Femoroacetabular Impingement Syndrome in Hockey Goalies

Femoroacetabular impingement syndrome (FAIS) sounds bad doesn’t it?  Truth is, it can be.  Just like a baseball pitcher who tears up their shoulder by trying to pitch with shoulder impingement, a hockey goalie who is trying to jam themselves into hip internal rotation, can tear up their hip joint.  Which leads to pain, wear and tear, even surgery down the road.

My two objectives for off-ice training hockey goalies are to:

  1. Reduce their risk of injury
  2. Improve their performance

These objectives are listed in priority order.  That’s right, my primary goal is to train hockey goalies in a way that reduces their risk of non-contact injuries.  So let’s look at FAIS and discuss how your off ice training can reduce the damage.

The first thing to consider in a discussion of FAIS is the fact that, just like our finger prints, no two athletes have the same shaped hip.  The hip joint is a ball and socket joint and everyone has a different shaped ball and a different shaped socket.  For some goalies the ball and the socket do not work well together and the actual structure of the joint creates a bony restriction to the anatomical range of motion.  This means that no matter how much you stretch or foam roll not everyone can do the splits or get a full butterfly flare. 

Trying to force your hip to move beyond its anatomical limit is stressful on the joint and will lead to damage over time including early onset of osteoarthritis.  Think about the sound your car makes when you crank the wheel all the way to one side as you try to do a U-turn – you can tell your car does not like that when it is whining and clunking.  Same goes for your hip.

There are different types of femoroacetabular impingement classified based on whether it is the ball (femoral head) or socket (acetabulum) that causing the pinch.  For the sake of this article, we are not going to get into the minutia but look at the big picture.  In an article co-authored by Steadman-Hawkins Orthopaedic surgeon Marc Philippon it was reported that of 33 professional hockey players who were surgically treated for hip pain, 27 of them or a whopping 81% had FAIS. 

Hockey goalies and other athletes with FAIS will often complain of pain in the front of their groin which is made worse with hip flexion and internal rotation.  If this is a true FAIS then it is not a matter of more stretching or trying to force the movement it is a case of working within a pain-free range of motion.  If the athlete can squat to 90 degrees comfortably, but below 90 degrees they feel the anterior hip pain then as a hockey strength coach, you need to keep them in the comfortable range of motion. 

Here is a technique that I picked up from my colleagues over at www.hockeystrengthandconditioning.com .  It is a great way to determine the athletes squatting mobility.

  1. Have the athlete take a quadruped position on the floor.
  2. While maintaining a neutral back position, the goalie shifts his hips back as far as possible without rounding the back or reproducing the anterior hip pain.
  3. The goalie will start with his knees approximately hip width apart, but on successive reps he will widen the stance until you determine the best pain free range for this exercise. 
  4. This ‘best pain free range’ then becomes his squatting stance and range of motion.

Trying to force a movement or overload a faulty movement pattern when training hockey goalies will lead to injury. Period.  If the movement pattern cannot be cleaned up through soft tissue or mobility work, then consider that it could be a bony limitation and learn to work within the restriction.