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Hip and Groin Pain in Hockey Players

When you say hip or groin pain, what do you mean?

There are so many conditions out there that can drive hip or groin pain, but for simplicity, I’m going to discuss the 4 major diagnoses I commonly see in hockey players.

  • Hip flexor impingement or FAI

  • Hip Labral tear

  • Sports Hernia/Athletic Pubalgia/Adductor tendon injury

  • Adductor/groin strains

Hip Flexor Impingement or FAI (Femoroacetabular impingement)

What does it feel like?

Hip flexor pain will most commonly present in hockey players as both a “pinch” and/or a “dull ache” in the front of the hip. The pinching sensation is exacerbated by passively (somebody else moving the leg) bringing the knee towards the chest, moving the leg towards the midline of the body, and rotating the hip inwards. The “dull ache” can be brought on when the leg is extended, putting the hip flexor in a stretched position. Alternatively, the pain can also be brought on when the athlete is actively moving by lifting their leg when lying on their back, squatting into a deep position, or doing a powerful movement such as skating. Many times athletes are able to play with minimal hip flexor pain in a game, but pain increases significantly after the athlete cools down and remains higher for the next few days.

Why does it happen?

Hip flexor pain is primarily driven by an overloading of the hip flexor tendon which causes the tendon to become sensitive and irritated in certain positions or with excessive load. Overloading of the tendon can happen in two ways, either with a quick explosive movement like going from a dead stop to a sprint, or from gradually and slightly overstressing the tendon over time (A lot of skating + not enough time to recover in between).

How does it affect on-ice performance?

Since the pain is brought on when the leg is both fully extended and flexed too much, the athlete will subconsciously try to “protect” the hip flexor by skating up higher and shortening their stride. While most athletes will be able to play through their hip flexor pain using these compensatory movements, it almost always impacts their speed and ability to change directions.

Hip Labral Tear

What does it feel like?

The feeling of a hip labral tear can present very similarly to a hip flexor impingement. In many cases, the athlete will have that same “pinching” pain in the front of the hip with the knee towards the chest, across the midline and the hip rotated in. In addition to the “pinching” in the front of the hip, the athlete may feel a “pinch” in the back of the hip or near the sit bone when the leg is rotated outwards completely. When the athlete is actively moving, they may feel ok with light weights but be unable to tolerate heavy weights due to a “deep” hip pain. When a hip labral tear is flared up or aggravated, players will often have pain at rest and with daily movements.

Why does it happen?

The labrum is a ligament that surrounds the ball and socket of the hip and provides increased stability and depth to the socket portion of the joint. When the hip is stretched in any direction, there is considerable stress placed on the labrum and it may begin to slightly tear if the movement is repeated enough. Large quick labral tears can also occur if there is a quick very powerful rotational movement with the leg planted (think the stance leg of a soccer kick) or if the leg is stretched quickly and forcefully like when a goalie stretches to get across the crease.

How does it affect on-ice performance?

This type of injury will be most apparent in goalies. Due to the amount of range of motion that is required to play goalie at a high level, the pain in the hips will often force goalies to miss time. If a goalie is able to play through the pain, they will have decreased power when moving laterally in the crease and they may have a lot of pain trying to stay low to block pucks.

For forwards and defensemen, a hip labral tear may also decrease on-ice performance. In some cases, players may be able to skate as low as they normally would, but they will most likely present with a decreased stride length to avoid overextending the hip.

Sports Hernia/Athletic Pubalgia

What does it feel like?

Pain from a “sports hernia” generally presents as a very deep pain in the groin that can radiate down the inside of the leg as well as up to the lower abdomen. The athlete will feel increased pain when either the muscles of the lower abdomen or the groin are activated and pulling on the pelvic bone. Examples of exercises that will trigger the pain are squeezing a ball between the knees or a resisted sit up.

Why does it happen?

Similar to other injuries in the hip, a sports hernia can occur immediately with a quick powerful movement or from gradual overloading over a longer period of time. The injury occurs when the muscles of the lower abdomen and/or upper thigh partially or completely detach from their attachment point on the pubic bone. In hockey, this injury can occur quickly from an explosive skating movement or taking a hit. The slower version of this injury will usually occur as a result of a very high skating volume, minimal recovery time, and under conditioned groin and lower abdominal musculature.

How does it affect on-ice performance

Due to the significant involvement of the core and groin, sports hernias will have a relatively large impact on all aspects of a player's game. Pain in games will flare up with powerful quick skating movements as well as increased physicality. Players who would usually be able to play through contact and checking will shy away from contact and get bumped off pucks easier. Players who are usually explosive, will be slower and lose their ability to blow by opponents.

Adductor/groin Strains

What does it feel like?

Unlike some of the other injuries we have discussed, adductor strains are almost always a result of a quick explosive movement. When the injury occurs, people will typically report a quick sharp/burning pain in the groin or inside of the thigh and an immediate inability to produce force through that muscle. In hockey, this will most likely occur when going from a dead stop to a sprint and the player will have significant pain and be unable to skate with any power immediately after.

Why does it happen?

Adductor/groin strains occur when the force of a movement exceeds the muscle's capacity to withstand that force, resulting in a tear of the muscle. In many cases, training programs designed to improve lower body strength focus on quad, hamstring and glute development, causing a muscular imbalance in the leg as well as undertrained adductors. With significant imbalances in strength in the lower leg and under-trained adductors, the muscle group is underprepared for the demands of hockey.

How does it affect on-ice performance

Adductor/groin strains will almost always force a player to come off the ice and be out for at least a few weeks. In addition to the pain the athlete has, they are simply unable to produce enough force in the leg to skate with any level of power, precision, or quickness.

If your hockey player is struggling with hip or groin pain, you can reach Dr. Dave at Blue Iron Physio by email or by call/text at 201-431-0828.

Best, Dr. Dave

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