With our mate, Sports Doctor, Gary Couanis just finishing up with the Kookaburras championships (coming home with the gold!) and with the upcoming Hockeyroos Championships, it's a good time to discuss injuries relating to hockey.
Hockey involves high speed running, cutting, direction change as well as repetitive and forceful rotation on the stance leg (particularly the left hip).
Identification and management of hip and groin pain in hockey players is a vital role for the treating medical team. Injury prevention programs to strengthen the hip and trunk muscles and improve balance and control have shown to be very successful in many sports and can be applied very easily to a warm-up and/or cool down session.
What is hip impingement?
The hip joint, which is a ball and socket, comes in very different shapes and sizes between people and also differences between left and right sides. If there happens to be a difference in the shape of the hip i.e. slightly larger, asymmetrical ball (Cam lesion), or a deeper socket (Pincer lesion) this can in some cases lead to impingement symptoms. Interestingly research has consistently shown that many people live with “abnormal” bony anatomy AND HAVE NO SYMPTOMS at all. Patients that do develop Femoroacetabular Impingement (FAI) have changes in bony anatomy, with hip and groin pain, as well as positive clinical tests impairing their functional ability. There are now specific X-ray views that can be used to predict which patients may develop osteoarthritis (OA) as they age, and even those that may develop OA within the next 5 years.
Where does it hurt?
Physiotherapists and medical practitioners have believed for a long time that hip pathology brings about pain in the front of the hip and groin. In a study by Heerey and colleagues (2016), that was confirmed in 100% of cases. What was interesting is that 50% of patients also had posterior pain in the gluteal region as well.
What leads to pain?
There are receptors in lots of structures that can contribute to a patient’s pain experience. These include the labrum (ring of cartilage around the socket), the synovium (capsule housing the fluid within the joint), the bone under the articular cartilage as well as the surrounding muscles and ligaments.
What can help?
Physiotherapy initially involves identifying aggravating activities and modifying these tasks to ensure the hip is not in an impingement or painful position. Simple changes to daily activities can have a profound impact on ones level of discomfort.
While soft tissue treatment targeting the muscles and joint flexibility can provide good short-term relief it’s imperative that patients continue to complete an individualized exercise program helping them get back to their desired sport or activity, or simply to reduce pain and improve movement.
Exercises will be used to target hip muscle strength, practicing functional tasks with better biomechanics, balance and limb control, trunk and core activation, and activities to improve flexibility. Research shows that hip strength; especially adductor (groin) muscle strength as well as flexibility has a direct impact on patient quality of life.
If you play hockey and/or have a hip complaint book in to see your local physiotherapist for a thorough assessment and plan to optimize your hip outcomes. We’d be more than happy to help! Click here to book an appointment today!
Daniel has previously worked in Premier League Hockey and was the tournament physiotherapist for the 34th International Men's Hockey Champions Trophy in 2012 and team physiotherapist for several Victorian Junior & Men’s State Hockey Teams.