All of us during our sporting career will be aware of minor aches and pains during and after high-impact sports-related training and match sessions. For the vast majority of us, these will be short-term issues such as overuse and inflammation-related problems to the muscles and tendons around the knee which invariably settle within a few days and require nothing more than the tried and tested ‘rest/ice/compression and elevation’ (RICE) treatment.

For some hockey players, the issue may either recur on resumption of high-intensity play or sometimes worsen – preventing further participation in their training and match play.

In this article, we will discuss some of the common issues that I see in the sports knee injury service and provide some simple techniques that may be useful in both preventing and treating oneself.

If these simple techniques do not lead to a satisfactory improvement in symptoms then I would always suggest you seek a specialist opinion from a sports physician, orthoptist, podiatrist, physiotherapist or sports knee service – such as ours here in Southampton, South Central England.

The three most common training issues and problems hockey players experience

1. Runner’s Knee / Anterior Knee Pain

Where does it hurt?

Pain under your kneecap that feels worse after running and when you walk up or down stairs and can be associated with a sensation of catching/crepitus ( crunching) or even painful giving way during activity

The majority settle with simple treatment including:

• Reduce running mileage and hours of intensive training – perhaps reduce the training intensity and concentrate involvement to match play for a few weeks
• Cross-train with activities that don’t aggravate your knee –mix up the training, avoid squats / high-impact training
• Apply ice for 15 minutes five times a day – the use of a compression cooling system such as Game-Ready or Breg V-Pulse can be dramatic and these systems are used by the majority of professional sports teams for obvious reasons as they are so effective in both reducing swelling and reducing pain symptoms
• Take an anti-inflammatory such as ibuprofen ( as long as you do not have any contra-indications to using them – always check the medication label )
• Foam roll your quads on a regular basis – little and often is the key

If the pain continues, see a team physiotherapist or sports knee doctor.

How to prevent Runner’s Knee / Anterior Knee Pain

• Strength train – build up slowly once able
• Foam roll daily as part of your regularly preventative treatment
• Shortening your stride can take pressure off your knees. Aim for 160-180 foot strikes per minute

Doing so will propel your body forward so you’ll get that lean naturally, without having to think about how you stand. It’s a lot easier to change how quickly your feet turn over than it is to change your body position, but it will get you a similar injury-prevention effect. Plus, this simple trick can also make you a more efficient (faster) runner.

Next time you train, look at your watch and count how many times your left foot hits the ground in one minute. Aim for 80 strikes per minute (160 left and right foot strikes.) If you’re getting 60 or 65 left-foot strikes a minute, that means your stride is too long, which puts much more compressive force on your knees.

A new study in Medicine & Science in Sports & Exercise finds that leaning forward slightly while running can help reduce the load put on your knees. That means they won’t absorb as much shock from all that pounding on the pitch. Leaning forward from your ankles, not hips, almost like you’re falling forward (think: skier’s stance) whilst you run in hockey, current literature, suggests that both leaning the trunk forward as well as converting to a midfoot or forefoot strike pattern reduces knee loading during running by shifting the mechanical demand to the ankle joint.

2. Patellar Tendinitis

Where does it hurt?

Pain below your kneecap (patellar tendon insertion on patella and tibia) and sometimes at the top of your shin; it worsens during activity and during match-play. As it becomes more established and chronic it also hurts going up and especially down stairs (when more force is transmitted through the inflamed tendon)

What’s going on? The force placed on the knee during running can sometimes put too much strain on the patellar tendon which effectively becomes inflamed and studies can reveal repeated micro-trauma to the tendon structure. It is still ‘safe’ to train and play but this problem can easily worsen in terms of increased symptoms and is generally slow to resolve. It often requires additional treatment once it gets chronic (after 6 weeks) such as physiotherapy/ultrasound therapy and rarely ultrasound-guided injections ( tendon stripping techniques and/or platelet-derived growth factor therapies.

How to treat Patellar Tendinitis

• Stop running until you can do so pain-free; cross-train and swim instead (generally avoid breast-stroke leg kicks)
• Apply ice for 15 minutes five times a day or cold compression therapy as before
• A patellar tendon strap can reduce pain as it effectively changes the mechanical pull on the tendon and affects the overall stress and pull on the insertion points.

If it doesn’t improve, see a physiotherapist or sports knee doctor.

How to prevent Patellar Tendinitis

• Strength train regularly
• Stretch your quads and hamstrings
• Foam roll daily

3. Iliotibial Band Syndrome

Where does it hurt?

Pain on the outside (lateral) of your knee. It usually comes on five minutes into a run and subsides when you’re finished.

What’s going on? The iliotibial band (ITB) runs from your hip to your knee, crossing the knee joint. A fluid-filled sac called the bursa sits between the ITB and the outside of your femur, near your knee. When the ITB is tight, the bursa gets squeezed, causing pain.

How to treat Iliotibial band syndrome

• You can run unless pain forces a change in your form
• Reduce your mileage and cross-train
• Foam roll your ITB on the soft part of your outer thigh
• If your foot overpronates on running, wear motion-control shoes or see a podiatrist/foot physio for orthotic insoles
• See a sports injury doctor if it persists

How to prevent Iliotibial band syndrome

• Strong glute and core muscles are key
• Foam roll your ITB daily
• A shorter, quicker stride can help. Aim for 170-180 footstrikes per
  minute

How to minimise the risk of injury when playing hockey

Don’t rush training and warm up well

One of the most integral aspects of training to become a high-level hockey player is to ensure that you are taking training as slowly and deliberately as you would any other long-term goal. Diving in guns blazing will potentially lead to injury and burnout. Your body is going to require some time to become used to the increased pace you are moving at.

Most ways that the body conforms to activities and exercise habits through adaptation take time – often measured in weeks not days. Nothing happens all at once. You’ll need to steadily increase your time and distance. Don’t try sprinting for long periods of time right out of the gate. You’ll need to temper your expectations and understand you’re training regimen will be cyclical and take time.

There is plenty of evidence that using a formal warm up routine such as the FIFA WARM–UP Programme will reduce the statistical chances of sustaining a serious knee injury during both training and match play. Some studies have shown a 50% reduction in serious injuries – such as meniscus tears, ACL (anterior cruciate ligament) tears and soft tissue knee problems mentioned earlier.

The FIFA programme is easy to use and is especially important for young athletes and both women and men at the international level.

Useful links and resources:

• FIFA Complete Warm-Up Programme
• FIFA 11+ Injury Prevention Warm-Up Programme
• FIFA GK specific programme (This can be adapted to hockey with some thought)
• FIFA Warm-Up Programme for Goal Keepers
• Videos of the warm-up exercises recommended by FIFA

Wear the right shoes

So much of the strain that your knees may experience when you are constantly running is caused by the brunt pounding that your feet do as they hit the pitch with each stride. There are so many bones, joints, ligaments, and muscles in the foot and if it is not properly guarded by a shoe that is designed to protect it while running, that type of negative impact can directly affect the knee.

Whatever the natural construction of your foot, there is a shoe that will adequately fit and aid it. Whether you are dealing with supination, high arches or flat feet, you’ll need to ensure your foot is adequately supported with quality footwear.

If you are unsure what type of shoe you should be going with, you can visit your local running retailer and take a gait analysis which will give you more significant specifics regarding exactly what your foot requires. Specialist advice can be sourced from podiatry/orthotists and physiotherapists.

Improve your form

Sometimes, especially when you first start your training, you can overdo it or improperly use your body in a way that compromises your joints. This is extremely common and is often connected to a lack of strength in your hips and abdominal muscles.

Knee pain is typically not something that happens in a vacuum; it can generally be linked to poor body mechanics, running form, or posture. These factors all cause your knees to take on unnecessary stress and impact when running, leading to aches, pains and sometimes full-blown injury.

Improve your posture as well as your hip and core strength to prevent any type of unnecessary and preventable strain being felt by your knees.

Always stretch – especially after training and matches

The importance of stretching cannot be overstated. Your body goes through so much during the process of training and exerting itself. Your muscles need that break to be tended to by properly stretching. So much of the tension that can be localised in the knee is due to tight quads and hamstrings.

Properly increasing blood flow with dynamic stretching before you run and helping to loosen muscles after you’re finished is integral to preventing injuries and keeping your knees healthy and you on the pitch, playing the game you love.

Conclusion

In conclusion, safeguarding your knees as a hockey player requires a proactive approach that encompasses both prevention and proper management of common issues like runner’s knee, patellar tendinitis, and iliotibial band syndrome. These injuries, although prevalent, can be avoided. By incorporating simple yet effective techniques into your training routine, you can significantly reduce the risk of these problems affecting your performance on the pitch.

Philip Chapman-sheath is one of the UK’s most experienced knee surgeons and has a worldwide reputation for excellence in knee surgery and injuries. Holding specialist clinics in Southampton, he has developed and maintained a special interest in adolescent sporting injuries.

Philip understands and recognises the importance of personalised treatment and getting the best treatment the first time to achieve excellent patient satisfaction and the best long-term results. Book an appointment today.