Skating mechanics often get blamed for the development of FAI in hockey players
Most blame the flexion and internal rotation of the femur during stride recovery. This combined hip motion is thought to lead to repetitive bony contact of the femur and the hip joint. Cam morphologies, thought to a precursor to FAI, will develop over time.
Except skating doesn’t reach hip impingement positions
When we look at hip positions in skating research and hip impingement research, they don’t line up.
Hockey players typically reach hip flexion angles of 45-60 degrees and hip IR angles of 5-15 degrees. Bony hip impingement most often occurs above 90 degrees of hip flexion with maximal hip IR and maximal hip adduction. Based on this evidence, repetitive bony contact leading to cam morphology doesn’t stand.
So where do cam morphologies and FAI come from?
Cam morphologies begin in hockey players’ early teens.
Research suggests that cam morphologies develop from high sport volume during periods of rapid growth (~12-14 years old). High volumes of skating puts compounding strain on the open growth plate of the femoral neck leading to a bony callus. Although cam morphology is a criteria for diagnosing FAI, it doesn’t always lead to FAI and hip pain (click here to read my newsletter on why hockey players get hip impingement symptoms).
Can we prevent cam morphologies? I don’t know. Should we try to prevent or reduce them? I don’t think it would hurt. Some people believe that structural changes are normal adaptations to the sport and might have some benefit (if this is you, I’d enjoy hearing your viewpoint. Please reply to this email with your thought process). I believe that if cam morphologies are a precursor to FAI, limiting or avoiding them could have an impact on the hip pain epidemic in hockey.
Here’s 3 ways I think we can do so:
#1: Schedule an off-season. Most youth players are on the ice 12 months per year. Cam morphologies develop from constant strain on the bone. Give the bone time to heal and recover by getting off the ice for 1-2 months.
#2: Have days off in-season. A lot of minor hockey teams are skating 5-7 days per week. On top of this, some players do extra skating sessions. Again, bone needs time to heal and recover after being strained. Have days off in-season to allow this to happen.
#3: Let kids be kids. I’m not a fan of cliche sayings, but this one is true. Too many kids have busier schedules than most professional players. Constant strain of the same skating movements likely leads to larger cam morphologies. Playing other sports, getting in the gym and playing with friends puts different strains on the growth plates while also developing athleticism.
Hockey players can develop FAI for different reasons. However, I don’t believe skating mechanics are to blame more than skating volume.
Kids don’t need to be pros until they need to be pros.