Last Updated on Wednesday, 27 January 2016 17:24
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I am a high school defenseman and felt a crack in my chest when I was checked into the boards during our last game. I went to the emergency room and had x-rays and was told I had a rib fracture. How long am I out from playing hockey? What precautions should I take?
Answer: Rib fractures are common in ice hockey and usually occur in older adolescents or college hockey players. Rib fractures usually occur when a player is checked against the boards or into the goalpost and less commonly with on-ice collisions.
Most rib fractures are either minimally or non-displaced fractures. This means that the rib is cracked but the broken pieces still line up following the shape of a normal rib. With minimal displacement, organs in the chest and upper abdomen such as the liver, spleen, kidneys, and lungs that the ribs protect are usually uninjured.
When a rib fracture is found, it is important to screen for other serious injuries. If there is localized tenderness over the ribcage or if the player feels a painful crunching sensation during a deep breath, an x-ray should be taken to determine the degree of fracture displacement. A very small percentage of hockey players may have damage to the internal organs with a rib fracture. It is especially important to follow-up with a physician if any difficulty breathing or abdominal pain is present. A displaced rib fracture could tear the lining of the lung leading to a collapsed lung or cause injury to the liver, spleen, and kidneys. For this reason, all rib fractures should be evaluated by a physician.
In your case, if you have been evaluated by a physician and do not have a displaced rib fracture or internal organ injury, the first step in management is to make sure that you have adequate pain relief to make skating tolerable. These injuries can be quite painful due to the continuous motion of the chest wall as you breathe. The broken ends of the rib can move with deep breathing while skating, leading to aggravated pain. In addition, we commonly provide a rib strap for our athletes to help “splint” the broken rib. The purpose of the rib strap is to minimize chest wall motion during a deep breath and lead to less pain.
Your physician may order prescription pain medications to get your pain under control. However, you should not be on any prescription strength pain medications when you return to on-ice activities. We recommend against the use of anti-inflammatory medications such as ibuprofen or naproxen in the first days after this type of injury because they tend to increase bleeding and may slow bone healing.
You may return to skating as soon as you can tolerate the pain. We most recommend a flack jacket to protect the fractured rib from additional blows or trauma to the fractured area. Our players usually need to wear the flack jacket from anywhere from a few days to up to three weeks depending on the location and severity of the fracture.
In summary, rib fractures typically heal quickly. In most cases, players are pain-free by three to four weeks after injury. It is important to be assessed by a physician to rule out underlying injuries and monitor for signs that it is safe to return to competition.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
