With winter in full swing, many of us are either playing or watching our favorite seasonal sports. Hockey is a popular sport that requires speed and power, and is known for its hard hitting collisions that often lead to injuries. Injuries to the hip are also one of the leading causes for players to miss games in hockey, due to the mechanics of the skating stride. Goalkeepers also may have hip problems due to the stresses on their hips in the butterfly position.
Athletic Soft-Tissue Injuries of the Hip
Sprains, strains, contusions, tendonitis, and bursitis are common soft-tissue injuries that can happen in hockey. Soft-tissue injuries fall into two basic categories: acute injuries and overuse injuries. Acute injuries are caused by a traumatic event, such as a fall, twist, or blow to the body. Sprains, strains, and contusions are examples of common acute injuries. Overuse injuries like tendonitis and bursitis occur gradually over time from repetitive stress without allowing time for the body to heal.
Hip labrum tears and Femoracetabular Impingement (FAI)
There are several factors that can lead to labral tears, including a developmental and body type component, most commonly FAI, as well as a traumatic event and improper training. FAI is a condition where the hip socket or head of the thigh bone is abnormally shaped causing to abut against each other. This can result in tears in the labrum, a cartilage ring on the ring of the hip socket. The labrum contributes to joint stability and helps with preservation of cartilage. Repetitive hip motions and extreme range of motion in hockey can make players susceptible to labral tears. Often it is a combination of both anatomical abnormalities of FAI and activity related motions that cause labral tears. Symptoms include pain in the groin area of the hip that gets worse with activity. Labral tears sometimes also present with painful catching and locking. Discomfort with sitting for prolonged periods and difficulties with squats are frequently reported as well.
Apart from a visit with your doctor including a detailed discussion of your symptoms and an examination, X-rays, MRIs and injections are typically required to come to a diagnosis. Conservative management of FAI includes activity modification to limit the repetitive contact occurring in the hip joint. Physical therapy often is helpful to improve range of motion and strength in the joint.
Surgical intervention is an option if non-operative measures fail. The goal would be to restore a normal anatomic relationship and surgically treat the labral tear.
Hamstring Tendon Rupture
Hamstring tendon ruptures can be caused by a fall or direct blow, a sudden change in acceleration or explosive activity in sports like hockey. Symptoms typically include experiencing a sudden sharp pain in the back of the gluteal area, a loud “popping” noise at the time of injury, swelling, tenderness and subsequent discoloration of the skin.
Early diagnosis and treatment is essential to a successful outcome for a hamstring tendon rupture. If diagnosis or treatment is delayed, the integrity of the healing tissue can be compromised due to scarring and decreased blood flow. Surgical repair is used in cases of complete rupture and retraction of the muscle or tendon. Following surgery, physical therapy is required.
Hip Flexor Tendinitis
Hip flexor tendinitis occurs when the tendons, which are thick cords of soft tissue that connect muscle to bone, become inflamed. It is most often caused by minor injuries to the affected area, repetitive movements, overuse, and occasionally acute trauma.
Non-surgical treatment includes limiting or stopping the activities that cause the pain and inflammation, using anti-inflammatory medication, and icing the affected area. Cortisone injections may also be used to decrease inflammation and pain, and physical therapy is typically recommended. If conservative treatments are ineffective, surgery is usually recommended.
To prevent hip injuries in hockey, along with strength training, a good flexibility program that focuses on the hip rotators and hip flexors should be a key aspect of an exercise program. If you have any type of persistent pain, it’s important to see an orthopedic expert.