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Welcome back to the Hockey Health Brief.
This week, we are taking a slightly more clinical look at injury prevention in hockey.
The goal is not to turn every player into a data point, and it is not to pretend that injuries can be perfectly predicted. Hockey is too chaotic for that. Contact, fatigue, puck impact, boards, workload spikes, prior injury history, strength deficits, sleep, recovery, and decision-making all interact.
But that does not mean we are guessing.
For clinicians, performance staff, coaches, and parents trying to support hockey athletes, the practical question is this:
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What can we actually track, and what can we actually act on?
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Newsletter #11
The Best Ability Is Availability
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In hockey, speed matters. Strength matters. Skill matters. Compete matters.
But none of it matters very much if the player is not available.
That is why one of the most important goals heading into training camp and the season is not just to improve performance. It is to build a system that helps players tolerate hockey, recover from hockey, and stay on the ice long enough to keep developing.
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The best ability is availability.
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For clinicians, that phrase should not be reduced to a cliché. Availability is a clinical outcome. It reflects tissue capacity, workload tolerance, recovery status, previous injury history, sport-specific movement demands, and the timing of return-to-play decisions.
It is not one test. It is not one exercise. It is not one piece of technology.
The big idea
| Availability is built through |
What clinicians can track |
| Previous injury identification |
Prior injury, concussion history, non-time-loss symptoms |
| Targeted strength |
Hip adductor strength, hamstring strength, trunk control, single-leg capacity |
| Hockey-specific movement tolerance |
Skating quality, hip ROM, edge control, repeated sprint tolerance |
| Workload management |
Session-RPE, skating volume, game load, acute workload changes |
| Recovery status |
Sleep, nutrition, soreness, fatigue, wellness trends |
| Early symptom monitoring |
Pain response, HAGOS-style outcomes, squeeze test pain |
| Return-to-play progression |
Objective benchmarks, exposure progression, symptom response |
| Environment and policy |
Checking rules, contact exposure, equipment compliance, rink safety |
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Clinical takeaway
The goal is not to predict every injury. The goal is to identify meaningful risk patterns early enough to change the plan.
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Start with the injury profile
Injury prevention starts with knowing what injuries are actually occurring.
At the NHL level, a large retrospective study of 24,776 injuries from 2012–2023 reported the head as the most commonly injured region at 21.2%, followed by the hand at 12.9%. Puck-related mechanisms were the leading cause of injury at 25.9%.[1]
That matters because hockey injury prevention is not just lower-extremity warm-ups.
Puck impact, stick contact, body checking, board contact, and player-player collision all matter. International tournament data similarly showed that body checking, stick contact, and puck contact accounted for 60.7% of injuries.[2]
But frequency is only one part of the story. Time loss matters too.
In NHL players, knee injuries and shoulder injuries produced some of the greatest mean time loss per injury. Concussions also remain a major burden, with one NHL analysis reporting an average of 13.8 games missed per concussion episode.[1,3] For goaltenders, proximal adductor injuries accounted for the highest total days missed across 14 NHL seasons, with 371 proximal adductor injuries resulting in 6,126 total days missed.[4]
| Injury category |
Why it matters clinically |
Prevention emphasis |
| Head/concussion |
High frequency and high consequence |
Rule enforcement, contact education, concussion recognition, RTP protocols |
| Hand/wrist |
Common from puck/stick contact |
Equipment, skill context, exposure awareness |
| Knee/shoulder |
High time-loss burden |
Strength, contact tolerance, RTP criteria, workload progression |
| Hip/groin |
Common, gradual-onset, often underreported |
Symptom monitoring, adductor strength, hip ROM, skating-specific capacity |
| Goaltender adductors/hips |
High days missed and position-specific demand |
Position-specific screening, hip/adductor capacity, progressive end-range exposure |
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Priority filter
A good prevention system does not treat all injuries the same. It prioritizes what is common, what is costly, and what is modifiable.
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Previous injury is the first screen
Before we talk about force plates, motion capture, local positioning systems, or strength profiling, clinicians should start with the simplest and most consistently supported risk factor:
In youth hockey, prior injury increased game-related injury risk by 46%, and lifetime concussion history increased risk by 41%.[5] In female NCAA athletes, sustaining one injury was associated with more than three times the odds of sustaining another.[6] Across machine learning and multivariable injury prediction models, prior injury consistently emerges as one of the strongest predictors.[7]
That means the intake matters. For hockey athletes, the history should go beyond “Did you miss games?”
| Clinical question |
Why it matters |
| What injuries did you have last season? |
Time-loss history helps identify major prior issues |
| What symptoms did you play through? |
Non-time-loss issues may still predict future problems |
| Did anything change how you skated, shot, battled, or trained? |
Functional change may matter more than formal diagnosis |
| Did symptoms recur after hard practices or tournaments? |
Recurrent load-related symptoms suggest unresolved capacity gaps |
| Did you return to play before you felt fully ready? |
Clearance does not always equal return to performance |
| Any concussion history? |
Prior concussion history influences future risk and management |
| Any persistent hip/groin symptoms? |
Prior groin symptoms are highly relevant in hockey |
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Clinical takeaway
A player’s history is not a weakness. It is the first layer of surveillance.
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The hip/groin problem is an iceberg
Hip and groin injuries deserve special attention because they are common, often gradual, and easy to undercount.
Prospective data in Swedish male professional and semiprofessional hockey players showed a cumulative seasonal incidence of hip/groin problems around 45%, with 53% of professional players reporting problems during the season.[8,9] Only about one in five of these problems resulted in formal time loss, and 70% had a gradual onset.[8]
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If we only count missed games, we miss most of the problem.
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NCAA data add another layer. Men’s ice hockey has among the highest rates of hip flexor and adductor strains across collegiate sports, with recurrence rates reported between 16% and 31%.[10]
For clinicians, this changes the management strategy.
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Action point
Do not wait for time loss. Track symptoms, strength, and skating response before the player starts missing time.
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Adductor strength is a key modifiable target
Across the broader sports literature, reduced hip adductor strength is one of the more supported modifiable risk factors for future groin pain and time-loss groin injury.[11]
In hockey, the rationale is obvious. The adductors are repeatedly loaded during skating. They help control hip abduction during push-off, recover the leg underneath the body, support crossovers, and tolerate repeated lateral force production. They are not just “groin muscles.”
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They are skating muscles.
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The only hockey-specific prevention study remains the Tyler et al. NHL study. In that study, 33 of 58 players were identified as “at risk” based on preseason adductor strength testing and completed a 6-week functional adductor strengthening program. Adductor strain incidence dropped from 3.2 to 0.71 per 1,000 player-game exposures across the pre- and post-intervention periods.[12]
That study was small and not a randomized controlled trial, so it should not be oversold. But clinically, the magnitude of effect is hard to ignore, especially when it aligns with broader adductor strengthening evidence.
Copenhagen progressions are useful, but they are not the whole system
The Copenhagen Adduction Exercise is the best-known practical tool for adductor strengthening.
A large cluster-randomized trial in male football players found that an adductor strengthening program using the Copenhagen exercise reduced groin problems by 41%.[13] A dose-response study in high-level youth rink hockey players found that twice-weekly Copenhagen work produced greater strength gains than once-weekly exposure, with excellent compliance and minimal soreness.[14]
We should be transparent: the strongest injury-reduction trial was not performed in ice hockey. But the transfer is reasonable because hockey places high demands on the adductors, groin problems are common, and the hockey-specific Tyler study also supports targeted adductor strengthening.
| Progression level |
Exercise option |
Clinical fit |
| Level 1 |
Side-lying adduction / short-range adductor lift |
Younger athletes, painful athletes, early exposure |
| Level 2 |
Short-lever Copenhagen |
Most players building preseason capacity |
| Level 3 |
Long-lever Copenhagen |
Stronger athletes with good tolerance |
| Level 4 |
Dynamic Copenhagen / lateral slide / skating-specific adductor control |
Advanced players, return-to-performance, high-load athletes |
| Phase |
Dose |
| Preseason build |
2–3 times per week |
| Training camp |
1–3 times per week depending on soreness and skating load |
| In-season maintenance |
1–2 times per week |
| Return-to-play |
Progress based on pain, strength symmetry, skating response, and 24-hour recovery |
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Programming point
The goal is not to make the groin sore. The goal is to build and maintain capacity.
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Clinicians should monitor, not just prescribe
For a clinician-facing injury prevention plan, the bigger takeaway is not simply “do Copenhagens.”
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Monitor early, then intervene before skating changes.
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The long-lever adductor squeeze test is a practical primary assessment. When available, a frame-stabilized dynamometer such as a ForceFrame can reduce examiner influence and allow bilateral testing. A typical protocol uses supine positioning with hips at 0° flexion, force transducers positioned just below the medial malleolus, three submaximal warm-up trials, then three maximal isometric contractions of 3–5 seconds, using the best trial for analysis.[15]
Not every setting has that equipment. Handheld dynamometry or even a sphygmomanometer can still be useful, but standardization becomes critical.
| Variable |
Standardize it |
| Athlete position |
Supine, consistent hip/knee position |
| Device placement |
Same location every test |
| Warm-up |
Same number of submaximal trials |
| Effort duration |
3–5 second maximal contractions |
| Verbal cueing |
Same instructions each time |
| Timing |
Same day relative to games/skates |
| Outcome |
Best trial or average of trials, chosen consistently |
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Testing principle
The value is not in a single number. The value is in the trend.
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Suggested hip/groin monitoring framework
| Time point |
What to collect |
Why |
| Preseason baseline |
Injury history, groin symptom history, long-lever squeeze, HAGOS, hip ROM, FADIR/FABER |
Establish risk profile and individual baseline |
| Training camp |
Squeeze test 1–2 times per week; symptom check; skating quality observation |
Camp is a high-load transition period |
| In-season high-load blocks |
Weekly or biweekly squeeze testing; HAGOS Sport every 2–4 weeks |
Detect trends before time-loss injury |
| Steady-state season |
Monthly strength/symptom monitoring |
Maintain surveillance without overwhelming staff |
| Return from injury/absence |
Re-baseline strength, ROM, symptoms, skating exposure tolerance |
Chronic load and tissue capacity may have changed |
| Congested schedule |
Monitor 24-hour response after hard skate/game |
Strength and ROM may be depressed after hockey exposure |
Published early detection strategies in other team sports have used weekly or monthly adductor strength monitoring with patient-reported outcomes. In one rugby cohort, weekly long-lever squeeze testing over 28 weeks generated 371 alerts across 39 of 49 players, with only one time-loss groin injury. In a youth soccer cohort, monthly monitoring detected 105 alerts, with most time-loss injuries classified as minimal or mild.[16,17]
These are not hockey studies, but they provide useful frameworks for surveillance frequency and alert management.
Alert thresholds: useful, but not perfect
Clinicians should be careful not to treat thresholds as absolute rules. They are decision-support tools. Still, practical thresholds can help identify when a player needs closer assessment.
| Alert |
Possible action |
| Adduction strength decline >10–15% from individual baseline |
Clinical reassessment, adjust load, targeted adductor work |
| Pain during squeeze test ≥3/10 |
Examine source of pain, reduce provocative load, monitor response |
| HAGOS Sport decline or worsening symptoms |
Review training load, skating tolerance, and clinical exam |
| Interlimb adduction asymmetry >15% |
Add unilateral emphasis and reassess |
| Hip rotation ROM decline >15° from baseline |
Assess recovery, impingement signs, and recent workload |
| 24-hour post-skating strength decline >15% |
Modify upcoming load and prioritize recovery |
| Change in skating mechanics |
Treat as clinically meaningful, even without missed time |
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Clinical reasoning still matters
The >10% threshold may be sensitive but can create many alerts. The >15% threshold may be more practical for large rosters but may miss smaller changes.[16,17] The best system combines objective data, symptoms, and function.
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Hockey-specific strength-through-range matters
Standard bilateral squeeze testing is practical, but it may miss hockey-specific deficits.
Skating loads the hip and groin through positions that are not fully captured by one neutral squeeze test. The adductors help control the leg as it moves away from the body and then help recover the leg back underneath the athlete. That means strength through range matters.
Secomb and colleagues tested hockey athletes at skating-relevant angles: 0°, 25°, and 50° of hip abduction. Their work suggests that unilateral joint-angle-specific testing may reveal deficits not captured by standard bilateral squeeze testing. Players who later sustained noncontact hip/groin injuries showed reduced hip abduction ROM and a drop-off in adduction strength between 25° and 50° of abduction.[18]
The 25° to 50° drop-off is not yet a fully validated hockey injury prediction threshold. But it is clinically useful.
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Translation
A player does not simply need a strong groin. They need a groin that can tolerate the range and force demands of skating.
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The 24-hour response may matter
Another important clinical point is that hockey exposure can acutely change hip and groin measures.
Suits and colleagues studied competitive male hockey players and found that after a single hockey exposure, total hip rotation ROM and adductor strength decreased. The decline was larger at 24 hours than immediately after skating: total hip rotation decreased by 18.5°, adductor strength decreased by 6.56 kg, and the ADD:ABD ratio dropped by 0.12 at 24 hours post-skating.[19]
Perceived exertion did not correlate with the magnitude of these changes. That matters because players may not accurately sense how much their hip/groin profile changed after a session.
| Situation |
Clinical implication |
| Back-to-back games |
The 24-hour window may carry residual strength/ROM changes |
| Training camp |
Consecutive skating days may accumulate hip/groin fatigue |
| Return-to-play |
Test response before, after, and 24 hours after skating exposure |
| Symptom-free but performance-limited athlete |
Look for objective recovery deficits |
| High soreness after adductor work + skating |
Adjust dose or timing |
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Timing matters
This does not mean every player needs daily testing. It means testing performed at random times relative to skating is harder to interpret.
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Workload monitoring: useful, but not magic
Workload monitoring is another important layer of availability.
The acute:chronic workload ratio has been associated with injury risk across team sports, and spikes above roughly 1.5 have often been discussed as concerning. However, hockey-specific thresholds are not fully validated, and ACWR methods vary widely across studies.[20,21]
Clinicians should avoid using ACWR as a rigid traffic light. But the underlying concept remains useful:
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A sudden spike in load matters.
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For hockey, external load may include skating distance, high-speed skating, accelerations, decelerations, player load, practice density, and game minutes. Local positioning systems are preferred indoors and have shown acceptable reliability and validity for measuring speed, acceleration, and distance in ice hockey.[22]
| Load domain |
Example measures |
Clinical use |
| External load |
LPS distance, speed zones, accelerations, decelerations, time on ice |
What the athlete did |
| Internal load |
Session-RPE, HR response, soreness, wellness |
How the athlete responded |
| Recovery |
Sleep hours, nutrition, fatigue, readiness |
Whether the athlete can adapt |
| Clinical response |
Pain, ROM, strength, movement quality |
Whether tissue capacity is holding up |
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Practical start
Track session-RPE, minutes, soreness, sleep, and symptoms consistently. The model does not need to be complex to improve decision-making.
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CMJ and force plate data: trend over threshold
Countermovement jump testing is increasingly common in performance settings. The key for clinicians is understanding what it can and cannot do.
Single baseline CMJ testing has limited ability to classify future injury risk as a standalone tool. In female NCAA athletes, baseline CMJ force-time metrics produced high overall model accuracy but failed to correctly classify injured athletes in that dataset.[6]
That does not mean CMJ is useless. It means single screens are limited.
Longitudinal change may be more valuable. Weekly CMJ monitoring in youth volleyball and basketball players showed that week-to-week reductions in CMJ performance greater than 8.2% predicted lower-limb injuries.[23]
| CMJ variable category |
What it may reflect |
| Jump height |
Global neuromuscular output |
| Eccentric braking metrics |
Deceleration strategy and eccentric control |
| Propulsive impulse |
Force production capacity |
| Rate of force development |
Rapid force expression |
| Asymmetry |
Interlimb strategy or recovery difference |
| Week-to-week change |
Fatigue, readiness, adaptation, or possible risk trend |
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Better question
The key is not asking, “Did this CMJ predict injury?” The better question is: “Is this athlete changing compared with their own normal?”
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Recovery metrics belong in the prevention model
Recovery is not separate from injury prevention.
In adolescent elite athletes, sleeping less than 8 hours has been associated with increased injury risk, and unhealthy diet patterns have also been linked with greater risk of new injury.[24,25]
Clinicians should not oversimplify this into “bad sleep causes injury.” That is not the point.
The point is that recovery behaviors influence adaptation, decision-making, tissue tolerance, and the athlete’s margin for error.
| Recovery factor |
Tracking method |
| Sleep quantity |
Hours slept; target trend over time |
| Sleep quality |
Simple 1–5 rating or validated questionnaire when appropriate |
| Nutrition |
Regular meals, energy availability, protein intake, underfueling flags |
| Hydration |
Practical habits, urine color when appropriate, body mass change in high-sweat settings |
| Stress |
Short wellness question, life/travel/school load |
| Soreness/fatigue |
Daily or 2–3 times per week wellness check |
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Clinical framing
A clinician-facing availability model should not separate performance and recovery. They are part of the same system.
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Contact and environment are part of prevention
Not all injury prevention happens in the weight room or clinic.
Youth body-checking policy changes have been associated with meaningful reductions in injury and concussion risk.[5,26] Flexible boards and glass have been associated with a 29% reduction in overall injury risk in international settings.[2] Mouthguards have shown a protective effect for concussion in collision sports, though they do not eliminate risk.[26]
This is important because clinicians should not place all responsibility on the athlete.
Availability is influenced by rules, coaching, equipment, rink design, officiating, contact education, and culture.
| System factor |
Prevention relevance |
| Checking policy |
Influences collision exposure |
| Rule enforcement |
Reduces dangerous contact |
| Equipment compliance |
Helmet, visor/cage, mouthguard, fit |
| Rink environment |
Boards/glass characteristics |
| Coaching culture |
Whether symptoms are reported early or hidden |
| Medical access |
Whether small issues are managed before time loss |
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System view
The athlete matters. The environment matters too.
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A practical clinician-facing availability model
For a hockey team, clinic, or performance program, the prevention model can be simplified into five layers.
| Layer |
What to track |
What to do with it |
| 1. History |
Prior injury, concussion, non-time-loss symptoms |
Flag athletes needing secondary prevention |
| 2. Capacity |
Strength, ROM, CMJ, adductor testing, movement tolerance |
Identify modifiable deficits |
| 3. Load |
Session-RPE, minutes, LPS/IMU if available, practice density |
Avoid abrupt spikes and support return-to-play |
| 4. Response |
Soreness, HAGOS, pain, fatigue, sleep, wellness |
Determine whether athlete is adapting |
| 5. Performance transfer |
Skating quality, repeated effort, position-specific tasks |
Decide whether capacity is showing up on the ice |
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Major clinical takeaway
Do not rely on one screen to predict injury. Build a surveillance system that helps guide decisions.
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The actionable take-home points
| Take-home |
Clinical action |
| Previous injury is the first screen |
Build every prevention plan around history |
| Non-time-loss symptoms matter |
Ask what players played through, not just what they missed |
| Hip/groin injuries are often undercounted |
Track symptoms and function before time loss |
| Adductor strength is modifiable |
Use progressive Copenhagen and targeted adductor loading |
| Squeeze testing is useful |
Use standardized protocols and track individual trends |
| Hockey requires strength through range |
Consider 25° and 50° hip abduction testing when resources allow |
| The 24-hour response matters |
Monitor recovery after hard skates, games, and RTP exposures |
| Workload spikes are predictable risks |
Manage training camp, tournaments, and return-to-play progressions |
| CMJ is best used longitudinally |
Track within-athlete change rather than relying on one baseline score |
| Recovery metrics belong in the model |
Sleep, nutrition, soreness, fatigue, and stress affect adaptation |
| Technology can help but cannot replace reasoning |
Use data to support clinical decisions, not replace them |
| Availability is the outcome |
The goal is not risk prediction; the goal is better decision-making |
The bottom line
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The best ability is availability.
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For clinicians, that means availability should be treated as an outcome we can influence.
Not perfectly. Not with one test. Not with one exercise. But with a better system.
Start with injury history. Identify previous concussions, recurring hip/groin symptoms, and non-time-loss problems that players may not volunteer unless asked directly. Build targeted capacity, especially in the areas hockey stresses most. Use progressive adductor work. Track squeeze strength, pain response, symptoms, and skating quality. Monitor workload. Watch the 24-hour response after hard skating. Use CMJ and technology as trend tools, not crystal balls. Protect recovery. Respect return-to-play as a continuum.
Injury prevention in hockey is not about avoiding hockey.
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It is about preparing athletes to tolerate hockey.
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Available players can train. Available players can compete. Available players can adapt. Available players can keep developing.
That is the goal.
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Available. Prepared. Durable.
Ready to play.
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References
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