hip impingement in hockey players: focus on butterfly style goalies
DESCRIPTION
Hip Impingement in Hockey Players: focus on butterfly style goalies. Christopher Larson, MD Twin Cities Orthopedics, Edina MN Team Physician: Minnesota Wild David Rust, MD Orthopedic Sports Medicine Fellow. Overview. Anatomy What is impingement? Affect on hockey players/goalies - PowerPoint PPT PresentationTRANSCRIPT
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Hip Impingement in Hockey Players: focus on butterfly style goalies
Christopher Larson, MDTwin Cities Orthopedics, Edina MN
Team Physician: Minnesota Wild
David Rust, MDOrthopedic Sports Medicine Fellow
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Overview
• Anatomy• What is impingement?• Affect on hockey
players/goalies• Treatment options• Other hip problems• Future of research and
INJURY PREVENTION!!
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Hip = ball and socket joint
Femur = thigh bone, head and neck are involved
Acetabulum = part of the pelvic ring
Labrum = cartilage ring on rim of acetabulum, mechanical “bumper”, seals the hip joint (gasket)
Articular cartilage = smooth gliding surface, worn out in arthritic joints
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What is impingement?• FAI = Femoral-Acetabular Impingement
– Abnormal contact between the ball and rim/socket during activity
– Results from a ball that is not perfectly round (CAM) or a socket that is too deep (PINCER)
• Labral Tear– Repetitive impingement leads to “pinching” of the
labrum between the ball and socket– Labral tears are common and often do not cause pain
– Important to recognize and treat the underlying impingement
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Signs and Symptoms
• Deep sharp groin pain• Worse with quick turns• Limited hip rotation/flexibility/stiff• Unable to sit for prolonged periods• Groin / Front of the hip pain after activity
• Impingement test = pain with hip flexion and internal rotation
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Must rule out other causes of pain
• Muscle and tendon strains
• Contusions, fractures
• Athletic pubalgia / SPORTS HERNIA
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Butterfly Effect• Evolution of style• Rules and regulations• Increased rate of surgery Approximately 5-10 NHL goalies
per year have FAI surgery:•JS Giguere•Tim Thomas•Niklas Backstrom•Vesa Toskala•Patrick Roy•Josh Harding•Antero Niitimaki•Rick DiPietro•Ray Emery•Craig Anderson
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Butterfly Effect• Skills that may place hip at risk
– pad flares – recovery pushes – T-pushes/One foot stops – One knee down on post– butterfly drops
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Treatment Options
• First step should be to work with coaches and athletic trainers to identify likely cause of pain
• Examination (with experienced provider) and regular x-rays will confirm diagnosis
• When should an MRI be considered?– Recent study found positive MRI finding in 77% of
asymptomatic professional and NCAA hockey players
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FAI X-Rays
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Treatment Options• Anti-inflammatory meds, rest, ice
• Modifications in technique and equipment, decreased repetitions
• Therapy can work on strengthening core muscles and hip rotators
• Numbing injections can assist in determining the source of pain, but cortisone is usually avoided in young patients
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Treatment Options• When should surgery be considered?
– Unable to perform athletics despite non-surgical treatment
– Pain with daily activities
– In our experience, athletes that have problems at a younger age are more likely to eventually need surgery and are at risk for more significant hip damage
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Hip ArthroscopyDr Larson has published over 40 articles regarding hip injuries in athletes & has operated on over 50 US and European Hockey Goalies from high school to the professional level in the last 3 years as a result of Impingement and disablingpain.
We are currently conducting several studies looking at the anatomy of the Hockey Goalie.
Before Surgery After Surgery
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Can we prevent impingement?• Shape of hip develops over time while the body is growing• Primarily takes shape during adolescent growth spurt• Ages 10-14 in girls and 12-16 in boys• Depends on type of activity and number of repetitions• May be similar to throwing injuries in youth baseball
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Possible preventive strategies • core fitness program for young goalies to
strengthen muscles and/or maintain flexibility
• Improve upright Posture in butterfly and splits positions
• skill repetition limits in practice • greater “off-season” time, cross-training• equipment limitations or improvements
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What does the future hold?
• Research looking at hockey goalies and players of all ages to find trends and identify who is at risk
• Rules and regulations to help protect athletes from injury
• Guidelines and recommendations for youth athletes, parents, and coaches
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Research Study: Cam Impingement in Butterfly Goalies
• Goal is to better understand, predict, and prevent hip injuries
• Hockey goalies, hockey players, non-hockey players, with or without symptoms, ages 10-40
• No cost to enroll
• Participants will complete questionnaire, examination, and x-rays
• No personal identifying information
• Gain knowledge with respect to the RISK of developing HIP problems based on the Examination and Xrays
• Minimal physical risk– Radiation from x-ray less than the typical annual exposure for an average
Minnesota resident
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Research Study: Cam Impingement in Butterfly Goalies
• Participation requires signed consent (adults and parent/guardian) and assent (adolescent)
• If interested please contact:– Becky Stone @ [email protected] or
952-456-7136– Dave Rust @ [email protected]
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Thank You
Twin Cities Orthopedics, Edina