Much like baseball and the increasing cases in Tommy John Syndrome, early hip issues are being seen more and more in hockey players at young ages. In this most recent season being part of a collegiate program, our team alone had two players out for the entire season recovering from post hip surgery and a large handful of players whose performance suffered due to several minor hip related injuries. The most prominent observation for me was how preventable all these setbacks were. In a team environment, the little things tend to matter as we often see instances create a domino effect disaster for the media to circle around like vultures. Is "hockey hip" as feared as concussions in the NFL? No way. We know a great deal more about soft tissue injuries than we do about long term effects of concussions, which makes this topic more enlightening and positive.
Common Hip Injuries
The most common injuries I have seen in hockey are strains, labral hip tears and a widely unfamiliar condition known as osteitis pubis. Both conditions can be traced back to abnormal shape and structure of the acetabulum, labrum, and/or femoral head. Essentially, the unnatural movements performed in ice hockey on a hard surface (ice) can lead to reoccurring overuse injuries, strains, and even tears that can ultimately lead to a more severe injury such as a labral tear or osteitis pubis.
When injuries such as hockey hip become more common among elite level athletes, the initial reaction from most coaches in the sport is that these injuries should just be accepted as part of the game. The fact is, most of these injuries can be prevented with the right approach to training the bio mechanics of the athletes with mobility, specific stretching techniques, pelvic stability and strengthening exercises. My unofficial case study this year was with our starting goaltender at BSU, who in the second half of the season played nearly 20 consecutive games without injury or inhibition to his performance. 3+ times a week, I worked individually with him using a variety of techniques specific to goalie movements that included: yoga, PNF stretching, banded distraction, and soft tissue myofascial release. My #1 goal when working with athletes and clients is to prevent injury in whatever activity they are performing and that was the exact result. In addition, his performance became enhanced the more games that he played as self confidence increased.
The main focus to take away from this article is to understand that inevitable injury should not just be accepted as part of the sport or activity if there are proven methods that exist to prevent them. Athletes, especially, should always have an increasing awareness of their bodies and partake in a purposeful training program specific to their sport or activity.
Conclusion: How do I prevent hockey hip?
1. Foam Rolling - Soft Tissue Myofascial Release
Foam rolling is a great tool for addressing pain and soreness from overuse. Apply consistent pressure to the sore spots on your lower body (Tip: Don't treat your muscles like a pile of play-doh but instead think of foam rolling as a poor man's massage. Apply gentle and consistent pressure to each spot until you feel a sense of release). Typical areas include: calves, IT bands, quads, and adductors.
2. Hip Mobility Exercises
3. Addressing the Psoas - Stretching and Strengthening
The psoas is a long fusiform muscle that essentially wraps from the lower lumbar region to the lesser pelvis and is a large component of the hip flexor. In addition, it joins the iliacus to form the iliopsoas which is especially important to be aware for hockey players. Consistent stretching and strengthening of these muscles allow them to perform their intended functions. Stretching - Iliopsoas Supine Stretch Strengthening - Standing or Hanging Leg Raises
4. Banded Distraction
Banded distraction addresses stress around the joint by creating space in the joint capsule, which allows for stretching in connective muscle tissue. The main cause of joint pain or injury usually starts with tightness of connective muscle tissue as they influence the movements. Banded distraction addresses these vulnerable areas with hockey players by promoting good joint health and proper functional movement.
Ex. - Banded Hip Extension, Banded Pigeon