pain is a common injury as the body is bent over and in constant motion, initiating or receiving body checks, rotating to generate power for a shot or pass, hit against boards or goal posts, or changing direction quickly. The lower back is susceptible to contusions and strains. Slide 38 Multifidus Iliopsoas Hamstrings Abdominals Erecorstinae Bones: Lumbar region 5 Vertebrae Slide 39 Patient is prone. Place thumb onto paraspinal muscles adjacent to the vertebral spinous process. In a bowing like motion stretch the muscles away from you and release. Perform slowly. Slide 40 Slide 41 Patient is supine. Have the patient lace fingers behind head. Standing to the side of the patient grab the patients contra lateral upper arm and pull toward you and caudally. Slide 42 Slide 43 The patient is in the lateral recumbent position. The side that the dysfunctional vertebra is rotated towards is up (eg, for a left rotated lumbar, the patient is lying on their RIGHT side). The patients upper most leg is dropped over the side of the table. The patients upper elbow is flexed. The lower elbow is also flexed and the arm is tucked under the head. Stand to the side of the patient with his/her face to you. Your one arm should be placed onto the upper elbow and the other arm placed on the upper hip. A twisting motion is performed by moving the patients elbow backward and the patients upper hip forwards, carrying the dysfunctional vertebra into correct position Slide 44 Slide 45 Knee, hip, thigh and Groin muscles are all known to be common injuries that can be sustained while participating in ice hockey. Knees frequently suffer from knee to knee contact and impact with boards at high speeds resulting in sprains or tears to the medial collateral and capsular ligaments. Hips thighs and groin are most susceptible to sprains, strains, and contusions. Slide 46 Muscles associated are: Adductor Magnus (Adductor Brevis and Adductor Longus) Gracilis Rectus Femoris Vastus Medialis Popliteus Muscle Tibialis Anterior Gastrocnemius Muscle Bones Associated: Femur Tibia Fibula Slide 47 Slide 48 Slide 49 Slide 50 Slide 51 Slide 52 Slide 53 Slide 54 Slide 55 Slide 56 Slide 57 Slide 58 Weight Training Warm up and cool downs (dynamic warm-ups) Stretching and band exercises (Flexibility) Nutrition and appropriate rest Slide 59 Reaching lateral side stretch Kneeling quad stretch Kneeling heel-down Achilles stretch Slide 60 Glide on the ice with your head and back straight. Slide your left leg back and point your skate away from the body. Bend the right knee and keep the left leg straight. Feel the stretch in the left groin area. Hold for at least 15 seconds and repeat on the other side. Slide 61 Hold a hockey stick while slowly skating forward. Raise the arms up and back with your palms up. This stretches the shoulders, upper back and arms. forward Slide 62 Lift your hockey stick above your head and tilt the top of your body to the right. Keep your feet apart. You should feel the stretch on your left side. Hold it for 10 seconds and then repeat on the opposite side. Slide 63 Skate forward with your feet apart and bend forward at the hips. Keeping your knees bent, feel a stretch in the back of your legs. You should hold this stretch for at least 15 seconds. Slide 64 Grasp your hockey stick behind your back and glide forward. Slowly raise the stick up, keeping your arms straight. Hold for 15 seconds. You should feel this stretch in your upper arms. Slide 65 Lie flat on the ice with your feet together and knees apart. Lift your chest off of the ice with your arms and hold for at least 15 seconds. This should be felt in the lower back and the groin. Step 7 Slide 66 Sit on a stable surface with left leg bent and right leg crossed over it. Push against the right knee with the left elbow and rotate your body to the right. Turn the body by pushing the left arm and hand. Do not jerk or pull. Feel the stretch in your upper and lower back, as well as the hips and ribs. http://www.ehow.com/how_2047720_stretch-before-playing-hockey.html Slide 67 Innervation Table Organ/SystemParasympatheticSympatheticAnt. Chapman's Post. Chapman's EENTCr Nerves (III, VII, IX, X) T1-T4T1-4, 2 nd ICSSuboccipital HeartVagus (CN X)T1-T4T1-4 on L, T2-3 T3 sp process RespiratoryVagus (CN X)T2-T73 rd & 4 th ICST3-5 sp process EsophagusVagus (CN X)T2-T8--- ForegutVagus (CN X)T5-T9 (Greater Splanchnic)--- StomachVagus (CN X)T5-T9 (Greater Splanchnic)5 th -6 th ICS on L T6-7 on L LiverVagus (CN X)T5-T9 (Greater Splanchnic)Rib 5 on RT5-6 GallbladderVagus (CN X)T5-T9 (Greater Splanchnic)Rib 6 on RT6 SpleenVagus (CN X)T5-T9 (Greater Splanchnic)Rib 7 on LT7 PancreasVagus (CN X)T5-T9 (Greater Splanchnic), T9- T12 (Lesser Splanchnic) Rib 7 on RT7 MidgutVagus (CN X)Thoracic Splanchnics (Lesser)--- Small IntestineVagus (CN X)T9-T11 (Lesser Splanchnic)Ribs 9-11T8-10 Appendix T12Tip of 12 th RibT11-12 on R HindgutPelvic Splanchnics (S2- 4) Lumbar (Least) Splanchnics--- Ascending Colon Vagus (CN X)T9-T11 (Lesser Splanchnic)R Femur @ hip T10-11 Transverse Colon Vagus (CN X)T9-T11 (Lesser Splanchnic)Near Knees--- Descending ColonPelvic Splanchnic (S2-4)Least SplanchnicL Femur @ hipT12-L2 Colon & RectumPelvic Splanchnics (S2- 4) T8-L2--- Slide 68 Slide 69 Question1: A, B, C, D, E. Question2: A, B, C, D, E. Question3: A, B, C, D, E. Slide 70 In hockey injury to the leg caused by the leather of the skate is called: a. skate bite b. leather burn c. skate cut d. boot bolt e. lucky break Slide 71 The most common separation injury is at which site A. ac separation B. C1/C2 C. Humoral tibial D. femoral hip E. L5 on sacrum Slide 72 Tearing of the ulnar collateral ligament is called: A. gamekeepers thumb B. witlow C. hitch hikers thumb D slap thumb E. catch you later thumb Slide 73