Hip impingement is a very common diagnosis for hockey players. It’s often described as a pinching in hip flexion or in flexion and internal rotation.
The majority of hockey players will show signs of cam morphology on x-ray, even those without pain. Most believe hip impingemnt is caused by a structural pathology. This can only be corrected with surgery. But, we aren’t addressing the dynamic issues of a movement-based problem.
This leads to:
- High surgical rates
- Poor surgical outcomes
- Poor return to sport rates
Hip impingement is a dynamic movement-based problem.
A common issue I see in hockey players is Shirley Sarhmann’s anterior femoral glide syndrome.
Sarhmann says that when the femoral head doesn’t glide in hip flexion it can cause pinching. Her research has found that weak hip flexors and weak glutes can be a cause of this problem. I often see muscles that drive skating, like the glutes and adductor magnus, contribute to hip impingement.
Address movement quality to improve hip impingement
Addressing these issues can decrease hip impingement symptoms by improving dynamic joint position.
The hip joint is a circle. Muscles on one side of the the hip can contribute to symptoms on the other side. The tight glutes and adductor magnus limit posterior gliding of the femoral head. The weak hip flexors will not push the femoral head posteriorly in the hip joint.
On top of movement at the hip, anterior tilting of the pelvis will create dynamic impingement. Some hockey players will always be in an anterior tilt, others will have a dynamic anterior tilt.
Finally, poor ankle mobility can create dynamic hip impingement. If players can’t get into a positive shin angle, they will always be on their heels. To keep from falling back, they will flex forward and pull hard with their hip flexors causing a pinch.
Whether it’s non-operative management or post-op rehab, addressing movement quality will get you better outcomes.
The majority of players have pathology on x-ray. But not all have hip impingement. I think most symptomatic hip impingement is caused by poor movement.
If we aren’t addressing movement quality, players will often continue to have hip pain. But if you can these issues, you could help them avoid surgery and get back to high performance.