By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: I am a high school defenseman and was checked into the boards in practice and felt a crack in my chest. I went to the emergency room and had X-rays and was told I had a rib fracture. When can I return back to skating? Answer: Rib fractures occur commonly in ice hockey, usually in older adolescents or in college hockey players. Luckily, most rib fractures are either minimally or non-displaced fractures. This means that the structures in the chest cavity which the ribs are supposed to protect (liver, spleen, kidneys and lungs) usually do not get injured.

Rib fractures usually occur when a player is checked against the boards or into the goalpost. I have not seen them occur with on-ice collisions.

While rib fractures by themselves do not contribute to serious long-term problems, it is important to check and make sure that there are no other serious injuries present. If there is a localized area over the ribcage which hurts when it is pressed on, or if the player feels like some of the bones are crunching when they take a deep breath in and out, then they should have X-rays taken to determine the amount of fracture displacement. It is especially important to follow-up with a physician if they have any difficulty with breathing or any abdominal pain.

A very small percentage of hockey players can have damage to the internal organs with a rib fracture. Therefore, it’s important to see a physician for x-rays for these to make sure that your injury is not more serious than what it seems initially. A rib fracture could cause a tear in the lining of the lung, which could cause it to collapse. Rib fractures can also cause injury to the liver, spleen or kidneys, which needs to be evaluated by a physician.

In your case, where you have a rib fracture and you do not have any other injuries, the first thing you should do is make sure you have enough pain relief so you can skate. These injuries can be quite painful because of the motion of the chest wall when you breath. Since you would be breathing more with the exertion of on-ice activities, this can cause the broken ends of the ribs to move frequently and it can be quite painful.

We most commonly provide a rib strap for our athletes to help “splint” the broken rib. The purpose of the rib strap is to prevent your chest wall from moving as much when you are taking a deep breath, which in turn will cause the rib fracture to be splinted and less painful.

You may return to skating as soon as you can tolerate the pain. We most commonly let our players go back with the use of a flack jacket to protect the fractured rib so they can skate with minimal pain, while minimizing the chance of taking another blow to the fractured area. Our players usually need to wear the flack jacket anywhere from a few days to up to three weeks, depending upon the location of the fracture and the severity of the initial contact that they had.

You should not be on any medications stronger than acetaminophen when you return back to play. We do not recommend the use of anti-inflammatory medications, such as Ibuprofen or Naproxen, in the initial few days after this type of injury because they tend to increase bleeding and they may slow down bone fracture healing.

Rib fractures usually heal quickly. In most cases, they are pain-free by three to four weeks after the fracture. It is important that you be assessed by a physician to make sure that there are no underlying injuries and be monitored closely by your athletic trainer to determine when you may safely return back 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 to This e-mail address is being protected from spambots. You need JavaScript enabled to view it .