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.

5 Comments

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  1. Maria Mountain October 5, 2014 at 10:00 am #

    Great question Dawson. There are many reasons you can experience symptoms like the ones you describe. You are right, some of them are true bony limitations as a result of the shape of your ball and socket hip joints. That could require a visit to the surgeon.

    HOWEVER – there are other reasons you may get those symptoms – based on the fact that you have been diligent with your stretching (depending on what stretches you are doing and how you are doing them) we will assume you have been following a proper stretching program doing it at least 5 times per week for 8-weeks without seeing ANY improvement (if that is not the case, then start there), it could be a capsular tightness.

    This will be very hard (impossible) to stretch out yourself, so I would be looking for a physiotherapist or a very good sport massage therapist who has the credentials and experience to do capsular mobilization. You may be very surprised at how much it helps.

    Do make sure you get that looked after because jamming into positions where you hips cannot go will lead to greater and greater damage to the hip joint itself – let’s keep you healthy and on the ice.

    Hope that helps point you in the right direction.
    Cheers,
    Maria

  2. Dawson October 4, 2014 at 11:15 pm #

    Is there anyway to try and treat this or atleast make it a little less severe? I am only 16 but already have hip pain like senior. I never noticed pain until an incident about two seasons ago where I just dropped lightly to my butterfly just to follow my own defender and there was an intense pain in the hip and it basically locked up, I didn’t get it looked at or anything and took it easy for the rest of that season and it felt better for a while but the past two seasons it has worse, to the point that I can now barely butterfly and slide simultaneously. I never had hip problems before that one incident so could that have been a start to the scaring or is it not impingements at all.. I went to a chiropractor this year and all he told me was I have irregular hips and that stretching will get rid of the problem but no matter how much stretching I do, it doesn’t seem to help. Any information would be greatly appreciated!

  3. Maria Mountain May 5, 2013 at 4:45 pm #

    Great that you did not have damage to your cartilage. Really lucky. There are loads of things you can do to help get your mobility and strength back. The most important thing is to make sure there are no restrictions from your physio or your surgeon. Then you need to avoid anything that gives you hip pain. If you feel stretching in the muscle or fatigue in the muscle that is fine, but you should not be getting joint discomfort.

    This video will give you some ideas to get you started… http://www.youtube.com/watch?v=jpPXJgkELUI and there are hundreds of exercise videos on the website or my YouTube channel to help – http://www.YouTube.com/RevolutionCondition

    Hope this helps, but let me know if you have other questions.
    Cheers,
    Maria

  4. Sammy Guzman May 3, 2013 at 5:47 pm #

    Hey Maria,

    Last October I was treated for bilateral FAI. I was very lucky that Dr. Jason Snibbe found zero articular Cartilage degeneration. I have since been released from PT and trying to regain mobility/strength. Even though the Dr removed substantial bone spurs, I still have limited Internal Hip Rotation. The only different is I feel more of a stretch. Prior to surgery, I had 0-1 degress of IR. Post op, I have 10-15 degrees. Any advice?

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  1. Butterfly Goalies: Is that pinch actually a hip impingement? | The Hockey Training Blog - May 17, 2010

    [...] What hockey goalies need to know about the pinch in their hip. [...]

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