Groin and Hip Injuries in Hockey Players (Part 2)
By: Bobby DeThomasis
In my last article I discussed the muscular structures around the hips that may be impacted in hip and groin injuries. I also discussed how muscular imbalances in the structures around the hips can make an athlete more susceptible to groin and hip flexor strains. In this article I am going to dive deeper into some of the other injuries that are all too common amongst hockey players, specifically hip impingement syndrome and hip labrum tears.
Hip impingement (Aka. femoral acetabular impingement syndrome or FAI) is a condition where a bone spur develops in the hip joint on either the head of the femur (Cam style FAI), on the acetabulum of the pelvis (pincer style FAI) or a combination of both. Despite which bony anatomical structure develops the bone spur the symptoms are typically similar. Athletes will usually have a pinching sensation in their groin area when the hip goes into flexion especially with adduction (coming across the body) and internal rotation. Although there have been many athletes that have played entire careers with FAI, over time other issues begin to arise. Due to the fact that FAI inhibits an athletes ability to go through a full hip range of motion compensatory patterns typically develop. To compensate for a lack of hip movement there will be a considerably higher amount of shear force placed on the knees and lower back region. This causes a much higher potential for low back disorders and knee injuries. On top of that, the bone spurs will ultimately start to wear away at the cartilaginous structures around the hips (the articular cartilage and the labrum). If the articular cartilage is affected the athlete could develop osteoarthritis. If the labrum is affected it could ultimately tear.
This bring me to my next issue which is hip labrum tears. This is a very serious issue as once the labrum has been torn it will not likely be able to heal on its own. Although the hip labrum does have some minor blood supply to it, if the tear is significant enough it will not repair itself without surgical intervention. One of the challenging issue with labrum tears is diagnosing it. Symptoms may include hip pain but not always. You may also just have pain that radiates into the low back. As such many hip labrum tears are mistaken for low back problems. Unfortunately once an athlete has sustained a hip labrum tear the only course of action to fix it would be to take a surgical approach. The proper course of action however would be to recognize the risk factors and use preventative methods to decrease susceptibility to labral tears.
One of the major risk factors for labral tears is lack of structural balance in the soft tissue around the hips. Although in recent years there has been more of an emphasis on hip flexibility not all hip joints are alike. As I mentioned in the first part of this article, stretching the wrong structures could be just as detrimental, if not even more so, then not stretching at all. Although overall flexibility around the hips is important, balance is much more important. Therefore you should first determine which structure are tight and which structures are weak. Stretch the tight muscles and strengthen the weak muscles. I have found that amongst just about all of the hockey players I have worked with in my career almost all of them have similar restriction patterns. The lateral muscles of the hip, most specifically the gluteus medius, gluteus minimus, iliotibial tract and the deep hip lateral rotators are almost always very tight. This is due to the nature of skating being so laterally dominant. Also, due to the amount of time hockey players spend in the flexed hip position, the psoas, iliacus and rectus femoris (the hip flexor muscles) are almost indefinitely tight as well. Coupled with these weaknesses I often see weaknesses in the adductors and the hip extensors (gluteus maximus and hamstring muscles).
Of course every athlete is different and the symptom patterns that I described do not apply to everyone. To get a detailed analysis of your structural balance and to determine what steps you will need to take to maintain healthy hips and groins for the duration of your hockey career email us at firstname.lastname@example.org to set up for an initial evaluation.