Hockey Hips

Living in the great "State of Hockey", we tend to see the same injuries in current and former hockey players. Ice hockey is a thrilling and demanding sport that places unique stresses on the body, particularly the hip joint. One common hip condition that affects many hockey players is Femoral Acetabular Impingement (FAI). Below we talk about what that condition is, what leads to it, and how you can manage FAI while optimizing overall performance on the ice (or in your daily life).

Femoral Acetabular Impingement (FAI)

Femoral Acetabular Impingement is a condition characterized by abnormal contact between the femoral head (the ball of the hip joint) and the acetabulum (the socket). This repetitive friction can lead to pain, limited range of motion, and, if left untreated, long-term damage to the hip joint. There are three main types of FAI: Cam, Pincer, and Mixed.



Cam = Abnormal femoral head/neck shape

Pincer = Abnormal socket shape

Mixed = Combination of both

Hockey players, with their constant lateral movements, pivoting, and quick accelerations, are particularly prone to developing FAI.

Recent studies show the incidence of FAI in 16-18 year old hockey players is significantly higher than non-hockey athletes. The findings indicated that greater than 75% of the tested subjects were pre-disposed to developing the symptoms of FAI. Considering most Minnesota hockey players learn to skate before they can even walk, this makes sense.

Symptoms of FAI:

• Hip Pain:

• Pinching and aching in the front of the hip with physical activity like skating.

• Groin Discomfort:

• Tightness in the groin area, especially when moving the hip joint.

• Limited Range of Motion:

• Reduced flexibility and range of motion in the hip, making certain movements, including internal rotation, challenging.

• Clicking or Catching Sensation

• Stiffness:

• Stiffness in the hip joint, particularly after periods of inactivity, such as sitting for extended periods.

Biomechanics of Skating

Unlike running on land, where stride length and limited ground time is a primary focus, skating involves maintaining continuous contact between the skate blade and the ice. The mechanics of striding on ice require a shorter stride, emphasizing the importance of a prolonged skate contact with the ice. To achieve speed you need internal rotation of the hip and pelvis, which allows for effective power generation and push-off during each stride. It also plays a crucial role in maintaining balance and stability, key components for high-performance skating.

Normal mechanics of walking and running involve the femur internally and externally rotating within the hip socket throughout the different phases of gait. Normally when the leg is behind you in extension, the hip needs to internally rotate and be closer to midline. When the leg is out away from the body, this typically biases an externally rotated hip. However, with skating you do the opposite and drive your foot out away from midline and force your leg into internal rotation. If you do not have ~45 degrees of hip internal rotation, then the "ball" or femur gets pushed forward in the socket causing that pinching sensation. Which may ultimately lead to FAI if left untreated.

Assessing & Addressing FAI

Range of Motion: Check how far you can go before feeling symptoms or compensating

Hip Flexion: Full = knee close to chest

(without your hands) Try raising your knee towards your chest without

• pinching in the front of your hip

• rounding your low back

• letting your knee travel outward

Hip Extension: Full = leg even with your body

While sidelying, try bringing your leg backward without

• arching your low back

• letting your hips open

• feeling a pull in your hip and thigh

Hip Internal Rotation: Full = ~45 degrees

While lying on your back, raise your knee to 90 degrees, and try rotating your foot out without moving your knee.

Hip External Rotation: Full = ~45 degrees

While lying on your back, raise your knee to 90 degrees, and try rotating your foot in without moving your knee.

If any of these are limited, and especially if they cause symptoms at the front of the hip, then further examination is recommended. Having the capacity to move through full ranges of motion without compensating is very important for overall health and decreasing the likelihood of FAI. Compensations over time may lead to soft tissue restrictions and injuries. Most commonly in the back of the hip, and muscles of the inner thigh. To address these patterns and habits, we prescribe specific exercises and drills that restore full motion. To address the soft tissue restrictions and/or adhesions we use manual therapy and extracorporeal shockwave therapy (ESAT).

Try these at home:

*Check your range of motion before and after.

Posterior Capsule Stretch - Hold the position for ~10 breaths

Passive Hip Internal Rotation - Hold the position for ~10 breaths

90/90 Hip Lift - Hold hips off the ground for ~10 breaths (or until you feel low back/glute)

If you are a former/current hockey player, or have a kid who plays, try these out to restore hip internal rotation. If you want more drills and exercises, or think you may need treatment, click the green button below to sign up.