Groin Strains in Hockey Players—Strength or Stretch Problem?

Abstract & Commentary

Synopsis: Muscle strength proved to be more important than flexibility in preventing muscle strains in hockey players.

Source: Tyler TF, et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001; 29(2):124-128.

Adductor strains are among the most common injuries sustained in skating athletes. In hockey players, the powerful eccentric contraction of the adductor muscles during the skating stride places the muscle group at high risk for injury. Other strength imbalances are responsible for injuries in other sports, such as the hamstring in sprinting athletes. The purpose of this study was to determine if hip flexibility and surrounding muscle strength are related to adductor strains in hockey players.

This is a prospective study of players on 1 NHL team over 2 seasons. During preseason screening exams, hip flexibility and strength measurements were recorded. The team physician made the diagnosis of an adductor strain. Injury was defined as any event that kept a player out of practice, or a game, or that required medical attention. Hip strength was measured by an instrumented manual muscle-testing device (Nicholas Muscle Tester). Hip flexibility was measured by a goniometer.

Eighty-one players were tested over the 2 seasons and 34 were cut from the team. Therefore, injury data were available on 47 players. Eleven adductor strains occurred in 9 players. Preseason hip adductor strength was equal right-to-left, but 18% lower in those with injury than those without. Hip flexibility was not associated with adductor injury.

Comment by James R. Slauterbeck, MD

So how many times have we told our athletes to stretch and stretch more so they will not "pull a muscle?" So which is better, to stretch or to strengthen? I believe both are important. This article demonstrates the importance of strengthening the agonist and antagonist muscles around the hip.

In a sport like hockey, in which anaerobic, high-speed, powerful bursts are common, the strength differences between large muscle groups are likely to become quite relevant, especially as fatigue becomes a factor late in the game. The important eccentric contraction of the adductor muscle group is paramount to the skating stride. Injury to the group is immediately evident as the agility of the athlete is greatly affected. Some adductor strains can end seasons or significantly decrease the effectiveness of the athlete.

Stretching still has many potential benefits for athletes. Stretching has been shown to increase muscle blood flow, thus increasing warmth and likely increasing muscle recruitment. Muscle flexibility increases range of motion and will increase power production. Therefore, as in muscle strains, a balance of stretching and strengthening will likely produce the best results for the overall health of our athletes.

However, for muscle strains we need to pay more attention to the adductor strength and set up our off-season training programs to increase the strength of the adductor muscles. This study should be remembered as we counsel our strength coaches and athletic trainers as to the importance of setting up balanced muscle strengthening programs for injury prevention.