Within the last year I have had the opportunity to work with the women’s ice hockey team at the UNH. Since that time I have tried to read as much as I can on hockey related injuries and what can be done to prevent these potential injuries through the work of hockey strength coaches like Kevin Neeld and Mike Boyle along with physical therapists like Gray Cook and Shirley Sahrmann amongst others so that I can create better off ice programs that speak to the specific needs of an ice hockey player and keep them healthy and strong throughout their competitive season.
On top of this, a couple of weeks ago one of our players remarked that both back and front squatting hurt her hips, but only when she would ‘get low’. Another chimed in with the same feelings. This lead me to dig deeper into what this could be and why it only bothered them when they would ‘get low’.
The one thing that comes up over and over again is femoracetabular impingement (FAI).
According to www.hipfai.com, FAI is a conditioning of too much friction of the hip. The ball (femoral head) and the socket (acetabulum) rub abnormally creating damage to the hip joint.
There are also various different types of FAI; cam, pincer and mixed. Again, according to www.hipafi.com, cam describes the femoral head and neck relationship as not perfectly round, with this loss of roundness contributing to abnormal contact between the head and the socket. A second form of FAI known as pincer, where the socket has too much coverage of the ball resulting in the labral cartilage being pinched between the rim of the socket and the femoral head-neck junction. The third and most common type of FAI is mixed where cam and pincer forms exist together. FAI limits hip range of motion, most notably hip flexion beyond 90 degrees. Furthermore, FAI is a bony block – you probably won’t have a ton of luck trying to stretch or perform mobility work to fix the issue.
The research in regards to FAI in hockey populations is pretty alarming. In a study by world renowned hip specialist Marc Phillipon, he found the following;
Femoracetabular Impingement (FAI)
• Pee Wee (10-12 years old): 37% had FAI
• Bantam (13-15 years old): 68% had FAI
• Midget (16-19 years old): 93% had FAI
Hip Labral Tears
• Pee Wee (10-12 years old): 48% had labral tears
• Bantam (13-15 years old): 63% had labral tears
• Midget (16-19 years old): 93% had labral tears
The data is clear – the longer one plays hockey the greater the likelihood that FAI is going to wreck havoc on the hip labrum.
This begs the question, if 93% of midget level hockey players (16-19 years old) have both FAI and labral tears, how many 20+ year old college hockey players are dealing with the same issues whether they are symptomatic or asymptomatic? It stands to reason that the entire team is minus one or two players.
So what can a strength and conditioning coach do to fix the issue?
In reality, probably not much – FAI is something that keeps developing over years and years of doing the same thing (skating in this example). But we can make an impact for the better and keep these athletes on the ice throughout their college careers. In a lot of ways it may be more about what we don’t do with hockey athletes as opposed to what we actually do with these athletes. After spending so time reading from the likes of the previously mentioned strength coaches (Neeld & Boyle) along with the writing of Eric Cressey and Tony Gentilecore.
Screen your athletes. Whether you use the FMS or have a system that you have developed on your own, you need to screen them. How do you know exactly what you are dealing with, what you may have to train around, if you don’t check? You have to understand what you are dealing with and who may be at risk, not matter what the movement deficiency might be so that you can train each individual they way they need to be trained.
Stop skating year-round. Get hockey players out of their skates in the off-season. As much as they are going to think you are crazy and fight you on this, they need it. You don’t have to be a genius to realize that doing the same thing over and over and over again is going to eventually cause some problems.
Stop squatting bilaterally. If you are a strength coach, personal trainer or anyone else squatting a hockey player (symptomatic or not) you are asking for problems. As previously mentioned, going below 90 degrees of hip flexion is not recommended for someone with FAI, its borderline dangerous. You could squat above 90 degrees, but you are probably playing with fire. Remember, the intent of training is to make the athlete both feel better and play better, neither of which can happen if they are hurt as a result of their off ice training.
Train around FAI by deadlifting. Whether it be Trap bar deadlifts, conventional deadlifts, or rack deadlifts. All and any of these variations are better options then squatting because you never ask the hip to get into 90 degrees or more of flexion. You can and should still get seriously strong. You should still perform bilateral movements – just pick the one that fits the hips of this population.
Hammer single leg work. Besides deadlifting I am not sure you need to do any other bilateral strength work. Anecdotally, hockey athletes respond well to single leg training (just look at the results that Mike Boyle has got over the last 10-15 years). In addition, both our athletes that remarked that squatting hurt their hips also remarked that 1-leg squats, slideboard lunges, and rear foot elevated split squats (and other split squat variations) were difficult but did not hurt their hips at all – the funny thing is no one has a good reason as to why single leg work doesn’t bother the skaters hip when bilateral squatting does bother the skaters hip. A common thought is that single leg work allows the hip to find its ‘sweet spot’ with hip internal and external rotation. This leads us right into the next recommendation…
Don’t be stupid. As Mike Boyle has famously said, “If it hurts, don’t do it.” It’s really that simple, even if you think it’s a movement that should be pain free. Find what works, what doesn’t hurt, and get really strong with those movements.
Though we can not prevent any of these injuries we probably can train around them and train appropriately off ice to keep hockey players asymptomatic and healthy throughout their competitive season.