Hip Impingement in Hockey Players:
focus on butterfly style goalies
Christopher Larson, MD
Twin Cities Orthopedics, Edina MN
Team Physician: Minnesota Wild
David Rust, MD
Orthopedic Sports Medicine Fellow
Overview
• Anatomy
• What is impingement?
• Affect on hockey
players/goalies
• Treatment options
• Other hip problems
• Future of research and
INJURY PREVENTION!!
Hip = ball and socket joint
Femur = thigh bone, head
and neck are involved
Acetabulum = part of the
pelvic ring
Labrum = cartilage ring on
rim of acetabulum,
mechanical “bumper”,
seals the hip joint
(gasket)
Articular cartilage = smooth
gliding surface, worn out
in arthritic joints
What is impingement?
• FAI = Femoral-Acetabular Impingement
– Abnormal contact between the ball and rim/socket
during activity
– Results from a ball that is not perfectly round (CAM)
or a socket that is too deep (PINCER)
• Labral Tear
– Repetitive impingement leads to “pinching” of the
labrum between the ball and socket
– Labral tears are common and often do not cause pain
– Important to recognize and treat the underlying
impingement
Signs and Symptoms
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Deep sharp groin pain
Worse with quick turns
Limited hip rotation/flexibility/stiff
Unable to sit for prolonged periods
Groin / Front of the hip pain after activity
• Impingement test = pain with hip flexion and
internal rotation
Must rule out other causes of pain
• Muscle and tendon strains
• Contusions, fractures
• Athletic pubalgia / SPORTS HERNIA
Butterfly Effect
• Evolution of style
• Rules and regulations
• Increased rate of surgery
Approximately 5-10 NHL goalies
per year have FAI surgery:
•JS Giguere
•Tim Thomas
•Niklas Backstrom
•Vesa Toskala
•Patrick Roy
•Josh Harding
•Antero Niitimaki
•Rick DiPietro
•Ray Emery
•Craig Anderson
Butterfly Effect
• Skills that may place hip at risk
– pad flares
– recovery pushes
– T-pushes/One foot stops
– One knee down on post
– butterfly drops
Treatment Options
• First step should be to work with coaches and
athletic trainers to identify likely cause of pain
• Examination (with experienced provider) and regular
x-rays will confirm diagnosis
• When should an MRI be considered?
– Recent study found positive MRI finding in 77% of
asymptomatic professional and NCAA hockey players
FAI X-Rays
Treatment Options
• Anti-inflammatory meds, rest, ice
• Modifications in technique and equipment,
decreased repetitions
• Therapy can work on strengthening core muscles and
hip rotators
• Numbing injections can assist in determining the
source of pain, but cortisone is usually avoided in
young patients
Treatment Options
• When should surgery be considered?
– Unable to perform athletics despite non-surgical
treatment
– Pain with daily activities
– In our experience, athletes that have problems at
a younger age are more likely to eventually need
surgery and are at risk for more significant hip
damage
Hip Arthroscopy
Dr Larson has published over 40 articles regarding hip
injuries in athletes & has operated on over 50 US and
European Hockey Goalies from high school to the professional
level in the last 3 years as a result of Impingement and disabling
pain.
We are currently conducting several studies looking
at the anatomy of the Hockey Goalie.
Before Surgery
After Surgery
Can we prevent impingement?
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Shape of hip develops over time while the body is growing
Primarily takes shape during adolescent growth spurt
Ages 10-14 in girls and 12-16 in boys
Depends on type of activity and number of repetitions
May be similar to throwing injuries in youth baseball
Possible preventive strategies
• core fitness program for young goalies to
strengthen muscles and/or maintain flexibility
• Improve upright Posture in butterfly and splits
positions
• skill repetition limits in practice
• greater “off-season” time, cross-training
• equipment limitations or improvements
What does the future hold?
• Research looking at hockey
goalies and players of all ages to
find trends and identify who is at
risk
• Rules and regulations to help
protect athletes from injury
• Guidelines and recommendations
for youth athletes, parents, and
coaches
Research Study: Cam Impingement in
Butterfly Goalies
• Goal is to better understand, predict, and prevent hip injuries
• Hockey goalies, hockey players, non-hockey players, with or without
symptoms, ages 10-40
• No cost to enroll
• Participants will complete questionnaire, examination, and x-rays
• No personal identifying information
• Gain knowledge with respect to the RISK of developing HIP problems based
on the Examination and Xrays
• Minimal physical risk
– Radiation from x-ray less than the typical annual exposure for an average
Minnesota resident
Research Study: Cam Impingement in
Butterfly Goalies
• Participation requires signed consent (adults
and parent/guardian) and assent (adolescent)
• If interested please contact:
– Becky Stone @ beckystone@tcomn.com or
952-456-7136
– Dave Rust @ drust1@fairview.org
Thank You
Twin Cities Orthopedics, Edina