Hockey Hip Injuries: FAI

Today’s Thursday Throwback highlights a structural abnormality that affects the overwhelming majority of the hockey population specifically and much of the elite athletic population in general.

While the tone of this post (and the linked article) is specific to one structural abnormality, the foundational theme is not. The real message here is that every athlete is built differently, both from their genetic make-up and how they’ve adapted to stressors over the course of their lifetime.

As a result, it’s incredibly important that coaches appreciate these individual variations and don’t attempt to coach every athlete into a somewhat arbitrary movement “norm”. Often times athletes are patterning movement around the range of motion that they have and can control. If an athlete doesn’t have the motion to perform an athletic movement correctly, it’s wise to dig deeper to see if it’s a structural or functional limitation. If functional, use whatever tools you have to improve it. If structural, coach around it. Either way, the goal is to optimize movement.

Check out the post, and post any thoughts/comments you have in the section below!

Hockey Hip Injuries: Femoracetabular Impingement

Femeroacetabular impingement (FAI) is an anatomical abnormality that anyone that trains hockey players needs to be aware of. In the most simple sense, FAI affects hip flexion ROM, especially past 90 degrees. This will necessarily lead to restrictions in many common lifting and jumping movements and will affect a player’s skating stride.

Mike Reinold recently posted a terrific article from Trevor Winnegge that I think you should read.

Check it out here >> Femoroacetabular Impingement: Etiology, Diagnosis, and Treatment of FAI

I don’t think strength coaches need to go through a screen for every possible injury that a player may incur, but I do think it’s important to be able to recognize signs of injuries or anatomical abnormalities when the player is warming up and training off the ice.

This article did a great job of outlining information related to the diagnosis and treatment of these injuries, but I think the real insight comes from the discussion section. I don’t always spend time reading through the discussion in most articles, but this was well worth the time. When you read it, you’ll see comments from people like Mike Reinold, Eric Cressey, and Jeff Oliver (really bright guys).

Pay special attention to comments regarding how FAI will affect movement so that you can be on the watch for this. Here’s a glimpse at some of my additions:

Round 1
We see a good number of these cases as well since the majority of our athletes are hockey players. As Eric mentioned, most have terrible soft-tissue quality around the hip.

The Slipped Capital Femoral Epiphysis mechanism probably holds extra weight amongst hockey goalies, who grow up dropping to their knees in an almost uncontrolled free fall at ages when they surely don’t have the muscular development to control the motion.

Given the magnitude of these surgeries, we try to focus on conservative approaches. Using single-leg work gives the hips more degrees of freedom, but keeping the athlete above their hip flexion end-range also helps ensure that we’re not getting compensatory lumbar movement.

Round 2 (In response to Jeff Oliver’s comments)
Great point about not being “knee benders”. Because of my history working with hockey players on the ice, it seems that most coaches want their players to skate with the “ideal” stride. I think FAI is one illustration of why some players may opt for a different pattern.

Lumbar compensation, in some plane, is almost inevitable when people reach their hip flexion ROM, especially in bilateral lower body exercises. The only difference between FAI athletes and “normal” athletes is that FAI athletes will hit that hip flexion end range sooner, in at least one hip. If it’s a unilateral problem, you’ll likely see one hip drop below the other during squatting. That’s why I like single-leg work so much for these athletes-it gives the spine options as to which plane to move (namely that lateral flexion becomes more available) and lessens the compression load. This way, if an athlete fails to stop at THEIR end range (which they need to be educated on), they’re in a less damaging environment.

The Slipped Capital Femoral Epiphysis involves some, typically blunt, force that causes a shift in the growth plate at the femoral head/neck junction, which negates the head/neck offset (at least this is the theory). I’ve heard this attributed to things that kids naturally do like jumping out of trees, falling while playing on the playground, or repetitively free falling to your knees while learning how to play goalie! Now, with no femoral head/neck offset, when the femoral head recentrates in the acetabulum, hip flexion will be limited and it’s likely that the repetitive attempts to push hip flexion past the newly found limits will cause some accumulated trauma locally, which (in my opinion) could lead to additional bone growth and therefore an additional exacerbation of the problem. I know that’s long-winded; I hope it all makes sense. Feel free to email me if you have other questions.

Again, I highly recommend you read the whole article. Knowledge is power, and given that FAI is leading to surgery in a lot of cases, the more you know about to the more you can prevent FAI leading to excessive labral damage and future osteoarthritis (as is often the case when FAI goes unchecked).

Check it out here >> Femoroacetabular Impingement: Etiology, Diagnosis, and Treatment of FAI

To your success,

Kevin Neeld

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