Hockey and Skating Injuries in Ajax: Imaging Basics

Ice sports produce a particular mix of injuries. Skaters move fast on a surface with almost no friction, wear rigid boots that lock the ankle in place, carry sticks, and share the ice with a hard rubber puck and solid boards. Add in body contact at some levels of hockey and the result is a set of injuries that looks quite different from what you see on a soccer field or running track.

For Ajax families with kids in minor hockey, adults in a beer league, figure skaters, ringette players and anyone who enjoys a public skate, it helps to know which injuries tend to involve bone, which tend to involve soft tissue, and which belong in an emergency department rather than a community clinic. This guide walks through those categories and explains where imaging, especially X-ray, usually fits in.

It is written for general understanding. A health-care provider, team physician or sports medicine clinician should assess any injury and decide whether imaging is needed.

First, the injuries that cannot wait

Before getting into the everyday bumps, it is worth being clear about the situations where the right answer is 911 or the nearest emergency department, not a clinic visit:

• Any suspected neck or spine injury, such as after going headfirst into the boards. If a player has neck pain, numbness, tingling or weakness, they should not be moved except by trained responders.
• Head injuries with worrying signs, including loss of consciousness, repeated vomiting, worsening headache, confusion, seizure, slurred speech, unequal pupils or unusual drowsiness.
• A skate blade cut that is deep or bleeding heavily, particularly at the neck, wrist or thigh.
• An obviously deformed limb, a bone through the skin, or a hand or foot below an injury that is cold, pale or numb.
• Inability to bear any weight after a significant impact, or severe pain that is escalating.
• A hard blow to the abdomen or chest followed by increasing pain, shortness of breath, dizziness or fainting.

Arena staff, coaches and trainers are often first on the scene for these, and following their lead on calling for help is the right move.

A note on concussion

Concussion deserves its own mention because it comes up so often in hockey. A concussion is a brain injury that affects how the brain functions. It is diagnosed by a health-care provider based on how the injury happened, symptoms and an examination.

A plain X-ray does not show a concussion. Imaging is generally used to look for other problems, such as bleeding or a skull fracture, when a provider is concerned about them, and that imaging is typically done in a hospital setting. If a player has symptoms after a hit to the head, they should be removed from play and assessed by a provider, who can guide the return to school, work and sport.

Collisions and the boards: shoulders, collarbones and ribs

Contact with the boards or another player often loads the shoulder girdle. Common concerns include:

• The collarbone, which can break when a player falls directly onto the shoulder or an outstretched arm
• The joint at the top of the shoulder, where the collarbone meets the shoulder blade, which can be sprained or separated
• Shoulder dislocation, where the top of the arm bone comes out of its socket
• Rib injuries from a check or a fall onto a stick or puck

An X-ray is a common first look in many of these situations because it shows the bones and how they line up. For a separated shoulder, a provider may want specific views. Shoulder soft tissue such as the rotator cuff is better assessed with other tests, and a provider may later consider an ultrasound if pain or weakness persists.

Rib pain is worth mentioning separately. Many rib injuries are managed without imaging, but chest pain with breathing difficulty is an emergency.

Falls on the ice: wrists, elbows and tailbones

Every skater falls, from toddlers on their first outing to experienced players. The hard surface means falls often land on:

• The wrist and hand, as the arm reaches out to catch the body
• The elbow, especially in falls backward or sideways
• The tailbone and hip, in falls straight back

Children and teens are especially prone to wrist and elbow injuries during public skates and learn-to-skate programs. Their bones are still growing, and injuries near the growth plates need careful assessment. If you are thinking of bringing a child to Rossland Diagnostic Clinic for an X-ray, please call 905-426-3111 first to confirm the arrangements before you come.

For a fuller look at why a sore wrist can be either a sprain or a fracture, see our earlier post on telling fractures and sprains apart.

Pucks, sticks and blocked shots: hands and feet

A frozen puck travelling at speed can do real damage, even through equipment. Blocking a shot with the foot can bruise or break the small bones inside the skate. A slash across the hand or fingers can fracture a finger bone even through a glove.

Signs that often lead a provider to consider an X-ray include:

• A finger that is crooked, rotated or will not straighten
• Swelling and tenderness over a specific bone in the hand or foot
• Difficulty gripping a stick or pushing off in a skate
• Pain that is still significant a day or two after the impact

One practical tip: if a foot has taken a puck, getting the skate off promptly and checking the area can help, because swelling inside a tight boot can make things more painful later. Follow any first-aid guidance from the bench or your provider.

Twists in a rigid boot: ankles and knees

Skate boots are designed to support the ankle, which changes the way ankles get hurt. Rather than the classic rolled ankle seen in court sports, skaters can injure the ligaments higher up, just above the ankle joint, when the foot is forced outward. These injuries can be slow to heal.

Knees are another common site, particularly when a player catches an edge or collides at speed. Many knee injuries involve ligaments or cartilage rather than bone. X-ray may still be part of the assessment to check the bones and rule out a fracture, while other imaging, arranged by your provider, may be needed for the soft structures inside the joint.

Overuse: hips, groins and backs

Skating is built on a powerful sideways push, and that motion places repeated stress on the hip and groin muscles. Groin and hip flexor strains are common in hockey players and figure skaters alike. Lower back pain is also familiar in skaters who spend a lot of time bent forward, and in figure skaters who repeat jumps and landings.

These overuse injuries usually involve soft tissue, and imaging is not always needed. When a provider does want imaging, an X-ray may be used to look at the hip joint and pelvis, while ultrasound may be considered for certain tendons and muscles. Persistent back pain in a young athlete, particularly one involved in jumping sports, is something to raise with a provider rather than push through.

What to expect at an X-ray visit

If your provider recommends an X-ray and the injury is stable, Rossland Diagnostic Clinic at 300 Rossland Road East in Ajax offers walk-in digital X-ray. Hours are Monday to Friday, 9:00am to 5:00pm, and Saturday, 8:00am to 3:30pm, but the department may close early once it reaches daily capacity. Calling 905-426-3111 for live availability is the best way to avoid a wasted trip, especially on a Saturday after an early-morning game at a local Ajax arena.

Some practical notes for players coming straight from the arena:

• Change out of your gear first. Shoulder pads, shin guards and skates need to come off for the images. Loose, comfortable clothing makes positioning easier.
• Remove metal near the injured area, such as rings, watches or chains. You may be asked to take off jewellery.
• Bring a health card and any paperwork from your provider. If you are unsure what you need, ask when you call.
• Expect more than one view. The technologist will position the injured area a few different ways to get a complete picture, moving gently and only as much as needed.

Free parking and ground-floor access help when you are arriving on crutches or with an arm in a sling. Digital images allow physicians to access them quickly, the report goes to the provider who ordered the test, and the clinic will promptly alert your physician to urgent findings. Images can be provided on CD when required, for example if you are referred to a fracture clinic or sports medicine specialist.

Notes for hockey parents and adult rec players

For parents. Kids are often keen to get back on the ice and may play down pain to avoid missing a game. Watch for a child who stops using a hand, favours one leg, or cannot do skills they could manage last week. A quiet change in how they move can tell you more than what they say. Your child’s provider can help decide whether imaging is needed.

For adults. The beer-league player in their forties often has the same competitive instincts as at seventeen, with bones and tendons that heal a little more slowly. If you are still sore a week after a collision or a fall, it is worth getting checked rather than taping it up and hoping. If you have broken a bone in what seemed like a modest fall, ask your provider whether a bone mineral density test should be part of the conversation; that test needs a referral.

For everyone. Well-fitted equipment, a proper warm-up, and following your league’s rules on contact go a long way. So does sitting out when something does not feel right.

Arenas in Ajax, Pickering and Whitby are busy from September through spring, and many of us spend our winter weekends in them. If an injury on the ice leads your provider to recommend an X-ray, call Rossland Diagnostic Clinic at 905-426-3111 for walk-in availability, or request an appointment for other imaging you have been referred for.