Breathing to help fix and prevent hockey injuries

Let me paint you a picture.

You’re referred to me by your physical therapist, coach or a friend and walk in ready to get your ass handed to you in the assessment. After our initial conversation, I tell you we’re going to start the session with some breathing drills.

You glaze over and assume it means something else, until I tell you to lie down on your stomach and take a deep breath.

“Wait, you just want me to breathe?”

“That is correct.”

Almost every time, I can provide a new client a take-home benefit with a couple of breathing cues, all inside the first 2 minutes on the gym floor.

Why, you ask? Well there are lots of reasons why breathing is a good practice to get into; and I’m not talking about the breathing we do mindlessly, day-in day-out. I’m talking about mindful “diaphragmatic” or “belly” breathing.

We live in what I’d call a very sympathetic world. Our sympathetic nervous system, also known as fight-or-flight, is cranked up all the time. It serves us hockey players well, too. We need that fast twitch speed and ability to assess situations quickly on the ice.

All this stress kind of shuts down our parasympathetic nervous system, also known as rest-and-digest. You know, the one that fixes all our bumps and bruises? Ya, that one.

The diaphragm is actually intended to be our body’s primary breathing muscle, but as a consequence of modern life, it’s been shunned like the grocery stick is to the middle of the bench. Instead, the much less efficient breathing muscles of the upper chest and neck then must take over, creating all sorts of issues.

Image courtesy of Crossfit Southbay, via A.D.A.M

Although it doesn’t look very sexy, diaphragmatic breathing allows us to create a better balance between fight-or-flight and rest-and-digest, and could be the key to fixing a lot of movement issues as well.

When you breathe, this dome-shaped muscle contracts, allowing the lungs to take in air. What you should see is the stomach rising as the dome compresses the abdominal cavity. This is why the best cue is to “get fat” if you’re having trouble figuring it out. I often see the exact opposite, and while it may present a more pleasing side profile, it only allows the lungs to partially expand and results in weaker core stabilization.

Image courtesy of painfreeoutlet.com

So why do we do it? Not only is it a good idea to get back to the muscles we should be using for an activity like breathing, but an underactive or dysfunctional diaphragm is going to lead to movement issues and unresolved injuries or tweaks. Neck and shoulder issues are the bulk of what I see, but back and hip irritation have also been linked to breathing concerns.

Proximal stability leads to distal mobility.

If we can create more stability in the core and centre of the body, the limbs and other areas where we need to be more mobile are free to do their job as well.

Below, I’m going to give you several tests to try based on areas that you may have trouble with or issues you want to clean up. The protocol here is to test the movement, correct with a breathing drill, then re-test to see if it got better.

If it did, great! If not, we may have to do some more digging. The breathing correctives are outlined at the end of the article.

FIX #1: SHOULDER ISSUES

I found it very interesting how many people had shoulder pain and dysfunction when I first started training. And hockey players? Well that’s pretty much a no-brainer, we all have some sort of shoulder issues, right?

I cleaned up their technique, had them pull way more than they pushed and focused on opening up their thoracic spine. Things got better, but never really got better, ya know?

Then I went further down the rabbit hole and recognized there was more to it. I realized that almost all shoulder problems are somehow tied to breathing mechanics, and a couple of simple drills can make a world of difference, especially when done consistently. Here are two (related) tests to see where problems may lie and outline the path to correcting them.

Shoulder Test/Re-Test #1: Active and Passive Shoulder Flexion

You may have to stand against a wall to do this properly, but stand tall and proud and slowly brings your hands up over your head in front of you. Your ribcage should stay down (the back should stay against the wall) and the head should stay in a packed position (no poke-necks).

How high did your arms get? Was there any pain?

Here’s an example of a bad active shoulder flexion (left) and a good active shoulder flexion (right). If you’re not careful, you may think the “bad” test is better than the good one. A closer looks reveals that the client is flaring his ribcage, overextending his lower back and poking his head forward. The test on the right is a true test of his active shoulder flexion.

Don’t get caught thinking your shoulders are da bomb, mmkay?

Photo courtesy of Tony Gentilcore

The passive test is the same as the active test, only lying down on your back. The knees should be bent and feet flat on the floor or table. The ribcage should stay down and lower back flush to ensure a true test.

Photo courtesy of Tony Gentilcore

We will review correctives later in the article.

Shoulder Test/Re-Test #2: Scapulo-Humeral Rhythm (probably need a friend for this one)

Stand in the same position as your active shoulder flexion test, but this time we’re going to bring the arms overhead by your sides, trying to touch the backs of your hands together above your head.

As the arms move overhead, the scapula should rotate ½ as much as the humerus does. So, to get overhead (180 degrees total), the humerus should rotate upward 120 degrees and the scapula should rotate the remaining 60 degrees.

Image courtesy of BEST Performance Group

If there is any pain with this movement, you should see a registered healthcare professional like a physical therapist (or refer to one, if you’re a trainer).

However, if your hands can’t touch at the top, see if your friend can just help it along by manually moving the shoulderblade into your armpit, as seen in the photo.

Better? Great, let’s get to breathing and fix it up.

FIX #2: (SOMEWHAT RELATED) BACK ISSUES

Everyone who’s ever had back issues raise their hand! Ya, a lot of us have, myself included and it’s no fun. Whether it’s chronic back pain or a little tweak here and there, worrying about blowing your back out is a real concern for many people.

You’re scared to lift things around the house, scared to bend over the wrong way and especially scared to go into the corners and mix it up. We can’t be having that… let’s fix it.

I said that lower back and shoulder issues can be related because their main structures are intimately connected via the thoracolumbar fascia. You can see the lats (major players in the shoulder) and the glutes (major players in the lower back) in the image below. If you have issues getting your arms overhead, you may very well have lower back problems as well, and vice versa.

Image courtesy of Neil Asher Healthcare

Back Test/Re-Test: Active Straight Leg Raise

This one is nice and simple. Lie on your back, legs straight. Lift one leg as high as you can before you stop or you feel pain. The knee should stay straight. Note how high you got. A good score is 90 degrees with no movement in the opposite leg.

Image courtesy of deansomerset.com

There are several other tests that I would complete before working on some breathing mechanics, but they’re beyond the scope of this article and would not be suitable without a trained professional to watch.

FIX #3: LIFTING HEAVY STUFF

There’s no question that if you’ve ever done a heavy squat or deadlift and not wrecked your back, you know that you need to be able to create massive amounts of tension through your core. If you can’t, you get hurt, pretty simple.

And I just told you in my last article that strength is the foundation that all other athletic attributes are built on, so best get to lifting, eh?

The diaphragm plays a massive role in stabilizing the core. It forms the lid on the “core box”, working with the obliques, quadratus lumborum, pelvic floor and transverse abdominus. Being able to take in air and maintain a high-pressure area in the abdominal cavity is crucial for lifting heavy (another reason I start with breathing drills).

Not only will these breathing drills assist in improving movement patterns, they’ll set up the context for creating tension before and during a heavy lift.

FIX #4: RELAXATION

You ever get home from a game knowing you need to get to bed but just can’t seem to shut your brain off? So you lie there, physically exhausted but mentally wired, replaying all the scenes of the game and watching the clock tick and tock it’s way to your alarm.

Yeah, me too.

Needless to say, the hockey world has a sleeping problem—I’m pretty sure most of us can agree.

So, when you watch the videos below, don’t just put them in the “workout” box, but remember they can also have a positive impact on your ability to relax and even fall asleep.

THE BREATHING CORRECTIVES

Prone Crocodile Breathing

If you’re new to the diaphragmatic breathing game, this is your place to start. Maybe you scored poorly on one of the above tests or you have an itch to throw more weight on the bar but aren’t yet comfortable doing so.

Either way, give this drill a shot before moving on.

https://www.youtube.com/watch?v=gxEGxqg2CEE

Prone Lengthening

This one is particularly useful if you have trouble with your shoulder and/or struggled with the shoulder flexion and scapulo-humeral rhythm tests. Many people’s shoulder dysfunction comes from a number of factors, one of those being tight/ropey serratus anterior. This drill will help to release that muscle, allowing it to do it’s part in moving the scapula to get that arm overhead.

As you can see, the serratus anterior (SA) works in concert with the upper traps (UT) and lower traps (LT) to allow the scapula to upwardly rotate.

Image courtesy of FlexibilityRX

https://www.youtube.com/watch?v=nWaOCaN818c

Crook Lying Belly Breathing

This is another great beginner drill as the lower back is supported and the table or floor can provide external feedback. This is also the best position for belly breathing, allowing the belly to fully expand. Along with the others, this one is great for those with back or hip issues.

https://www.youtube.com/watch?v=KgxQ_DoQRd4

Quadruped Breathing

This is another great drill for those with issues rotating that scap when going overhead. The serratus anterior is a massive player and if you can get it rotating properly (or at least better than it was), you may be able to provide relief and learn what it is you need to focus on moving forward.

https://www.youtube.com/watch?v=a-2RCN0Rv38

So there you have it, a good, hard look at what you should be looking for and how to make it better, just by changing the way you breathe.

If you have any questions related to this article or strength and conditioning in general, please don’t hesitate to comment below or get in touch with me via Instagram.

Yours in breathing,

Coach Gav