The following article was written by Matt Kelly, MScPT who is a physiotherapist and former Canadian junior hockey player.  Matt has worked with athletes of all levels including high school, collegiate and professional. He is also one of the main contributors for Be Elite Rehab and Performance


One common complaint I hear from athletes in general, but in particular hockey players, is that they have tight hips. Here are three reasons why hockey players might have “tight hips”…

Skating is “stressful” on your hips

The skating motion begins at the hip. Every stride is achieved by an explosive extension, abduction, external rotation at the hip (Robbins, Turcotte, & Pearsall, 2018). One group of muscles that is commonly tight in hockey players is the adductor group, which is an antagonist muscle to all three movements occurring at the hip during the hockey stride. Chang, Turcotte, & Pearsall (2009) have looked at muscle function of the hip adductor group in forward skating through EMG testing at different skating speeds. They found two spikes in EMG in all muscles, however the greatest spike was in the adductor magnus. The first spike was at blade-ice contact, where the adductor magnus would work to stabilize the stance leg. The second spike was during propulsion-recovery, where they found that the adductor had the greatest increase in magnitude and in duration. The adductor magnus is eccentrically active during late push-off to decelerate the leg and transition from push-off to recovery where the adductor magnus is concentrically active. They also found that increasing skating speed increases angular velocity at the hip joints, which means there will be an increase in the rate of strain on the hip muscles.

Another study by Jonasson et al. (2016) compared hip ranges of motion between athletes (soccer and ice hockey players) and non-athletes. The main finding of their study was that the athletes had decreased hip ranges of motion. However, there were no differences in radiographic images which would have shown signs of femoroacetabular impingement syndrome (FAIS), which is known to reduce hip range of motion. This finding suggests that the decreased range of motion could be caused by soft tissue restrictions. The repetitive nature of sports places continuous strain on muscles. I like to use the analogy of going to the gym and doing 100 bicep curls. The next day, your arms will be so sore that you won’t be able to fully extend them. Although athletes may not feel the delayed onset muscle soreness (DOMS) in their hips after a game/practice, there is a significant amount of stress on those muscles and there may be some onset of DOMS which reduces range of motion. Chronic strain on these muscles can potentially have lasting effects on range of motion.

Irritated static structures

It has become a well known fact that a high percentage of hockey players have radiographically defined FAIS and labral tears (Siebenrock, et al., 2013; Philippon et al., 2013; Epstein et al., 2013) . Research on skating biomechanics has shown that the hip is in an “at-risk” position during skating to develop issues such as FAIS and labral tears (Stull et al., 2011). These at risk positions are flexion and internal rotation in late recovery phase and abduction and external rotation in late push off. They are considered at risk positions because these are the mechanisms believed to contribute to FAIS and labral tears in hockey players.

Although the majority of hockey players with these issues may be asymptomatic (Silvis et al., 2011), the overuse and repetition of the at-risk positions can lead to irritation of certain structures such as bone, labrum, or capsule. With joint irritation, we often times will get muscle guarding, which is a mechanism the body imposes in an attempt to protect irritated tissues. We will often see people come in with “tight hip flexors” who have been stretching them for weeks or even months but to no avail. These people often have deeper hip issues which cause the muscle to guard the joint. Therefore, they will get some short term relief from stretching but no long lasting effects as the problem is deeper than the muscle itself.

Hip Microinstability

Hip microinstability has been a relatively new diagnosis for hip pain. There is not a lot of research on this subject but there is some promising articles, although many are still skeptical. Based on some of the research that I have read, this could make sense to occur in hockey players. But again, there is noconcrete research to back up these thoughts, this is me making sense of what I’m reading and putting different thoughts together.

The pathomechanism of hip microinstability has been suggested to be repetitive hip joint rotation and axial loading (Kalisvaart & Safran, 2015). Anatomically, the iliofemoral ligament and anterior labrum limit external rotation of the hip as well as anterior translation of the femoral head, which according to Maitland would occur with hip external rotation (Myers et al., 2011). The repetitive motion of skating, which includes repetitive external rotation and abduction, can potentially damage static stabilizers of the hip, more specifically the anterior labrum and iliofemoral ligament. This can lead to increased translation of the femur in the acetabulum which can damage surrounding tissues such as bone, ligament/capsule, and labrum as previously discussed (Kalisvaart & Safran, 2015).

Nepple et al. (2014) found that hip labrum tears reduced the strength of the labrum seal with distraction forces, which could be significant in hip microinstability. With hockey players often having such a high prevalence of labrum tears (Epstein et al, 2013), the lack of hip seal caused by the labrum tear contributing to microinstability within the hip joint seems possible. And again, the increased translation of the femur in the acetabulum can cause damage to other structures and lead to reflexive muscle guarding.

Solution

  • Proper recovery post game/practice (foam roll, soft tissue release, etc.)
  • Take caution with tight hip flexors! They may not be tight, they may be guarding the anterior hip. Check for other muscle imbalances.
  • Strengthen the deep hip rotators (hip rotator cuff) and train neuromuscular stability in the hip
  • Refer out as appropriate

Matt Kelly, MScPT
Be Elite Rehab and Performance


John’s Thoughts…

The athlete’s hip is an inherently complicated region with varying pathoanatomical and psychosocial contributors to symptoms. Understanding the biomechanics involved in ice hockey (and the significant differences between forwards/defensemen/goaltenders) is incredibly important in the treatment of this population. In addition to the soft-tissue contributions laid out concisely by Matt, clinicians also need to take into consideration the adaptive femoroacetabular osseous morphological changes that occur in the vast majority of ice hockey players (Brunner et al., 2016; Philippon et al., 2013).

These morphological changes are present frequently in asymptomatic athletes and should not be considered pathological (Frank et al., 2015), however understanding how this impacts movement behavior and perceived ‘stiffness’ is incredibly important. In addition to the important factors addressed in Matt’s article, the treating clinician should also consider…

  1. Managing load through modification of training volume or programming
  2. Alteration of movement patterns during training and/or participation in sport
  3. Graded exposure to provocative or ‘stiff’ movements as the athlete is able to tolerate

Athletes can stretch or perform soft-tissue mobilization to their heart’s content, but if the underlying reason for their perceived stiffness is related to their osseous anatomy, meaningful changes will be hard to find.


Continued Reading…

      


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About the Author John Snyder, PT, DPT, OCS, CSCS

I am a Physical Therapist, a Board Certified Orthopaedic Specialist, a Strength & Conditioning Specialist, an Educator, and a Research Junkie. My goal is to provide resources for orthopedic and sports medicine clinicians to keep up to date with the current literature and allow them to translate it to their practice.

One comment

  1. Can cyclist suffer from the same issue… especially with hip internal rotation? Lots of the pain there for me… its deep pain also.

    Like

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