3 Reasons Why Hockey Players Have “Tight Hips”

One common complaint I hear from athletes in general, but in particular hockey players, is that they have tight hips. Here are 3 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 FAI, 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 DOMS in their hips after a game/practice, there is a significant amount of strain on those muscles and there will be some onset of DOMS which reduces range of motion. Chronic strain on these muscles can 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 FAI and labrum tears  (Siebenrock, Kaschka, Fauchiger, Werlen, Schwab, 2013, Philippon, Ho, Briggs, Stull, LaPrade, 2013, Epstein McHugh, Yorio, Neri, 2012) . Research on skating biomechanics has shown that the hip is in an “at-risk” position during skating to develop issues such as FAI and labrum tears (Stull, Philippon, LaPrade, 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 cause FAI and labrum 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 no concrete 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

References

Chang, R., Turcotte, R., & Pearsall, D. (2009). Hip adductor muscle function in forward skating. Sports Biomechanics, 8(3), 212-222.

Epstein, D. M., McHugh, M., Yorio, M., & Neri, B. (2013). Intra-articular hip injuries in National Hockey League players: a descriptive epidemiological study. The American journal of sports medicine, 41(2), 343-348.

Kalisvaart, M. M., & Safran, M. R. (2015). Microinstability of the hip—it does exist: etiology, diagnosis and treatment. Journal of hip preservation surgery, 2(2), 123-135.

Nepple, J. J., Philippon, M. J., Campbell, K. J., Dornan, G. J., Jansson, K. S., LaPrade, R. F., & Wijdicks, C. A. (2014). The hip fluid seal—Part II: The effect of an acetabular labral tear, repair, resection, and reconstruction

Myers, C. A., Register, B. C., Lertwanich, P., Ejnisman, L., Pennington, W. W., Giphart, J. E., … & Philippon, M. J. (2011). Role of the acetabular labrum and the iliofemoral ligament in hip stability: an in vitro biplane fluoroscopy study. The American journal of sports medicine, 39(1_suppl), 85-91.

on hip stability to distraction. Knee Surgery, Sports Traumatology, Arthroscopy, 22(4), 730-736.

Philippon, M. J., Ho, C. P., Briggs, K. K., Stull, J., & LaPrade, R. F. (2013). Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players. The American journal of sports medicine, 41(6), 1357-1362.

Siebenrock, K. A., Kaschka, I., Frauchiger, L., Werlen, S., & Schwab, J. M. (2013). Prevalence of cam-type deformity and hip pain in elite ice hockey players before and after the end of growth. The American journal of sports medicine, 41(10), 2308-2313.

Silvis, M. L., Mosher, T. J., Smetana, B. S., Chinchilli, V. M., Flemming, D. J., Walker, E. A., & Black, K. P. (2011). High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players. The American journal of sports medicine, 39(4), 715-721.

 Stull, J. D., Philippon, M. J., & LaPrade, R. F. (2011). “At-risk” positioning and hip biomechanics of the Peewee ice hockey sprint start. The American journal of sports medicine, 39(1_suppl), 29-35.