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The Hip in Ice Hockey: A Current Concepts Review

      Abstract

      Ice hockey is a fast, physical sport with unique associated biomechanical demands often placing the hip in forced and repetitive supraphysiological ranges of motion. Ice hockey players commonly endure and are sidelined by nebulous groin injury or hip pain. Underlying causes can be chronic or acute and extra-articular, intra-articular, or “hip-mimicking.” This article serves to review common hip-related injuries in ice hockey. For each, we define the particular condition; comment on risk factors and preventive strategies; discuss key historical, physical examination, and imaging findings; and finally, suggest nonoperative and/or operative treatment plans.
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      References

      1. USA Hockey. 2014-2015 season final registration reports. http://assets.ngin.com/attachments/document/0077/6505/2014-15_Memebership_Reports.pdf. Published 2015. Accessed June 4, 2015.

      2. National Collegiate Athletic Association. 1981-1982–2013-14 NCAA sports sponsorship and participation rates report. http://www.ncaapublications.com/productdownloads/PR1314.pdf. Published 2014. Accessed June 4, 2015.

        • Agel J.
        • Dompier T.P.
        • Dick R.
        • Marshall S.W.
        Descriptive epidemiology of collegiate men's ice hockey injuries: National Collegiate Athletic Association Injury Surveillance System, 1988-1989 through 2003-2004.
        J Athl Train. 2007; 42: 241-248
        • Donaldson L.
        • Li B.
        • Cusimano M.D.
        Economic burden of time lost due to injury in NHL hockey players.
        Inj Prev. 2014; 20: 347-349
        • Ayeni O.R.
        • Kowalczuk M.
        • Farag J.
        • et al.
        Trends in reporting of mechanisms and incidence of hip injuries in males playing minor ice hockey in Canada: A cross-sectional study.
        Open Access J Sports Med. 2014; 5: 143-149
        • Agel J.
        • Harvey E.J.
        A 7-year review of men’s and women’s ice hockey injuries in the NCAA.
        Can J Surg. 2010; 53: 319-323
        • Tibor L.M.
        • Sekiya J.K.
        Differential diagnosis of pain around the hip joint.
        Arthroscopy. 2008; 24: 1407-1421
        • Nicholas S.J.
        • Tyler T.F.
        Adductor muscle strains in sport.
        Sports Med. 2002; 32: 339-344
        • Garrett Jr., W.E.
        Muscle strain injuries.
        Am J Sports Med. 1996; 24: S2-S8
        • Chang R.
        • Turcotte R.
        • Pearsall D.
        Hip adductor muscle function in forward skating.
        Sports Biomech. 2009; 8: 212-222
        • Emery C.A.
        • Meeuwisse W.H.
        • Powell J.W.
        Groin and abdominal strain injuries in the National Hockey League.
        Clin J Sport Med. 1999; 9: 151-156
        • Merrifield H.H.
        • Cowan R.F.
        Groin strain injuries in ice hockey.
        J Sports Med. 1973; 1: 41-42
        • Tyler T.F.
        • Nicholas S.J.
        • Campbell R.J.
        • McHugh M.P.
        The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players.
        Am J Sports Med. 2001; 29: 124-128
        • Tyler T.F.
        • Nicholas S.J.
        • Campbell R.J.
        • Donellan S.
        • McHugh M.P.
        The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players.
        Am J Sports Med. 2002; 30: 680-683
        • Avrahami D.
        • Choudur H.N.
        Adductor tendinopathy in a hockey player with persistent groin pain: A case report.
        J Can Chiropr Assoc. 2010; 54: 264-270
        • Holmich P.
        Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: A prospective study of 207 patients.
        Br J Sports Med. 2007; 41 (discussion 252): 247-252
        • Serner A.
        • Tol J.L.
        • Jomaah N.
        • et al.
        Diagnosis of acute groin injuries: A prospective study of 110 athletes.
        Am J Sports Med. 2015; 43: 1857-1864
        • Speer K.P.
        • Lohnes J.
        • Garrett Jr., W.E.
        Radiographic imaging of muscle strain injury.
        Am J Sports Med. 1993; 21 (discussion 96): 89-95
        • Tyler T.F.
        • Fukunaga T.
        • Gellert J.
        Rehabilitation of soft tissue injuries of the hip and pelvis.
        Int J Sports Phys Ther. 2014; 9: 785-797
        • Serner A.
        • van Eijck C.H.
        • Beumer B.R.
        • Holmich P.
        • Weir A.
        • de Vos R.J.
        Study quality on groin injury management remains low: A systematic review on treatment of groin pain in athletes.
        Br J Sports Med. 2015; 49: 813
        • Shu B.
        • Safran M.R.
        Case report: Bifid iliopsoas tendon causing refractory internal snapping hip.
        Clin Orthop Relat Res. 2011; 469: 289-293
        • Philippon M.J.
        • Devitt B.M.
        • Campbell K.J.
        • et al.
        Anatomic variance of the iliopsoas tendon.
        Am J Sports Med. 2014; 42: 807-811
        • Andersson E.A.
        • Nilsson J.
        • Thorstensson A.
        Intramuscular EMG from the hip flexor muscles during human locomotion.
        Acta Physiol Scand. 1997; 161: 361-370
        • Andersson E.
        • Oddsson L.
        • Grundstrom H.
        • Thorstensson A.
        The role of the psoas and iliacus muscles for stability and movement of the lumbar spine, pelvis and hip.
        Scand J Med Sci Sports. 1995; 5: 10-16
      3. Goudreault R, Pearsall DJ, Tucotte R, Montgomery D, Lefebvre R. Forward skating in ice hockey: Comparison of EMG activation patterns of at three velocities using a skate treadmill. Presented at the Fourth World Congress of Biomechanics, Calgary, Alberta, Canada, August 2002.

        • Buckeridge E.
        • LeVangie M.C.
        • Stetter B.
        • Nigg S.R.
        • Nigg B.M.
        An on-ice measurement approach to analyse the biomechanics of ice hockey skating.
        PLoS One. 2015; 10: e0127324
        • Winston P.
        • Awan R.
        • Cassidy J.D.
        • Bleakney R.K.
        Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers.
        Am J Sports Med. 2007; 35: 118-126
        • Holmich P.
        • Holmich L.R.
        • Bjerg A.M.
        Clinical examination of athletes with groin pain: An intraobserver and interobserver reliability study.
        Br J Sports Med. 2004; 38: 446-451
        • Mozes M.
        • Papa M.Z.
        • Zweig A.
        • Horoszowski H.
        • Adar R.
        Iliopsoas injury in soccer players.
        Br J Sports Med. 1985; 19: 168-170
        • Wettstein M.
        • Jung J.
        • Dienst M.
        Arthroscopic psoas tenotomy.
        Arthroscopy. 2006; 22: 907.e1-907.e4
        • Blankenbaker D.G.
        • De Smet A.A.
        • Keene J.S.
        Sonography of the iliopsoas tendon and injection of the iliopsoas bursa for diagnosis and management of the painful snapping hip.
        Skeletal Radiol. 2006; 35: 565-571
        • Flanum M.E.
        • Keene J.S.
        • Blankenbaker D.G.
        • Desmet A.A.
        Arthroscopic treatment of the painful “internal” snapping hip: Results of a new endoscopic technique and imaging protocol.
        Am J Sports Med. 2007; 35: 770-779
        • Ilizaliturri Jr., V.M.
        • Villalobos Jr., F.E.
        • Chaidez P.A.
        • Valero F.S.
        • Aguilera J.M.
        Internal snapping hip syndrome: Treatment by endoscopic release of the iliopsoas tendon.
        Arthroscopy. 2005; 21: 1375-1380
        • Blazina M.E.
        The “hip-pointer”, a term to describe a specific kind of athletic injury.
        Calif Med. 1967; 106: 450
        • Hall M.
        • Anderson J.
        Hip pointers.
        Clin Sports Med. 2013; 32: 325-330
        • Feeley B.T.
        • Powell J.W.
        • Muller M.S.
        • Barnes R.P.
        • Warren R.F.
        • Kelly B.T.
        Hip injuries and labral tears in the National Football League.
        Am J Sports Med. 2008; 36: 2187-2195
        • LaPrade R.F.
        • Wijdicks C.A.
        • Griffith C.J.
        Division I intercollegiate ice hockey team coverage.
        Br J Sports Med. 2009; 43: 1000-1005
        • Adhau R.
        • Angrish P.
        • Ahuja A.
        • Sandhu A.S.
        Multiple muscle tear after fall on buttock-role of conservative management and exercise for early recovery and return to play.
        Muscles Ligaments Tendons J. 2014; 4: 154-157
        • Southam J.D.
        • Silvis M.L.
        • Black K.P.
        Sacral stress fracture in a professional hockey player: A case report.
        Orthopedics. 2010; 33: 846
        • Nodzo S.R.
        • Hohman D.W.
        • Galpin R.D.
        Bilateral acetabular fractures in an adolescent after low-energy trauma.
        Pediatr Emerg Care. 2012; 28: 568-569
        • Malycha P.
        • Lovell G.
        Inguinal surgery in athletes with chronic groin pain: The ‘sportsman's’ hernia.
        Aust N Z J Surg. 1992; 62: 123-125
        • Simonet W.T.
        • Saylor III, H.L.
        • Sim L.
        Abdominal wall muscle tears in hockey players.
        Int J Sports Med. 1995; 16: 126-128
        • Irshad K.
        • Feldman L.S.
        • Lavoie C.
        • Lacroix V.J.
        • Mulder D.S.
        • Brown R.A.
        Operative management of “hockey groin syndrome”: 12 years of experience in National Hockey League players.
        Surgery. 2001; 130 (discussion 764-766): 759-764
        • Gilmore J.
        Groin pain in the soccer athlete: Fact, fiction, and treatment.
        Clin Sports Med. 1998; 17 (vii): 787-793
        • Paajanen H.
        “Sports hernia” and osteitis pubis in an athlete.
        Duodecim. 2009; 125 ([in Finnish]): 261-266
        • Palisch A.
        • Zoga A.C.
        • Meyers W.C.
        Imaging of athletic pubalgia and core muscle injuries: Clinical and therapeutic correlations.
        Clin Sports Med. 2013; 32: 427-447
        • Larson C.M.
        Sports hernia/athletic pubalgia: Evaluation and management.
        Sports Health. 2014; 6: 139-144
        • Delee J.C.
        • Drez D.
        Orthopaedic sports medicine: Principles and practice.
        Ed 4. Elsevier, Philadelphia2014
        • Joesting D.R.
        Diagnosis and treatment of sportsman's hernia.
        Curr Sports Med Rep. 2002; 1: 121-124
        • Lacroix V.J.
        • Kinnear D.G.
        • Mulder D.S.
        • Brown R.A.
        Lower abdominal pain syndrome in National Hockey League players: A report of 11 cases.
        Clin J Sport Med. 1998; 8: 5-9
        • Meyers W.C.
        • Foley D.P.
        • Garrett W.E.
        • Lohnes J.H.
        • Mandlebaum B.R.
        Management of severe lower abdominal or inguinal pain in high-performance athletes. PAIN (Performing Athletes with Abdominal or Inguinal Neuromuscular Pain Study Group).
        Am J Sports Med. 2000; 28: 2-8
        • Coker D.J.
        • Zoga A.C.
        The role of magnetic resonance imaging in athletic pubalgia and core muscle injury.
        Top Magn Reson Imaging. 2015; 24: 183-191
        • Zoga A.C.
        • Kavanagh E.C.
        • Omar I.M.
        • et al.
        Athletic pubalgia and the “sports hernia”: MR imaging findings.
        Radiology. 2008; 247: 797-807
        • Robinson P.
        • Bhat V.
        • English B.
        Imaging in the assessment and management of athletic pubalgia.
        Semin Musculoskelet Radiol. 2011; 15: 14-26
        • Brown R.A.
        • Mascia A.
        • Kinnear D.G.
        • Lacroix V.
        • Feldman L.
        • Mulder D.S.
        An 18-year review of sports groin injuries in the elite hockey player: Clinical presentation, new diagnostic imaging, treatment, and results.
        Clin J Sport Med. 2008; 18: 221-226
        • Jakoi A.
        • O'Neill C.
        • Damsgaard C.
        • Fehring K.
        • Tom J.
        Sports hernia in National Hockey League players: Does surgery affect performance?.
        Am J Sports Med. 2013; 41: 107-110
        • Bedi A.
        • Kelly B.T.
        Femoroacetabular impingement.
        J Bone Joint Surg Am. 2013; 95: 82-92
        • Bedi A.
        • Dolan M.
        • Leunig M.
        • Kelly B.T.
        Static and dynamic mechanical causes of hip pain.
        Arthroscopy. 2011; 27: 235-251
      4. Agricola R, Weinans H. Femoroacetabular impingement: What is its link with osteoarthritis? Br J Sports Med 2016;50:957-958.

        • Stull J.D.
        • Philippon M.J.
        • LaPrade R.F.
        “At-risk” positioning and hip biomechanics of the Peewee ice hockey sprint start.
        Am J Sports Med. 2011; 39: 29S-35S
        • Philippon M.J.
        • Weiss D.R.
        • Kuppersmith D.A.
        • Briggs K.K.
        • Hay C.J.
        Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players.
        Am J Sports Med. 2010; 38: 99-104
        • Epstein D.M.
        • McHugh M.
        • Yorio M.
        • Neri B.
        Intra-articular hip injuries in National Hockey League players: A descriptive epidemiological study.
        Am J Sports Med. 2013; 41: 343-348
        • Ayeni O.R.
        • Banga K.
        • Bhandari M.
        • et al.
        Femoroacetabular impingement in elite ice hockey players.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 920-925
        • Nepple J.J.
        • Vigdorchik J.M.
        • Clohisy J.C.
        What is the association between sports participation and the development of proximal femoral cam deformity? A systematic review and meta-analysis.
        Am J Sports Med. 2015; 43: 2833-2840
        • Philippon M.J.
        • Ho C.P.
        • Briggs K.K.
        • Stull J.
        • LaPrade R.F.
        Prevalence of increased alpha angles as a measure of cam-type femoroacetabular impingement in youth ice hockey players.
        Am J Sports Med. 2013; 41: 1357-1362
        • Notzli H.P.
        • Wyss T.F.
        • Stoecklin C.H.
        • Schmid M.R.
        • Treiber K.
        • Hodler J.
        The contour of the femoral head-neck junction as a predictor for the risk of anterior impingement.
        J Bone Joint Surg Br. 2002; 84: 556-560
        • Siebenrock K.A.
        • Kaschka I.
        • Frauchiger L.
        • Werlen S.
        • Schwab J.M.
        Prevalence of cam-type deformity and hip pain in elite ice hockey players before and after the end of growth.
        Am J Sports Med. 2013; 41: 2308-2313
        • Whiteside D.
        • Deneweth J.M.
        • Bedi A.
        • Zernicke R.F.
        • Goulet G.C.
        Femoroacetabular impingement in elite ice hockey goaltenders: Etiological implications of on-ice hip mechanics.
        Am J Sports Med. 2015; 43: 1689-1697
        • Clohisy J.C.
        • Knaus E.R.
        • Hunt D.M.
        • Lesher J.M.
        • Harris-Hayes M.
        • Prather H.
        Clinical presentation of patients with symptomatic anterior hip impingement.
        Clin Orthop Relat Res. 2009; 467: 638-644
        • Nepple J.J.
        • Goljan P.
        • Briggs K.K.
        • Garvey S.E.
        • Ryan M.
        • Philippon M.J.
        Hip strength deficits in patients with symptomatic femoroacetabular impingement and labral tears.
        Arthroscopy. 2015; 31: 2106-2111
        • Audenaert E.A.
        • Peeters I.
        • Vigneron L.
        • Baelde N.
        • Pattyn C.
        Hip morphological characteristics and range of internal rotation in femoroacetabular impingement.
        Am J Sports Med. 2012; 40: 1329-1336
        • Bedi A.
        • Dolan M.
        • Hetsroni I.
        • et al.
        Surgical treatment of femoroacetabular impingement improves hip kinematics: A computer-assisted model.
        Am J Sports Med. 2011; 39: 43S-49S
        • Kubiak-Langer M.
        • Tannast M.
        • Murphy S.B.
        • Siebenrock K.A.
        • Langlotz F.
        Range of motion in anterior femoroacetabular impingement.
        Clin Orthop Relat Res. 2007; 458: 117-124
        • Kuhn A.W.
        • Ross J.R.
        • Bedi A.
        Three-dimensional imaging and computer navigation in planning for hip preservation surgery.
        Sports Med Arthrosc Rev. 2015; 23: e31-e38
        • Eijer H.
        • Leunig M.
        • Mahomed M.
        • Ganz R.
        Cross-table lateral radiograph for screening of anterior femoral head-neck offset in patients with femoro-acetabular impingement.
        Hip Int. 2001; 11: 37-41
        • Cakic J.
        • Patricios J.
        Femoroacetabular impingement: Prevention or intervention? The sports physician's quandary.
        Br J Sports Med. 2014; 48: 1073-1074
        • Hunt D.
        • Prather H.
        • Harris Hayes M.
        • Clohisy J.C.
        Clinical outcomes analysis of conservative and surgical treatment of patients with clinical indications of prearthritic, intra-articular hip disorders.
        PM R. 2012; 4: 479-487
        • Emara K.
        • Samir W.
        • Motasem el H.
        • Ghafar K.A.
        Conservative treatment for mild femoroacetabular impingement.
        J Orthop Surg (Hong Kong). 2011; 19: 41-45
        • Wall P.D.
        • Fernandez M.
        • Griffin D.R.
        • Foster N.E.
        Nonoperative treatment for femoroacetabular impingement: A systematic review of the literature.
        PM R. 2013; 5: 418-426
        • Krych A.J.
        • Griffith T.B.
        • Hudgens J.L.
        • Kuzma S.A.
        • Sierra R.J.
        • Levy B.A.
        Limited therapeutic benefits of intra-articular cortisone injection for patients with femoro-acetabular impingement and labral tear.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 750-755
        • Naal F.D.
        • Miozzari H.H.
        • Wyss T.F.
        • Notzli H.P.
        Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes.
        Am J Sports Med. 2011; 39: 544-550
        • Casartelli N.C.
        • Bizzini M.
        • Maffiuletti N.A.
        • Lepers R.
        • Leunig M.
        Rehabilitation and return to sport after bilateral open surgery for femoroacetabular impingement in a professional ice hockey player: A case report.
        Phys Ther Sport. 2015; 16: 193-201
        • Bizzini M.
        • Notzli H.P.
        • Maffiuletti N.A.
        Femoroacetabular impingement in professional ice hockey players: A case series of 5 athletes after open surgical decompression of the hip.
        Am J Sports Med. 2007; 35: 1955-1959
        • Nawabi D.H.
        • Bedi A.
        • Tibor L.M.
        • Magennis E.
        • Kelly B.T.
        The demographic characteristics of high-level and recreational athletes undergoing hip arthroscopy for femoroacetabular impingement: A sports-specific analysis.
        Arthroscopy. 2014; 30: 398-405
        • Philippon M.J.
        • Schenker M.L.
        A new method for acetabular rim trimming and labral repair.
        Clin Sports Med. 2006; 25 (ix): 293-297
        • Philippon M.J.
        • Stubbs A.J.
        • Schenker M.L.
        • Maxwell R.B.
        • Ganz R.
        • Leunig M.
        Arthroscopic management of femoroacetabular impingement: Osteoplasty technique and literature review.
        Am J Sports Med. 2007; 35: 1571-1580
        • Pierce C.M.
        • Laprade R.F.
        • Wahoff M.
        • O'Brien L.
        • Philippon M.J.
        Ice hockey goaltender rehabilitation, including on-ice progression, after arthroscopic hip surgery for femoroacetabular impingement.
        J Orthop Sports Phys Ther. 2013; 43: 129-141
        • McDonald J.E.
        • Herzog M.M.
        • Philippon M.J.
        Performance outcomes in professional hockey players following arthroscopic treatment of FAI and microfracture of the hip.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 915-919
        • Bharam S.
        Labral tears, extra-articular injuries, and hip arthroscopy in the athlete.
        Clin Sports Med. 2006; 25 (ix): 279-292
        • Groh M.M.
        • Herrera J.
        A comprehensive review of hip labral tears.
        Curr Rev Musculoskelet Med. 2009; 2: 105-117
        • Gallo R.A.
        • Silvis M.L.
        • Smetana B.
        • et al.
        Asymptomatic hip/groin pathology identified on magnetic resonance imaging of professional hockey players: Outcomes and playing status at 4 years’ follow-up.
        Arthroscopy. 2014; 30: 1222-1228
        • Silvis M.L.
        • Mosher T.J.
        • Smetana B.S.
        • et al.
        High prevalence of pelvic and hip magnetic resonance imaging findings in asymptomatic collegiate and professional hockey players.
        Am J Sports Med. 2011; 39: 715-721
        • Mason J.B.
        Acetabular labral tears in the athlete.
        Clin Sports Med. 2001; 20: 779-790
        • Kelly B.T.
        • Weiland D.E.
        • Schenker M.L.
        • Philippon M.J.
        Arthroscopic labral repair in the hip: Surgical technique and review of the literature.
        Arthroscopy. 2005; 21: 1496-1504
        • Byrd J.W.
        • Jones K.S.
        Primary repair of the acetabular labrum: Outcomes with 2 years' follow-up.
        Arthroscopy. 2014; 30: 588-592
        • Ha Y.C.
        • Kim K.C.
        • Shin Y.E.
        Patient satisfaction after arthroscopic repair of acetabular labral tears.
        Clin Orthop Surg. 2014; 6: 159-164
        • Tibor L.M.
        • Leunig M.
        Labral resection or preservation during FAI treatment? A systematic review.
        HSS J. 2012; 8: 225-229
        • Ayeni O.R.
        • Adamich J.
        • Farrokhyar F.
        • et al.
        Surgical management of labral tears during femoroacetabular impingement surgery: A systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 756-762
        • Ayeni O.R.
        • Alradwan H.
        • de Sa D.
        • Philippon M.J.
        The hip labrum reconstruction: Indications and outcomes—A systematic review.
        Knee Surg Sports Traumatol Arthrosc. 2014; 22: 737-743