Hockey Doc

The Hockey Doc: Groin pain and femoroacetabular impingement

By Dr. Rob LaPrade
http://drrobertlaprademd.com

Question: I play goalie and have had hip and groin pain for the past couple weeks with the increasing number of saves during practice. What could be the cause?

Answer: Hip pain can have several different causes, but one common cause of groin and hip pain in hockey players is femoroacetabular impingement (FAI). It is often found in athletes that engage in repetitive hip movements involving excessive range of motion.

In hockey goalies, the injury can occur in goalies when they do the butterfly maneuver and turn their foot in. It typically happens gradually, over several years, so hockey players may not notice their hips getting stiff.

It is now recognized that many cases diagnosed as hip adductor strains and sports hernias in hockey players in the past may have been misdiagnosed cases of FAI. In any event, it is now recognized that FAI is an epidemic in hockey players and my hip surgery partner, Marc Philippon MD, and I are conducting studies to try and determine its cause in hockey players.
FAI occurs due to abnormal increase in the amount of bone where the ball of the femur inserts into the hip socket. The cause of FAI is unknown, but these abnormal bony formations may be the result of an injury, genetics or excessive exercise during early bone formation.

There are three types of FAI – cam, pincer and mixed. Cam FAI is due to excess bone growth on the top surface of the femoral head that is ball part of the joint, which causes excessive pressure at the edge of the socket when performing activities such as wide leg splits. Pincer FAI is due to abnormal bone growth on the upper rim of the cup-like part of the hip socket, which has a similar result. Mixed Impingement is a combination of the cam and pincer abnormalities.

Most hockey players have cam-type FAI. FAI may result in damage to the cartilage, labral tears, and/or early hip osteoarthritis.

Pain in the groin is the most common symptom, but pain may also show up in the buttocks, hip, outer part of the upper leg and sacroiliac joint. A history of frequent groin strains may indicate underlying FAI. Another indication is pain with prolonged sitting, walking or athletic activities. Stiffness, weakness, clicking and snapping are signs that are reported by some patients with FAI.

If you are having hip and groin pain, it is best to get it checked out because untreated FAI may lead to joint damage, potentially leading to worse symptoms in the short term and osteoarthritis down the road. Because of this, many hockey players have needed hip replacements at an early age in the past.

With more recognition of such hip problems allowing for earlier diagnosis and treatment, the need for hip replacement surgery may be prevented. When being worked up, your orthopaedic doctor will most likely order X-rays and an MRI. A physical exam that tests your pain with various hip motions and measures your maximum range of hip motion will help to determine whether or not you have FAI.

If you are diagnosed with FAI, then surgery may be necessary to correct the bone abnormalities and restore normal motion between the ball of the femur and the hip socket. Hockey players often return to their sport between three and four months after FAI hip surgery.

Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado.  He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it to This email address is being protected from spambots. You need JavaScript enabled to view it. .