HISTORY:

motocross

Hockey derives its name from field hockey, which has been played for several centuries in England.  Ice hockey evolved from field hockey, bandy, hurley and similar games that require the hitting of a ball with a stick between two uprights.  Games such as these have been played since 400 B.C., according to historians.

There is little doubt that modern ice hockey was first played and developed in Canada.  After the Canadians observed the Iroquois Indians chasing deer across the ice on skates made of bone, they used skates to play bandy.  This early game has evolved into what we know as modern hockey.

The Amateur Hockey Association of Canada and the Ontario Hockey Association were the first two organized leagues and were in competition with each other for players.  Realizing that they would run each other out of business by competing, they merged to form the National Hockey Association in 1910.  It was renamed the National Hockey League in 1917, when the owners restructured the league to omit one owner from membership.

SYNOPSIS

Hockey is played on a rink, or ice surface, two hundred feet long and eighty-five feet wide.  The rink is surrounded by the "boards," a fiberglass or wooden wall forty to forty-eight inches high.  Ten feet from each end of the rink, and centered on a line drawn the width of the rink, are the goals.  Each goal is framed by two vertical goal posts, four feet high and set six feet apart.  A metal crossbar connects the tops of the two posts.  Attached to the goal frame is a nylon net, which "catches" pucks that have entered the goal.

A hockey team may have up to seventeen players eligible to play in a game, not more than six of which may be on the ice at one time.  Each team is allowed one goalkeeper and five "regular" players on the ice at a time.  Players may be changed at any time during play, provided that the players leaving the ice are at the bench and out of the play before replacements come on.

The goalkeeper may wear any protective padding to guard his body, provided it does not give him "undue assistance in keeping goal."  Any protective mask approved by the Rules Committee may be worn by a goalkeeper.  All players must wear an approved helmet, unless they were under contract to an NHL team prior to June 1, 1979.

The puck must be composed of vulcanized rubber, one inch thick, three inches in diameter, and between 5.5 and six ounces in weight.

An official game consists of three twenty minute periods, with a fifteen minute intermission between periods.  The team scoring the greatest number of goals is the winner.  In case of a tie, the teams play an additional five minute period, with the team scoring first being named the winner.  If the score remains tied after the five minute overtime, the game is declared a tie.

A goal is scored when the puck is put between the goal posts, beneath the cross bar, and completely across the goal line by the stick of an attacking player, or in any way by a defending player.  The puck may deflect off any part of an attacking or defending player.  A puck deliberately directed into the goal by an attacking player by any means other than a stick shall not be allowed.

Each period is begun with a "face-off" at the center spot of the rink.  The official drops the puck between the sticks of the players facing off, who must stand facing their opponents' end of the rink.

Each team attempts to move the puck toward its opponent's defending zone by "stickhandling" the puck or by passing it to a teammate.

A penalty is called against a player, or a team, when certain rule infractions occur, and usually result in the offending player being sent off the ice for a set amount of playing time. When a player, other than the goalkeeper, commits a minor penalty, he is sent off-ice to the "penalty box" for two minutes of regulation time.  During this penalty time, no substitution for the offending player can be made, meaning that the player's team must play "short-handed," or with one fewer player than the opposing team.  For a major penalty, the offending player is sent to the penalty box for five regulation minutes, with no substitution permitted.

Five infractions which can potentially cause eye injuries are:

  • Elbowing:  Using the elbow to foul an opponent:  minor or major at the referee's discretion.
  • Fighting:  Engaging in a fist-fight with another player:  major penalty for instigating a fight, minor or major for retaliating, at the referee's discretion.
  • High sticking:  Carrying the stick above the normal height of the shoulder:  minor or major, at the referee's discretion.
  • Slashing:  Impeding the progress of an opponent by "slashing" at him with the stick:  minor or major.
  • Spearing:  Making a spearing motion with the stick toward an opponent:  major penalty.

HOCKEY DICTIONARY OF TERMS

  • Assist:  Credited to a player who passes to a teammate who scores on the same play, or who passes to a second teammate who then scores on the same play.
  • Center:  An offensive player who usually remains roughly centered between the two other offensemen, or wingers.  The center is usually a player that creates goal-scoring opportunities by reading the defense and passing to the appropriate teammate.
  • Check:  To stop the progress of an opponent in possession of the puck by physically blocking his movement or by removing the puck from his possession.
  • Clearing the Puck:  The act of simply shooting the puck out of ones defensive zone to relieve an opposing team's attacking pressure.
  • Defensemen:  One of two players on a team whose primary job is to prevent or terminate the opponent's goal-scoring opportunities.  The defensemen usually stay in a position behind the three offensive players.  When a team is in the attacking zone, or opponent's defensive zone, the attacking team's defensemen are often said to be "at the points."  "The point" is the area to the left and right, just inside the attacking zone.  From here, the defenseman can pass to a teammate or blast a "shot from the point."
  • Dropping the Gloves:  Preparing to fight.  A player may quickly drop his gloves to the ice to prepare for or challenge an opponent to a fist-fight.
  • Even Strength:  Describes the situation in which both teams have the same number of players on the ice.  (See short-handed.)
  • Icing:  When a player shoots the puck from his own side of center ice to beyond the opponent's goal, and an opponent then touches the puck, it is "icing," and the play is called back.
  • Off-Sides:  Passing the puck from the defensive zone to a teammate in the central, or neutral, zone, or from the neutral zone to a teammate in the attacking zone.  This is an illegal pass and the play is called back.  The offensive players cannot enter a forward zone ahead of the puck.
  • Penalty Killing Unit:  The players on a team that specialize in preventing the opposing team from scoring when the players' own team is "short-handed."
  • Poke Check:  A type of check in which a player "pokes" the puck away from an opponent by reaching in with his stick.
  • Power Play:  The situation in which a team has more players on the ice than the opposing team, because the opposing team has been penalized.  A team will usually increase its scoring pressure while on the power play.
  • Rebound:  When a shot deflects off the goalie or a goal post, and comes back in front of the goal, it is called a rebound.
  • Short-Handed:  Describes the situation in which a team has fewer players on the ice than the opposing team, due to a penalty.  The short-handed team tries to "kill off" the penalty, or prevent its opponent from scoring.
  • Slap Shot:  A high velocity shot taken by lifting the stick off the ice, winding up, and slapping the puck hard with the stick blade.  A slap shot may travel in excess of 100 miles per hour in a professional or college game.
  • Winger:  One of the two offensive players that remain mostly to the left or right of the center.  The wingers are often the goal scorers of the team.
  • Wrist Shot:  A shot taken by placing the stick against the puck and snapping the wrists forward. This shot travels at considerably less speed than a slap shot.

VISUAL DEMANDS IN HOCKEY

Hockey is such a dynamic sport that almost all skills important for sports vision apply to this sport also.  It is our recommendation that the skills listed below, along with the practitioner's own list of skills, be considered for the development of the hockey player.  Due to the quick nature of the sport and quick changes from offense to defense, all the skills listed are important to any position played.  If there are special considerations for a particular position they will be mentioned in the text.

  • Visual Acuity:  Maximum static and dynamic visual acuity are essential for playing hockey.  Dynamic visual acuity is critical in hockey due to the dynamic nature of the sport and the speed at which the players and the puck are moving.  Dynamic visual acuity is essential for tracking the puck and defending the goal.
  • Peripheral Vision:  Necessary for recognition of fellow teammates from opponents.  Vital to all positions and aspects of the game.  Goalies benefit from good peripheral vision while defending the goal from multiple opponents approaching the goal.  Defensemen benefit from the sense of spatial location of the offense to help break down their attack on goal.  It benefits the player to know where the boards, players, puck, and goal are at all times.
  • Depth Perception:  Essential for all players who are constantly needing to monitor their reaction times and speed of passes to fellow players.  When the puck is in the air, it is more difficult to judge its distance making this skill even more important for play.
  • Eye Motility:  Full range of motility is necessary to track the puck.  Receiving a pass or defending the goal require quick fixating and tracking motilities.
  • Eye-Hand/Body/Foot Coordination:  Quite essential to the performance of a hockey player.  They must be able to coordinate their movements on skates while using a stick to manipulate the puck.
  • Visualization:  Helpful for all players to improve their performance.
  • Speed of Recognition Time:  Essential skill needed to sort out fellow teammates and location of the puck at a glance.  A goalie must be able to judge the height and direction of the shot on goal in order to properly defend his goal.
  • Speed of Focusing:  Tracking the puck requires a rapid change in focus for all players of hockey.  Due to the dynamic nature of the game the players must be able to discriminate fine details to prevent penalties or other line calls from being made.
  • Ability to Withstand Eye Fatigue Without Decreased Performance:  Hockey has many concentrated periods where eye movements and concentration are required.  Frequent line changes by the coach will help decrease fatigue of the visual system.
  • Color Perception:  Useful in recognizing fellow players without raising your head to look at their jerseys.  Players usually have their head up, so this will be something that can be worked around in most situations.
  • Eye Dominance:  May help to determine which side of the ice the player will be best suited for.  Right eye dominant players may perform better on the left side.  Probably not of major importance unless there is a large amount of uncorrected sphere or cylinder in non-dominant eye.
  • Fixation Ability:  Everyone requires this skill, especially goalies and defensemen who must fixate on an incoming puck.
  • Visual Memory:  Helpful to goalies and defensemen in remembering where a particular opponent frequently approaches the goal.  May also be of importance to an offensive player in remembering the defense's weak side.
  • Central/Peripheral Awareness:  Important to all players.  An offenseman uses central vision for shots on goal and peripheral vision for awareness of his teammates' position.  Goalies and defensemen must use central vision while blocking shots and peripheral vision while maintaining awareness of the entire opposing team.
  • Spatial Localization:  See Peripheral Vision.

VISUAL SCREENING/TESTING PROCEDURES INDICATED FOR ATHLETES IN HOCKEY

  1. Static Visual Acuity
    1. Snellen Chart
    2. Vectographic
  2. Dynamic Visual Acuity
    1. Keystone Rotator with Sherman Chart
    2. Motorized J.W. Engineering Rotator
  3. Contrast Sensitivity
    1. Vistech Tester
    2. Vector Vision
  4. Peripheral Vision
    1. Automated Perimeter
    2. B&L Vision Tester with attachment
    3. P.A.T. - Peripheral Awareness Trainer (Wayne Engineering)
  5. Depth Perception/Eye Teaming
    1. AO Vectographic Slide
    2. Randot
    3. Stereo Fly
    4. Worth Four-Dot
  6. Eye Motility
    1. Projected King-Devick
    2. Entrance Eye Movements
    3. Wayne Saccadic Fixator
    4. Pegboard Rotator
    5. Vis-Flex (Wayne)
  7. Refractive Condition
    1. Autorefractor
    2. Retinoscope
  8. Eye-Hand/Body/Foot Coordination Proaction & Reaction
    1. Wayne Saccadic Fixator with Footboard
    2. AcuVision 1000 Vision Trainer
    3. Reaction Plus - WR Medical Electronics
    4. Quick Feet - Sports Robots
    5. Reaction Coach - START Technology
  9. Eye Muscle Postures
    1. Maddox Rod
    2. Cover Test
    3. B&L Vision Tester
  10. Color Vision
    1. Ishihara Plates
    2. B&L Vision Tester
  11. Accommodative Flexibility
    1. +2.00/-2.00 Flipper
    2. 8 BI/BO Flipper
    3. Near/far Wayne Saccadic Fixator
  12. Eye Dominancy
  13. Sight Tube

  14. Speed/Span Recognition
  15. Tachistoscope

  16. Timing/Anticipation Skills
    1. Bassin Anticipation Timer
    2. Wayne Speed Trac
  17. Visual Localization
    1. Brock String
    2. Yoked Prism
  18. Ocular Health
    1. Ophthalmoscope
    2. Tonometer
    3. Biomicroscope
    4. Visual Fields Tester

TRAINING TECHNIQUES TO ENHANCE VISUAL PERFORMANCE IN HOCKEY

Since hockey is a very visually demanding sport requiring a broad range of visual skills, hockey performance can potentially be improved by nearly any visual training technique.

  1. Peripheral Vision
    1. AcuVision 1000 - Gives the doctor and athlete a printout of the strengths and weaknesses in 6 quadrants of the visual field.
    2. Computerized saccadic fixator, such as by Wayne Engineering.
    3. The fixator can be used to decrease reaction and proaction times to targets in the peripheral field.  "Visual spatial stickups" are an accessory which can make the task more interesting and improve the athlete's peripheral awareness.
    4. Peripheral Awareness Tester, by Wayne Engineering
    5. Tachistoscope:  This instrument can be used to increase the athlete's visual memory of targets in the peripheral field.
    6. Swinging ball:  This simple technique involves hanging a ball from the ceiling by a string.  The ball is swung around the seated patient at eye level.  The athlete must fixate a stationary point directly in front of him, and call out when he first becomes aware of the ball in his side vision.
  2. Dynamic Visual Acuity
    1. Marsden Ball:  The athlete must strike a moving ball, suspended by a string, with a multicolored bat.  The practitioner can increase the demand by calling out which colored portion the athlete must use to strike the ball.
    2. Numbers or shapes can be drawn on or attached to tennis balls, ping-pong balls, or bean bags.  The athlete must identify the numbers or shapes as quickly as possible as the objects are thrown to him.
    3. Rotator:  A Kirschner rotator can be purchased, or a rotator can be improvised, using a phonograph.  Speed of rotation should be increased as the athlete improves.
    4. N - F focus shift while the athlete jumps on the trampoline.
  3. Depth Perception
  4. Stereopsis should be trained directly:

    1. Vectograms - Awareness of SICO and matching of spatial localization.  Should be done at distance and near.
    2. Analglyphic Targers - Awareness of SICO and matching of spatial localization.  Should be done at distance and near.

    All stereopsis training should be at varying distances and in all fields of gaze both with and without movement by the athlete during the procedure.

  5. Eye Motility
    1. Rotator
    2. Projected King-Devick, by Bernell
      Attempt to increase the athlete's speed, while eliminating errors.
    3. Marsden Ball
  6. Eye-Hand/Body/Foot Coordination
    1. Wayne saccadic fixator with footboard
    2. Bean bags or tennis balls can be thrown to the athlete, under a strobe light.  For goalies, especially, bean bags or plastic pucks can be slid along the floor, to be stopped with the athlete's foot, also under a strobe light.
    3. Quick Feet - eye - foot
    4. START - eye - foot
    5. Reaction Plus - eye - hand
  7. Visualization
  8. The athlete should visualize every aspect of a perfect performance, such as skating in and scoring, checking an offensive player and clearing the puck, or seeing and stopping a shot-on-goal (goalie).  Visualization should first be done in a quiet room with the eyes closed, then with the eyes open, and eventually with open eyes and auditory and visual distractions.  After first practicing in-office, the athlete should be encouraged to practice visualization as part of his pregame warmup routine.

  9. Speed of recognition
    1. Peripheral Awareness Tester, by Wayne Engineering
    2. Tachistoscope
    3. Automated Visual Fields tester
    4. Number or shape recognition on objects thrown to the athlete
    5. Strobe Light
  10. Speed of Focusing
    1. +/- lens flippers
    2. Near-Far Accommodative Rock
    3. Vis Flex, by Wayne Engineering
  11. Ability to Withstand Eye Fatigue Without Decreased Performance
  12. This ability should increase as the binocular system is "firmed up" by generalized training.

  13. Color Perception
  14. Not directly trainable.  Uniform recognition, such as in differentiating between an opponent and teammate, may become faster as speed-of-recognition time is trained.

  15. Fixation Ability
    1. Wayne Saccadic Fixator
    2. Vis Flex, by Wayne Engineering
    3. Projected King Devick, by Bernell
    4. Computer Orthoptics
  16. Visual Memory
  17. Improved through visualization.

  18. Spatial Localization
    1. Vis Flex, by Wayne Engineering
    2. Brock String
    3. Inserting toothpicks into a drinking straw, spearing Cheerios with a pick-up stick, etc.
    4. Yoked Prisms

SPORTS VISION PROBLEMS RELATED TO HOCKEY

PROBLEM

POSSIBLE SOLUTION

1.   Participating in hockey with any uncorrected refractive error may reduce a player's performance and increase his risk of injury.

Soft contact lenses are the best method of correction without decreasing field of view.  They are less likely to dislodge than rigid lenses, but rigid may be used if adequate cylinder correction cannot be achieved with soft toric lenses.  Another alternative is a rigid lens with a hydrogel skirt.

2.   Player cannot adjust to contact lenses or is non-compliant with lens care.

Fit in a sport frame that can be worn under the helmet and face mask.  Sport frames are vented to help reduce fogging problems.

3.   High velocity projectiles such as a puck or high stick can cause severe damage to the orbital area if there is no protection.

Face guards that attach to helmets are available for all levels of competition.  Players should wear their optimal correction under the mask to further decrease chances of injury.  As the player improves his visual skills, his chance of injury lessens.

4.   Unskilled players and those who are less experienced than their fellow league members are at greater risk of injury.

All players should understand the rules and strategies of hockey and should practice as much as possible to develop skills.  The younger the player, the greater the risk of injury.  All players should be corrected to their best visual acuity to decrease their chance of injury.

5.   Lexan face masks often fog up during play. This is due to the contrast in temperature between the hot sweaty player and the cold playing surface.

Instruct players in availability of anti-fogging compounds.  If this does not work, the player may wish to switch to a wire face protector.  The wire mesh will also eliminate scratching problems that younger, inexperienced players often encounter.

6.   Presbyopia is not commonly a problem because most players' careers are over before a near correction is needed.

Avoid fitting a bifocal correction for use during play time.  A sharp distance correction should be adequate for even a younger presbyope.

7.   The "one-eyed athlete" should be cautioned about participating in a sport that accounts for such a large percentage of ocular injury resulting in blindness.

The best precaution would be for non-participation in the sport.  When this is not possible, prescribe polycarbonate sport spectacles to be worn with the face mask.  This will protect the player if his mask is displaced during play.  Record your recommendations in the patient's file, and include a signed release form outlining your instructions.

8.   Poor eye movements, decreased binocular function, slow visual motor responses, and decreased peripheral awareness are all a potential hindrance to performance.

Enroll patient in a sports vision therapy program.

FIRST-AID FOR HOCKEY OCULAR INJURIES

Trainers should be taught to remove foreign bodies from beneath the lids and on the conjunctiva by irrigation or light swabbing with a sterile cotton swab. Superficial corneal foreign bodies should be removed by the trainer by irrigation only. Imbedded corneal foreign bodies should be removed in-office by the eye care professional. The trainer should be able to instill ophthalmic drops and to handle and remove contact lenses.

Lid or brow lacerations that do not impair lid function or involve the lid margin should be cleaned and closed by the trainer with a sterile closure strip. For lacerations penetrating the lid or involving the margin, play should be terminated and the player referred to an optometrist or ophthalmologist for evaluation.

Play should be terminated and the player immediately referred to the primary eye care professional in the following circumstances:

  • -  imbedded corneal foreign body
  • -  haze or blood in the anterior chamber
  • -  decreased visual acuity or field loss
  • -  pupil irregularity
  • -  diplopia
  • -  lacerations impairing lid function
  • -  suspected perforation
  • -  blunt trauma to the eye or orbit

In the case of blunt trauma, the trainer should apply an ice pack before sending the player to the eye care practitioner.

Trainers should also be able to check visual acuities at distance and near, check pupils for equality and reactivity, and assess extraocular muscle motility.  The trainer should be instructed to never forcibly open lids that are shut by swelling or blepharospasm, and to patch and shield any eye in which perforation is possible.

After removing an imbedded corneal foreign body, the professional should apply antibiotic ointment, pressure patch the eye, and have the athlete return for a next day follow-up.  Play should be terminated until the cornea has healed.  Corneal abrasion should also be treated with antibiotics, patching, and next day follow-up.  Play should not be resumed until healing is complete.  For contusions, the eye doctor should palpate the orbital rim for fracture, check ocular motility, and test for hyposensitivity of the inferior orbital skin.  If any of these three tests are positive, or if the contusion is severe, the athlete should be referred for radiologic examination.  Ice packs should be applied for the first twenty-four hours to reduce swelling.

OCULAR SUPPLIES WHICH SHOULD BE IN A HOCKEY TRAINER'S FIRST-AID KIT:

  1. Near acuity card
  2. Penlight
  3. Hard eye shield, for suspected perforating injury
  4. Sterile eye patches
  5. Micropore tape
  6. Sterile irrigating solution
  7. Sterile cotton swabs
  8. Ice pack
  9. Artificial tears
  10. Butterfly bandages
  11. DMV
  12. Spare contact lenses
  13. Phone numbers of eye care practitioners in each playing location.  For eye care practitioner use only:
  14. Fluorescein strips
  15. Antibiotic ointment (0.5% erythromycin)
  16. Proparacaine 0.5%

PROTECTIVE/CORRECTIVE EYEWEAR RELATED TO HOCKEY

  1. Soft contact lenses are the corrective method of choice for most hockey players.
  2. Rigid gas permeable contact lenses, or a rigid lens with a hydrophilic skirt, may be utilized when a crisper correction is possible.
  3. Sports frames with 3mm polycarbonate lenses are indicated when contact lenses cannot be worn or when you have a one-eyed athlete.
  4. Face protectors are mandatory in minor hockey leagues.  There are two types commonly worn.
  5. Clear polycarbonate plastic (Lexan) is attached to the helmet.  Younger players tend to scratch the plastic during play or in the transport of their equipment.
  6. Wire mesh mask is recommended for younger and more careless players who may scratch the Lexan Face protectors.
  7. Sport strap for glasses is recommended for players unable to purchase sports frames.  Only plastic and preferably 3mm polycarbonate lenses should be worn on the ice.  Do not allow players to use glass lenses unless they refuse to purchase the safer options available and sign  waiver sheet.

BIBLIOGRAPHY

  1. Binocular Anomalies - Procedures for Vision Therapy, John R. Griffin, O.D., Professional Press Books, 1988.
  2. The Complete Encyclopedia of Ice Hockey, Zander Hollander and Hal Bock, eds., Prentice-Hall, Inc., 1974.
  3. "Emergency Treatment of the Injured Athlete," Michael J. White, et al, Clinics in Sports Medicine, Jan., 1989.
  4. The Encyclopedia of Hockey, Robert A. Styer, A.F. Barnes and Co., Inc., 1973.
  5. "Eye Injuries in Canadian Amateur Hockey," Thomas J. Pashby, M.D., The American Journal of Sports Medicine, Volume 7, Number 4:  254-257, 1979.
  6. "Eye Injury in Sport," Nicholas P. Jones, Sports Medicine, Volume 7:  163-181, 1989.
  7. Hockey for the Coach, the Player and the Fan, Fred Shero and Andre Beaulieu, Simon and Schuster, 1979.
  8. Hockey Rules Illustrated, George Sullivan, editor, Simon and Schuster, 1982.
  9. Modern Principles of Athletic Training, Carl E. Klafs and Daniel D. Arnheim, The C. V. Mosby Company, 1981.
  10. Sports Injuries:  The Unthwarted Epidemic, Paul F. Vinger, M.D. and Earl F. Hoerner, M.D., PSG Publishing Company, Inc., 1981.