There has been a lot of talk from us around our recent move (check out our new space at 3093 Dundas St. West!), but today I wanted to shift gears back into orthopaedic injury management and prevention since I’m better at talking about this…
Among the athletes I typically see at the clinic, pre-teen and teenage hockey players are up there. Whether they are coming in for lower body or upper body injuries, I almost always seem to assess and treat their hips/pelvis. Why? It is VERY common for hockey players, including youth athletes, to develop changes in the hip joint that can lead to serious injury over time. Femoral acetabular impingement (FAI) is the most common culprit.
Research evidence has shown that the incidence of these changes occur in up to 79% of hockey players at the peewee, bantam, and midget level (1). These changes are typically ‘asymptomatic’ in this age group, but continued activity without intervention can lead to symptoms (for example, hip pain with squatting and taking a long stride, or lower back pain during/after hockey). Not all players will develop true problems from these changes, but the risk is there, and we need to act to prevent it at a younger age.
So what can we do?
Proper off-ice training can be critical in developing the control and mobility needed to reduce the athlete’s risk of future injury.
What is Control in the context of the athlete?
Control is being able to activate specific muscles and move your body in specific ways
Control is our primary concern when discussing hip injury prevention for hockey players as it will help with the following:
- Improved balance of forces at the hip joint leads to more diffuse forces across the hip and therefore less ‘wear and tear’ in one area of the hip
- Improved balance of muscle activation/use leads to reduced risk of overuse of one or a few muscles and therefore reduced risk of muscle injury
What is Mobility?
Mobility is the range of motion we can achieve while using our muscles to move us
- IMPORTANT NOTE***: this contrasts with flexibility which is our body’s ability to move through stretching and relaxation… arguably not very beneficial since athletes typically don’t relax their muscles during sport
- As a caveat: Ideally, mobility increases ONLY if control is maintained throughout the entire range of motion.
A reduction in hip mobility and pelvic joint movement has been shown with an activity as simple as walking (2), so I don’t think it is unreasonable to assume that these changes can be amplified during higher-level activities such as hockey. What I typically see in the clinic when assessing youth hockey players is poor hip/thigh control with a movement as simple as a squat. I often see the knees moving every which way during the squat descent, an inability to squat to a depth at or below ‘parallel’, and arms outstretched to help with balance. This to me highlights the mobility and control issues already noted, but also a strength limitation.
So now that we have some insight into the underlying issue, how do we reduce the risk of symptom development while still allowing participation in sport? A thorough biomechanical assessment from your trusted rehabilitation specialist would be a good start! Every athlete will require an individualized treatment plan based on their strengths and weaknesses. But given that you have come this far in the blog, I will give you a few ideas of what we will assess and treat based off of recent recommendations (3):
- Hip mobility (obviously…), but with focus on the end-range of movement. Think about bringing your knee to your chest without using your arms to hug your leg to your body. The first 80-90% is probably pretty easy, but the last 10% is where the challenge begins.
- Bipedal (two-legged) movements to build movement control. We can use specific cues to help the athlete move efficiently and CONTROL their mobility → this would progress to unipedal (single-leg) movement since hockey players spend a lot of time on one leg as they skate.
- Strengthening in the above bipedal and unipedal positions as well as end range positions. If an athlete can CONTROL their movement when they are lifting/pushing/pulling added weight, it will translate to better long-term outcomes and reduced symptom aggravation.
- Acceleration, deceleration, and direction-change training. Having the correct mobility, the correct control, and added full-body strength will minimize the joint forces felt at the hip while completing these drills (thus limiting symptom aggravation).
Though the above is not an exhaustive list of how we can better prevent AND treat your youth athlete’s potential hip problems, hopefully it is a step in the right direction for those looking to build a foundation that will allow for long-term, pain free, participation in sport. If you have concerns regarding your youth athletes pain, movement and/or function, coming in for a detailed biomechanical assessment will bring you one step closer to avoiding injury and improving your bodies tolerance of the sport. Highlighting and resolving biomechanical and strength deficits is something that can’t be done by reading this blog, so please use our expertise appropriately.
As always, thanks for reading!
Jordan Fortuna, Manager of Clinical Services
Jordan is a graduate of the University of Toronto Physiotherapy program and has since been practicing in orthopaedic settings. He has developed an interest in sports physiotherapy through his many years as an athlete, participating in baseball, golf, snowboarding, and more recently rock-climbing, cycling, and strength training. He has worked with a variety of clientele including athletes from disciplines such as competitive dancing, running, rock-climbing, and mixed-martial arts, as well as non-athletes of a wide age range and ability. Regardless of activity level, he is dedicated to improving mobility, optimizing function, and strengthening to help achieve your goals through the use of an individualized exercise prescription and manual therapy. He also has additional training in acupuncture and sports taping.
- Phillipon, M.J., Ho, C.P., Briggs, K.K., Stull, J., and LaPrade, R.F. Prevalence of increased alpha angles as a measure of Cam-type femoroacetabular impingement in youth ice hockey players. Am J Sports Med. April 2013; 41: 1357-1362.
- Kennedy, M.J., Lamontagne, M., and Beaule, P.E. Femoroacetabular impingement alters hip and pelvic biomechanics during gait: Walking biomechanics of FAI. Gait & Posture. July 2009; 30(1): 41-44.
- Bennell, K.L., O’Donnell, J.M., Takla, A., Spiers, L.N., Hunter, D.J., Staples, M., and Hinman, R.S. Efficacy of a physiotherapy rehabilitation program for individuals undergoing arthroscopic management of femoroacetabular impingement – the FAIR trial: a randomised controlled trial protocol. BMC Musculoskeletal Disorders. Feb 2014; 15(58).