Hip Impingement in Hockey Players: focus on butterfly style goalies

Christopher Larson, MDTwin Cities Orthopedics, Edina MN

Team Physician: Minnesota Wild

David Rust, MDOrthopedic Sports Medicine Fellow

Overview

• Anatomy• What is impingement?• Affect on hockey

players/goalies• Treatment options• Other hip problems• Future of research and

INJURY PREVENTION!!

Hip = ball and socket joint

Femur = thigh bone, head and neck are involved

Acetabulum = part of the pelvic ring

Labrum = cartilage ring on rim of acetabulum, mechanical “bumper”, seals the hip joint (gasket)

Articular cartilage = smooth gliding surface, worn out in arthritic joints

What is impingement?• FAI = Femoral-Acetabular Impingement

– Abnormal contact between the ball and rim/socket during activity

– Results from a ball that is not perfectly round (CAM) or a socket that is too deep (PINCER)

• Labral Tear– Repetitive impingement leads to “pinching” of the

labrum between the ball and socket– Labral tears are common and often do not cause pain

– Important to recognize and treat the underlying impingement

Signs and Symptoms

• Deep sharp groin pain• Worse with quick turns• Limited hip rotation/flexibility/stiff• Unable to sit for prolonged periods• Groin / Front of the hip pain after activity

• Impingement test = pain with hip flexion and internal rotation

Must rule out other causes of pain

• Muscle and tendon strains

• Contusions, fractures

• Athletic pubalgia / SPORTS HERNIA

Butterfly Effect• Evolution of style• Rules and regulations• Increased rate of surgery Approximately 5-10 NHL goalies

per year have FAI surgery:•JS Giguere•Tim Thomas•Niklas Backstrom•Vesa Toskala•Patrick Roy•Josh Harding•Antero Niitimaki•Rick DiPietro•Ray Emery•Craig Anderson

Butterfly Effect• Skills that may place hip at risk

– pad flares – recovery pushes – T-pushes/One foot stops – One knee down on post– butterfly drops

Treatment Options

• First step should be to work with coaches and athletic trainers to identify likely cause of pain

• Examination (with experienced provider) and regular x-rays will confirm diagnosis

• When should an MRI be considered?– Recent study found positive MRI finding in 77% of

asymptomatic professional and NCAA hockey players

FAI X-Rays

Treatment Options• Anti-inflammatory meds, rest, ice

• Modifications in technique and equipment, decreased repetitions

• Therapy can work on strengthening core muscles and hip rotators

• Numbing injections can assist in determining the source of pain, but cortisone is usually avoided in young patients

Treatment Options• When should surgery be considered?

– Unable to perform athletics despite non-surgical treatment

– Pain with daily activities

– In our experience, athletes that have problems at a younger age are more likely to eventually need surgery and are at risk for more significant hip damage

Hip ArthroscopyDr Larson has published over 40 articles regarding hip injuries in athletes & has operated on over 50 US and European Hockey Goalies from high school to the professional level in the last 3 years as a result of Impingement and disablingpain.

We are currently conducting several studies looking at the anatomy of the Hockey Goalie.

Before Surgery After Surgery

Can we prevent impingement?• Shape of hip develops over time while the body is growing• Primarily takes shape during adolescent growth spurt• Ages 10-14 in girls and 12-16 in boys• Depends on type of activity and number of repetitions• May be similar to throwing injuries in youth baseball

Possible preventive strategies • core fitness program for young goalies to

strengthen muscles and/or maintain flexibility

• Improve upright Posture in butterfly and splits positions

• skill repetition limits in practice • greater “off-season” time, cross-training• equipment limitations or improvements

What does the future hold?

• Research looking at hockey goalies and players of all ages to find trends and identify who is at risk

• Rules and regulations to help protect athletes from injury

• Guidelines and recommendations for youth athletes, parents, and coaches

Research Study: Cam Impingement in Butterfly Goalies

• Goal is to better understand, predict, and prevent hip injuries

• Hockey goalies, hockey players, non-hockey players, with or without symptoms, ages 10-40

• No cost to enroll

• Participants will complete questionnaire, examination, and x-rays

• No personal identifying information

• Gain knowledge with respect to the RISK of developing HIP problems based on the Examination and Xrays

• Minimal physical risk– Radiation from x-ray less than the typical annual exposure for an average

Minnesota resident

Research Study: Cam Impingement in Butterfly Goalies

• Participation requires signed consent (adults and parent/guardian) and assent (adolescent)

• If interested please contact:– Becky Stone @ beckystone@tcomn.com or

952-456-7136– Dave Rust @ drust1@fairview.org

Thank You

Twin Cities Orthopedics, Edina