Groin and Hip Injuries in Hockey Players (Part 1)
By: Bobby DeThomasis
Anyone who has played hockey can tell you that one of the most common areas that get injured in hockey players is the hip/groin complex. Typical injuries include but are not limited to “groin strains” (I will explain later why I put that in parentheses), hip flexor strains, hip impingement syndrome and labral tears. Despite the commonality of these injuries, there are still many misconceptions about how they occur and what treatment options exist both on a rehabilitative and preventative scale. In this article, I will be focusing mostly on groin and hip flexor strains. In my next article I will dive deeper into hip impingement syndrome and labral tears, but first I think it is important to understand some of the anatomical structures in the hips that can be associated with hip injuries in hockey players.
To understand hip and groin injuries you must first understand what can actually be injured. It has been estimated that over 80% of NHL players either have or had groin strains at some point in there professional career. That is an astounding number of athletes that end up with similar injuries (I say similar because there are several groin muscles that can be strained). The hip joint is known as a “ball and socket joint” in the the head of the femur (the large thigh bone) is “ball” shaped and sites into the hip socket (acetabulum). Due to the structure of the hip joint it has almost unlimited planes of motion that it can move through. These movements include flexion/extension, abduction/adduction, internal/external rotation and circumduction. Due to the ability of the hips to move in so many directions it obviously needs many muscles to support those movements. In the front of the hip you have the hip flexor complex which is primarily made up of the Illiacus, Psoas and Rectus Femoris muscles. On the back you have the Hamstrings and the Gluteus Maximus. On the inside you have the adductor complex which includes the Adductor Magnus, Longus and Brevis, the Gracilus and the Pectinius (groin muscles). On the outside you have the Gluteus Medius and Minimus and the Tensor Fascia Latae.
It is a common misconception to think that the best way for a hockey player to decrease his potential for a groin strain is to increase the flexibility of the groin musculature (the Adductors). However, a study conducted by Nicholas Tyler titled ‘The Association of Hip Strength and Flexibility on the Incidence of Groin Strains in Professional Ice Hockey Players’ determined that there was no decrease in the amount of groin strains in hockey players with higher levels of pre-season adductor flexibility. This study would indicate that there is very little correlation between flexibility in the adductor muscles and groin strains. What was even more interesting though was a correlation that they found between the balance of strength between the Adductors and the Abductors (Gluteus Medius and Minimus). They found that when in all the uninjured athletes they tested the Adductors had 95% of the strength of the Abductors as opposed to 78% in the injured athletes. This would indicate that the strength of the Adductors would be a better predictor of an athletes susceptibility for groin strains. Due to the high level of repetitive hip extension/abduction a hockey player go through while skating the adductors must be very strong to stabilize the leg when it is in the extended position. If the strength of the adductors is not sufficient to stabilize the leg in the extended position, the potential for injury will increase dramatically.
The study by Nicholas Tyler really proved how important a strong groin is for hockey players and how stretching the groin may actually increase injury potential. The hip is a complex joint and understanding it’s kinematics is very important for optimal function and injury prevention. If you are a hockey player and would like an individualized program that will improve on ice performance all the while making sure that you stay healthy for an entire season you can email us at email@example.com to set up or your initial evaluation. In my next article I will be discussing hip impingement syndrome and labral tears. In the mean time, start strengthening those adductors!