Pillar Three

Return to Play

Returning to hockey is not simply a calendar decision. It requires a progressive plan that restores capacity, skating tolerance, confidence, and readiness for the unpredictable demands of the game.

One of the biggest gaps in sports medicine is the space between “cleared” and “ready.” A hockey athlete may feel better with daily activity, pass a basic strength test, or complete a few skates, but still be underprepared for acceleration, edge work, puck pressure, contact, repeated shifts, and late-game fatigue.

This is especially true for adductor, hip, and groin injuries. These injuries can be frustrating because pain may settle before the athlete has rebuilt the strength, tissue tolerance, and sport-specific loading needed for hockey. A better return-to-play process uses clinical examination, progressive loading, repeated reassessment, and hockey-specific exposure instead of relying on pain alone.

Clinical examination still drives the early roadmap

Imaging can be helpful, but it should not replace a strong clinical exam. A prospective cohort study of male athletes with acute adductor injuries found that the initial clinical examination explained a large portion of return-to-sport time, with MRI adding only a small amount of additional predictive value. Proximal adductor longus insertion pain and a palpable defect were especially important clinical findings associated with longer recovery timelines. [1]

For hockey athletes, this matters because return-to-play planning should start with what the athlete can demonstrate clinically: location and extent of pain, strength tolerance, range of motion, squeeze response, skating-specific positions, and how symptoms respond to progressive loading.

Return to play should be criteria-based, not date-based

A common mistake is assuming that every groin or adductor injury follows a predictable timeline. Research on acute adductor injuries shows that no single clinical measure precisely defines the point of recovery. Palpation pain, strength, flexibility, and symptom response all provide useful information, but none should be used alone. [3]

That supports a criteria-based approach. Instead of asking, “How many weeks has it been?” the better questions are:

  • Can the athlete generate high-quality adductor force without symptom escalation?
  • Can they tolerate skating positions that place the hip in abduction and extension?
  • Can they accelerate, decelerate, cut, and change edges repeatedly?
  • Can they complete hockey-specific work under fatigue?
  • Can they return to practice exposures before game-speed competition?

Even severe adductor injuries may not always require surgery

One of the most important recent shifts in adductor injury management is the growing support for structured, exercise-based care. In a prospective case series of athletes with complete proximal adductor longus tendon avulsions, nonoperative exercise-based treatment led to a median return to sport of 69 days. At one-year follow-up, athletes reported high function, no performance limitations, and strong symmetry measures. [2]

This does not mean every injury should be treated the same way. It does mean that the injury label alone should not determine the plan. The athlete’s sport, symptoms, exam findings, imaging when appropriate, performance demands, and response to loading all matter.

Hockey return to play needs skating-specific progression

Hockey is unique because the groin and hip are loaded in positions that do not perfectly match field sports. The athlete must repeatedly push from abducted positions, recover the leg under the body, control the pelvis, change edges, and tolerate contact while producing force. A return-to-play plan should gradually expose the athlete to these demands.

A practical progression often moves through these stages:

  • Stage 1: Restore calm movement. Reduce irritability, restore basic range of motion, and begin low-level trunk, hip, and adductor loading.
  • Stage 2: Build strength capacity. Progress isometric, isotonic, and eccentric adductor work while maintaining hip, trunk, and lower-body strength.
  • Stage 3: Reintroduce skating positions. Add lateral movement, slideboard work, controlled edge positions, and progressive skating exposure.
  • Stage 4: Add speed and fatigue. Progress acceleration, deceleration, repeated shifts, change of direction, puck work, and conditioning.
  • Stage 5: Return to practice and competition. Reintroduce team practice, contact, battle drills, and game play in a planned sequence.

Time-loss is not the only thing that matters

Adductor and groin problems often exist before an athlete misses time. Hockey-specific research has shown that hip and groin problems are common across a season, and prior non-time-loss groin problems can be a strong risk factor for future problems. [7]

That is why return to play should not end the moment the athlete gets back into games. Secondary prevention matters. Athletes need ongoing strength work, workload monitoring, recovery habits, and a plan for managing early symptoms before they become bigger problems.

What the research suggests about timelines

Timelines vary based on injury severity, location, symptoms, sport demands, and the athlete’s response to rehab. A systematic review on acute adductor muscle injuries reported that partial tears often returned in approximately 1 to 6.9 weeks with physical therapy, while complete tears averaged 8.9 weeks nonoperatively and 14.2 weeks surgically. [4]

Those numbers are useful for context, but they should not be treated as automatic clearance points. Hockey athletes need to earn progression through objective milestones and sport-specific tolerance.

Load management is part of treatment

Modern adductor management is not only about exercises. It is about matching the athlete’s current capacity to the demands being placed on the tissue. A clinical concepts review on adductor strains, ruptures, and long-standing adductor-related groin pain emphasizes individualized exercise and load-based rehabilitation across the full continuum of injury management. [5]

For hockey, that means controlling spikes in skating volume, managing back-to-back games, watching how symptoms respond 24 hours later, and making sure strength work does not disappear once the athlete returns to the ice.

A practical return-to-play checklist

  • Pain is minimal and does not increase meaningfully during or after hockey-specific loading.
  • Hip range of motion is adequate for skating demands.
  • Adductor strength and squeeze tolerance are progressing toward the athlete’s normal baseline.
  • The athlete can tolerate lateral push-off, edge work, acceleration, deceleration, and repeated shifts.
  • Conditioning is sufficient for the intended practice or game role.
  • The athlete has completed progressive practice exposure before full competition.
  • A secondary prevention plan is in place after return.

The takeaway

Return to play is not a single test, a date on a calendar, or the absence of pain. It is a process of rebuilding the athlete’s ability to tolerate the demands of hockey.

The best return-to-play decisions combine clinical judgment, objective measures, sport-specific progressions, workload management, and honest communication between the athlete, parent, coach, and healthcare team.

This article is for education only and is not a substitute for individualized medical care. Athletes with pain, persistent symptoms, or return-to-play questions should be evaluated by a qualified healthcare professional.

Research that informed this article

  1. Serner A, Weir A, Tol JL, et al. Associations between initial clinical examination and imaging findings and return-to-sport in male athletes with acute adductor injuries: a prospective cohort study. The American Journal of Sports Medicine. 2020;48(5):1151-1159. doi:10.1177/0363546520908610.
  2. Serner A, Hölmich P, Arnaiz J, et al. One-year clinical and imaging follow-up after exercise-based treatment for acute complete adductor longus tendon avulsions in athletes: a prospective case series. The American Journal of Sports Medicine. 2021;49(11):3004-3013. doi:10.1177/03635465211015996.
  3. Serner A, Hölmich P, Tol JL, et al. Progression of strength, flexibility, and palpation pain during rehabilitation of athletes with acute adductor injuries: a prospective cohort study. Journal of Orthopaedic & Sports Physical Therapy. 2021;51(3):126-134. doi:10.2519/jospt.2021.9951.
  4. Farrell SG, Hatem M, Bharam S. Acute adductor muscle injury: a systematic review on diagnostic imaging, treatment, and prevention. The American Journal of Sports Medicine. 2023;51(13):3591-3603. doi:10.1177/03635465221140923.
  5. Thorborg K. Current clinical concepts: exercise and load management of adductor strains, adductor ruptures, and long-standing adductor-related groin pain. Journal of Athletic Training. 2023;58(7-8):589-601. doi:10.4085/1062-6050-0496.21.
  6. Eckard TG, Padua DA, Dompier TP, et al. Epidemiology of hip flexor and hip adductor strains in National Collegiate Athletic Association athletes, 2009/2010-2014/2015. The American Journal of Sports Medicine. 2017;45(12):2713-2722. doi:10.1177/0363546517716179.
  7. Wörner T, Thorborg K, Clarsen B, Eek F. Incidence, prevalence, and severity of and risk factors for hip and groin problems in Swedish male ice hockey players: a 1-season prospective cohort study. Journal of Athletic Training. 2022;57(1):72-78. doi:10.4085/1062-6050-0522.20.
  8. Tyler TF, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. The American Journal of Sports Medicine. 2002;30(5):680-683. doi:10.1177/03635465020300050801.
  9. Tyler TF, Nicholas SJ, Campbell RJ, McHugh MP. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. The American Journal of Sports Medicine. 2001;29(2):124-128. doi:10.1177/03635465010290020301.
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