Cleveland_Clinic_Host: Winter sports such as hockey and skiing can produce a range of injuries. When to seek medical care is not always clear. Knee pain may result from tendonitis due to overuse injury or to a torn ACL (anterior cruciate ligament). Our expert can address tendonitis, knee ligament injuries, shoulder instability and shoulder separation. Learn when to consult a sports medicine specialist about pain, and how new, less invasive procedures can minimize your time off the ice and away from the slopes.
Tony Miniaci, MD, is the Executive Director of Cleveland Clinic Center for Sports Health and a professor at the Cleveland Clinic Lerner College of Medicine. His specialty interests include shoulder and knee arthroscopy and reconstruction and cartilage and implant joint resurfacing.
An orthopaedic surgeon from Toronto, Canada, Dr. Miniaci was a full professor at the University of Toronto. He also has belonged or served on the numerous Committees of the American Orthopaedic Society for Sports Medicine; American Shoulder and Elbow Society; International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine; and the Canadian Orthopaedic Association.
Dr. Miniaci was Team Physician for the London Tigers Baseball Club from 1990 to 1993, and he has been an Orthopaedic Consultant to the Toronto Blue Jays since 1995. He has also worked as a consultant to the National Hockey League Players Association and served as the Head Team Physician for the Cleveland Browns Football from 2003-2009.
To make an appointment with Tony Miniaci, MD or any of the other specialists in our Center for Sports Health at Cleveland Clinic, please call 877.440.TEAM. You can also visit us online at www.sports-health.org
Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Anthony Miniaci. We are thrilled to have Dr. Miniaci here today for this chat. He is the Director of Cleveland Clinic Center for Sports Health and an Orthopaedic surgeon. Let’s begin with the questions.
Winter Sports Injury Treatment
hortonwho: What is best for pulled or sore muscles, icing the injury or heat? I have heard arguments supporting both sides.
Speaker_-_Dr__Miniaci: The concept behind heat is to improve blood flow to the area. The concept behind cold therapy is to decrease the inflammation. As you said, there are discussions both directions. Spasms are best treated with heat
jollyholly: With muscle aches and sprains, how do you know when rest is better or therapy is better?
Speaker_-_Dr__Miniaci: Time is a great indicator. If the pain is persistent and does not go away after a couple of weeks or if the pain is intolerable, it is recommended to be evaluated by a physician.
John88: Hello - With winter upon us, the rink is getting colder. Do colder temperatures increase the risk of injuries? If so, what can the players do to decrease this risk?
Speaker_-_Dr__Miniaci: There is no evidence to show that the colder temperatures increase the risk of injuries but it is important to do appropriate warm-ups and dress appropriately.
growingold: It is important to go to rehab after a sports related injury? Does age make a difference?
Speaker_-_Dr__Miniaci: Unfortunately, age makes a difference with everything. Good rehabilitation programs following injury or surgery will help in your recovery.
Icemom4: What is the most common hockey injury you see among youth hockey players that are at the checking level? What recommendations do you have for these players to prevent this injury?
Speaker_-_Dr__Miniaci: The most common injuries are high impact, high speed and high velocity injuries.
- The most rigid impediment are the 'boards’ that players are checked into when hit. Therefore, shoulder injuries and shoulder separations are the most common injuries from hitting the boards.
- High ankle sprains are common in hockey players as well, because the player plants the skate and gets caught in the ice, giving them a rotational injury.
- Groin injuries are common especially in goalies.
- Knee injuries occur but are much less common than in a sport such as football
John88: What role does equipment play in preventing hockey injuries? Do you have any recommendations for younger hockey players?
Speaker_-_Dr__Miniaci: Over the years, there have been many changes in the equipment and the rules. Specific examples are hockey face shields to prevent eye injuries, mouth guards are mandatory, helmets and goalie equipment have greatly improved. Some of the rule changes, such as checking from behind, have been banned. Yet, at the end of the day, hockey is still a high speed and high impact sport where injuries can occur.
TC: What exercises or stretches should youth hockey coaches be recommending before games and practices?
Speaker_-_Dr__Miniaci: A general warm-up and good conditioning is the best. There is not a lot of good evidence to show that stretches actually reduce injuries. A general conditioning program is important because fatigue does play a role in injuries.
ELNmom: My son fractured his femur playing high school hockey a couple of years ago. He had surgery, but still feels the 'weather' changes. The fracture went through the growth plate - but his growth was definitely not affected since he is now 6'2". What is the theory behind feeling weather changes in your bones?
Speaker_-_Dr__Miniaci: We know that different levels of humidity and temperature will cause different levels of fluid retention. People with arthritis complain of this same phenomenon.
jcritzer: As a coach what can we do to lessen/minimize the 'risk' of injury to the kids? before/during/after being on the ice?
Speaker_-_Dr__Miniaci: Good general conditioning, good understanding of the rules, education about irresponsible actions (such as stick swinging from emotions) is vital. Players often feel that they are protected and the risk of injury is lessened because of all the equipment - but they can still be injured. Post game conditioning is important because of the aerobic benefits.
Sekiya: Are there any new shoulder repair techniques on the horizon for hockey injuries?
Speaker_-_Dr__Miniaci: We are always making medical advancements. The advent of arthroscopy back from the 1970's has assisted with the developments. A lot of our work is focused on prevention of these injuries and trying to be as minimally invasive as possible, so we do not interfere in normal mechanics with a surgical repair.
calabrese: My son has been getting back spasms while playing hockey. He doesn't get them all the time, and he is usually fine off the ice. The spasms are along the spine in his upper back. What are some possible causes for this and should I take him to be looked at? I don't want him to end up with something more serious because I didn't take care of the problem now, when it is not too bad.
Speaker_-_Dr__Miniaci: If the spasms persist they should be evaluated. It is difficult to determine if this is a chronic condition or a new occurrence.
eriknystrom: How can players avoid being hit from behind while still working to get the puck?
Speaker_-_Dr__Miniaci: One of the most important things is for the player to understand that hitting from behind is not only bad sportsmanship, but is also dangerous. The STOP sign on the back of jerseys actually started at the NHL level.
happyg: I know that the Clinic was sports "clinics" for certain sports, such as golf. Do they have one for hockey?
Speaker_-_Dr__Miniaci: We are developing multiple sport specific athletic performance programs now, as a result of our other successful programs. Because of my big interest in hockey, we are working in this area. We do not have a formal program at this time, but we have a number of people that can provide evaluations and recommendations at our Center for Sports Health at Cleveland Clinic.
beth: Over the years I have taken my young hockey son to a variety of practitioners to deal with keeping weight on, asthma, shoulder injuries for sports etc. Is there one place that I can take him for all of these services?
Speaker_-_Dr__Miniaci: Great question! As you may or may not know, last year Cleveland Clinic opened a free standing sports facility off of I-480. The concept of this facility is to provide a holistic approach to athletic injuries. We have specialists here ranging from primary care sports medicine physicians, nutritionists, therapists and 2 orthopaedic surgeons. We provide many of the services on site including rehabilitation, performance programs, radiology and surgery.
Cleveland_Clinic_Host: To make an appointment with Tony Miniaci, MD or any of the other specialists in our Center for Sports Health at Cleveland Clinic, please call 877.440.TEAM. You can also visit us online at www.sports-health.org.
eriknystrom: After a femur break, due to a hockey collision, how likely is it that the femur could be re-injured?
Speaker_-_Dr__Miniaci: Assuming everything healed properly, and sufficient time has passed for the bone to remodel, there should not be increased risk of fracturing at the exact same site. However, sometimes the fractures heals itself by creating thick bone around the area, thus becoming stronger than areas surrounding the fracture --those areas may fracture.
nystrom: What are the most common ski injuries? Do you see different types of injuries between snow boarders, X-Country skiing and downhill skiing?
Speaker_-_Dr__Miniaci: Yes, we see different injuries because the athletes fall differently.
- Snow boarders will put their hands down and fractures of the wrist and fingers are more common.
- In downhill skiing, the athletes see more knee injuries.
- X-country skiers have more chronic inflammation injuries, such as tendonitis, because it is an endurance sport.
mannerly: Would wearing a knee brace while skiing help prevent injuries?
Speaker_-_Dr__Miniaci: There is no evidence to indicate that prophylactic bracing will prevent injury.
sillyme: Is it OK to go back to skiing after knee surgery? I did not want to have a replacement because they told me skiing would be out if I did.
Speaker_-_Dr__Miniaci: You should follow the recommendations of your physician, depending on what type of knee surgery you had. Just because someone has a knee replacement does not preclude some individuals from skiing. Check with your doctor.
eriknystrom: What type of helmet should be used when skiing to maximize protection?
Speaker_-_Dr__Miniaci: There are different types of ski helmets, depending on the type of sport: slalom skiing, ski jumping etc. A helmet that fits well and protects your head is the most important.
speakplain: With winter sports, is there a recommendation on how long you can be outside (and at what temperatures) before needing to come back in and warm up? My kids would stay out for hours, while I am freezing after 1/2 an hour.
Speaker_-_Dr__Miniaci: Feeling cold and frost bite are different. There are specific recommendations. Blanching of the exposed skin is indicative of developing frostbite. Skin protection is most important, and making sure that you feel warm.
kajr0210: Occasionally, my son gets bumped against the boards during full-contact hockey. Although his head is protected by a helmet (and he wears a mouth guard) what are the common symptoms of a concussion? When is emergency medical treatment necessary?
Speaker_-_Dr__Miniaci: Symptoms of a concussion include: brief loss of consciousness; disorientation; gait/ balance disturbances; amnesia and/or neck pain.
Ruling out any injury to the neck is the initial evaluation on the ice. The player should then be removed from competition and periodic re-evaluation if SYMPTOMS should continue.
Emergency medical evaluation with MRI or CAT scan is necessary if unconsciousness persists or is prolonged. SYMPTOMS persisting longer than 48-72 hours generally warrant imaging.
Cleveland Clinic has a sports concussion program called ImPACT (Immediate Post-concussion and Cognitive Testing).This is an evaluation with state-of-the-art computer technology that is able to make a more precise diagnosis of a concussion, rather than conventional imaging technology such as CT and MRI scans.
If a concussion is present, Cleveland Clinic Sports Health physicians can meet with the athlete to discuss the concussion rehabilitation program. For more information you may contact our Center for Sports Health at Cleveland Clinic at 877.440.TEAM. You can also visit us online at www.sports-health.org
canto2: Are head injuries a big issue in winter sports? What are some of the long term affects of these head injuries? My son's friend had a skull fracture from a fall, even though he was wearing a helmet. In fact, it was from the helmet. Is there anything you can do to the helmet to make it safer? What is the proper fit?
Speaker_-_Dr__Miniaci: Helmets do not cause skull fractures; it is likely the impact of the trauma. Head injuries are quite an issue in high speed sports such as skiing and hockey. No one should participate in either sport without a helmet. There is constant product improvement with fitting the helmets.
dddna5: Is there an easy way to determine an injury to the knee is more than a sprain?
Speaker_-_Dr__Miniaci: If the knee immediate swells, that is a great indicator that something is occurring in the joint. Losing the forward motion of the knee also indicates the need for an evaluation.
Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Anthony Miniaci is now over. Thank you again Dr. Miniaci for taking the time to answer our questions about winter sports injuries.
Speaker_-_Dr__Miniaci: Thanks for all the great questions, Being Canadian by birth my love of hockey and skiing comes honestly. If you are going to live in a northern climate there is nothing better to make these long cold winters go very quickly. We feel at Cleveland Clinic Sports health that we have some exceptional individuals and programs that can help meet your medical needs when it comes to a variety of sports including hockey and skiing.
- To make an appointment with Dr. Anthony Miniaci or any of the other specialists in our Center for Sports Health at Cleveland Clinic, please call 877.440.TEAM. You can also visit us online at www.sports-health.org
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This chat occurred on December 11, 2009.
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