Knee injuries, are among some of the most common in sports accounting for the missed time in all leagues whether you are new to the game, or at the top of the sports world. Although in contact sport we will never be able to prevent all injuries, and another player barreling through the side of your leg is likely to do some damage, there are several steps we can take to reduce knee injuries, and strive to nearly eliminate non-contact knee injuries.
These strategies are not only effective for injury prevention but also assist in making you a more powerful and dynamic hockey player. Further although we feel these strategies are important for all hockey players, if you are a female, they are even more important for you. In sports that require cutting, pivoting, and multi-directional athletic abilities, women are 4-6 times more likely to have an ACL injury than men, and 70 percent of ACL injuries occur with no direct contact (Source 1).
It is important to remember that the knee is a stable joint and it is very little we can do to directly target its structure, rather we direct our attention to the muscles and joints above and below it. It is these surrounding muscles and joints that determine how the knee will function, and focusing on them is an effective strategy for knee health and longevity.
Step #1 to Bulletproof Knees: Get Your Glutes Stronger
The glutes, specifically the gluteus medius are an important muscle group for knee stability.
Knee valgus (knees collapsing inward) has been extensively reported as a factor in ACL as well as a variety of other knee injuries (Source 2, Source 3). A ton of issues can contribute to knee valgus and it will be a reoccurring theme in this article. Weak or improperly activated glutes are one frequent cause of knee valgus (Source 4) and are one of the first things I will address when I see knee valgus occurring. There are a ton of major strengthening exercises, including squats, deadlifts, and hip thrusts that target the glutes and they should be foundational strength movements. However, they will not alone fix this issue and valgus can still occur during the movement if the stabilization muscles such as the gluteus medius are not activating.
Mini band exercises such as clamshells (either standing or lying on one’s side), can be a great tool to teach the athlete to externally rotate (open up) the hips, and serve as a great corrective exercise to activate the important muscles that resist knee valgus. At times, we can also keep a mini band around the knees while performing warm-up sets for exercises like squats to teach the athletes to keep the knees from collapsing during the movement.
The key is to develop the strength and feeling of activated glutes so that when you perform a different exercise or a skill on the ice, the glutes function properly to control the knee. Different versions of mini-band walks can also be very effective at activating these muscles. We also will discuss proper movement and cueing later, as it cannot be ignored as an important factor.
Glute Exercise #1: Standing Clamshell
Glute Exercise #2: Side-Lying Clamshells:
Glute Exercise #3: X-Band Walks
Step #2 to Bulletproof Knees: Improve Foot Stability
For some hockey players, they will strengthen the glutes properly but knee valgus still occurs. If this is the case (and they understand that they don’t want their knees to drop in), there is often a lack of stability in the feet, in fact, the feet are a common culprit for many issues throughout the body as if they are not functioning properly, we will never truly be moving on a stable base. It is worth mentioning that foot stability can go hand and hand with ankle mobility which we have discussed (here) and should not be ignored..
When performing athletic movements both on and off the ice, we want to try to achieve a “tripod foot” with the weight evenly distributed throughout the foot and the arch maintained (Source 5). Try this yourself, when you are standing up simply let your arch collapse. If it isn’t already, you will notice that as your foot collapses, your knee also drops into the valgus position as a result.
How to fix this? Simple single-leg exercises are a good start as they require a stable foot for balance. Single leg squats and RDLs are great exercises to start while focusing on foot stability. Placing two small weight plates a few inches apart, and standing on them (without shoes) with one under your heel and one at the front of your foot can teach you to hold an arch position as your arch will literally be the bridge between the two. Simply balancing on one leg is a challenge for most people, but if you can master this, you can move to a movement such as an RDL while on the plates, and focusing on keeping the knee aligned over the foot.
Step #3 to Bulletproof Knees: Improve Hip Mobility (Internal Rotation)
While training for strong glutes will help stabilize the knee, the hips still need to be able to move freely, and many hockey players are overly tight in the hips to start. Internal rotation specifically is important, because at times contact sports such as hockey force us into bad positions and we need to have some flexibility without simply breaking. More often than not a hit to the outside of the knee will cause an injury, however, if there is some movement allowed at the hips, the force will not all be taken by the knee and the severity of an injury may be reduced. If the hips are completely locked on the other hand, much less force to the outside or inside of the knee will cause it to give out.
One way to think about this is to look at goalies and their butterfly position as it requires great internal rotation of the hip in order to kick the feet out to the side while sealing the five-hole. The knees in this position have dropped right in, similar to the valgus position we typically want to avoid, but goalies can get in and out of this position quickly for thousands of repetitions and don’t snap their ACL doing so. Why? They have so much internal hip rotation that their femur can rotate, and the stress of this movement is not placed solely on the knees.
There are tons of great ways to mobilize your hips and to really get them moving smoothly you will probably need to do a few. One great exercise we use religiously at relentless hockey is the 90-90 stretch or some variation of it. This stretch is a great bang for your buck to target both internal and external rotation of the hip, and spending some time with this one is a great start to unlocking your stiff hips.
Internal Hip Rotation Exercise: 90/90 3-Way Stretch
Internal Hip Rotation Exercise: 90/90 Flow
Step #4 to Bulletproof Knees: Increase Your Relative Hamstring Strength
One general trend we find in many athletes, hockey players specifically, is an imbalance between the quadriceps and the hamstrings. For several reasons this is often a focus for our offseason programs, with increased risk for knee injuries being one of them (Source 6). Since these are some of the largest muscles that stabilize the knee, imbalances can be troublesome. Reduced hamstring activation in comparison to the quadriceps can cause the knee to track improperly, often resulting in valgus (Source 3, Source 7)
Many heavy compound movements are great for developing the hamstrings if coached properly. In addition, movements such as eccentric slider/swiss ball curls directly target the hamstrings and will help even out this imbalance. Single leg romanian deadlifts are another favourite to target the hamstrings. Although they require some practice, they are also a great tool to teach stability from the foot all the way up the chain while moving through the important hinge pattern. In my opinion this is one of the most important exercises for any athlete to get comfortable with, and although challenging, they provide a great return on your investment.
Hamstring Exercise: Swiss Ball Curl
Hamstring Exercise: Single Leg RDL
Step #5 to Bulletproof Knees: Improve Your Movement Quality
Although this may seem like a no brainer, the way in which we train ourselves to move is by far the most important thing we can do to keep our knees healthy. “High risk” movement patterns have been seen at all levels of play (Source 8), not just amongst beginner athletes. If your knees are dropping inward on a squat or jump, being told by a coach to keep them out may be enough to solve the issue (this should almost always be step 1), and practicing these now proper reps will go along way in keeping your knees healthy. Although working with a coach who has a good eye for proper movement is your best bet, taking a video of your exercises are a good start if you are by yourself.
Movements such as single-leg landings are a great teaching tool. Many knee injuries occur when we have to stop rapidly or plant a foot hard to change direction, so learning to properly land and absorb force is crucial. Many noncontact knee injuries occur when the hips are fully extended, but the knee is slightly bent forward and turned inward placing almost all of the stopping force on the knee. Because of this we are always teaching athletes to land from jumps by using their hips instead of a simple knee bend. This position is both safe and allows for more power to be produced. The video demonstration below of single-leg landings shows the proper loading of the hip, as well as the knee, and for any athlete, mastering this movement should be the first step before an extensive plyometric program occurs.
At first, try to do these with a slight pause upon landing, without a ton of hopping around, to really get comfortable in this position. They are harder than they look!
Whether you have struggled with knee injuries before, have nagging aches, or are trying to prepare for another injury-free season, these recommendations are important for any hockey player regardless of your level of play. Give them a shot today!
Kyle is a Hockey Performance Specialist who’s worked with hundreds of hockey players from Peewee to Pro. A former elite hockey player, Kyle earned his degree in Kinesiology before becoming a Strength Coach that specializes in hockey performance. Today, he runs Relentless Hockey where he works with players across the world, including pros in over 20+ leagues including the NHL, KHL, and OHL.