Hip Injury Reduction for Goalies: A Proven Approach
As a result of the high injury rates to goalies (1), and the hip joint in particular (2), an injury prevention movement has been growing. This movement includes putting youth goalies on a “butterfly count” (similar to what we’ve seen in baseball with pitcher’s arm injuries and a pitch count) to youth athletes having preventive surgery done to mitigate the chance of future injury (3). While these measures may reduce the rate of injury, both would come at a development cost such as limiting the coach’s ideal skill development plan, or the goalies time that would be spent rehabbing from surgery instead of honing their craft. While the position will always be demanding on the hips, in this article we’ll explore another option to decrease injury risk by better understanding the hip itself and how we can impact it.
In a healthy hip joint, the ball head of the femur and the socket of the pelvis glide easily across each other on a smooth, low friction surface of articular cartilage. Think of this cartilage and the associated labrum around the socket as the last line of defense in preventing your femur head from jamming into your pelvis (4) aided by the four ligaments which attach from the femur neck and head onto the pelvis.
Hip joint structure
So, what’s the first line of defence? That would be the muscles attached to the pelvis and femur that provide stability to the joint and pelvis. Those major muscles are the gluteus medius, gluteus maximus, piriformis, and deep core muscles (5). When these major muscles aren’t strong/coordinated enough to stabilize the joint or pelvis, or absorb the forces going through them, breakdown will occur. This causes the head of the femur to press through those last lines of defence and rub together with the pelvis potentially leading to pain, loss of internal rotation, and likely a labrum tear. Furthermore, a diagnosis of femoroacetabular impingement is likely, creating either a pincer issue, or a camber issue that is more common in goalies (6). A combination of the two is also a potential diagnosis.
Three types of femoroacetabular impingement
So, the question then becomes: Is it possible to get these primary stabilizers strong and coordinated enough to provide the support necessary throughout a goalie’s career? In my experience, yes, it is.
After being forced to quit the game I love in my early 20’s due to chronic and acute hip and back pain, I now go on the ice and in the net 2-4 times a week. In the past 5 years, my athletes have added hundreds of games to their resume without missing any time due to hip injuries. This has been done with a simple approach; make sure the athlete’s physical traits are greater than the demand placed on them from the game.
The foundation for this lies in the strength and coordination of the muscles of the hip and pelvis and its dynamic relationship with the rest of the body. This means exercise selection should itself be dynamic, not static, and focus on the stability of the pelvis in a neutral position along with loading of the muscles that support it and the femur head. If all someone had to do was heavy isolated exercises like hip thrusters, leg press, and glute extensions, then it would be easy, and we wouldn’t have an injury issue. But it’s not that simple, and we must confront the matter.
What we’re looking for are movements that we can use to manageably load our muscles of focus to greater levels that can handle the stress and breakdown of a season. In relation to a back squat that we will discuss further, I have found 2.25 times the athlete’s body weight to be a good marker. The main principle is that it must be a dynamic movement that’s relevant to how you move on the ice, where your hip and knees are coordinating, stabilizing , and moving your center of mass where it needs to be. At the end of the day it’s not the exercises that we chose that will cause the adaptations we are looking for, but how those prescribed exercises are done. Personally, I have found the squat to be one of the best tools for this.
I prefer the barbell back squat because I find it easy to see imbalances left to right and front to back. It is also easy to have an athlete “pause” during the rep and be coached into different positions/find different feelings, which isn’t possible in the middle of a jump. Also, from a training effect standpoint, it is the dynamic lift that we can load the most. Some will argue that a single leg squat can be loaded more relative to a bi-lateral deficit, but to achieve such a deficit, one would need to fully isolate that leg, and thus, move further away from an athletic movement similar to that done on the ice. Below we can see a 183lb athlete that has struggled with “tight” hip flexors. Image 1 shows his initial squat pattern without any cueing other than to squat, and Image 2 is a coached rep during the same session at the identical external weight of 165lbs.
Image 1 left and image 2 right
As you can see in Image 1, the athletes’ knees are falling towards the middle. This is a key sign of having weak/uncoordinated hip and pelvis stabilizing muscles with a habit to load through the smaller hip flexors, groin and medial knee muscles. In Image 2, the athlete has been cued to externally rotate the top of their femurs and to feel the load in the muscles previously outlined to help keep the knee in line with the foot. By doing this, we’ve forced a greater load onto those hip muscles. Over the next few years the goal will be to load that stability in this pattern over 2.25x’s his bodyweight. This kind of coordinated strength will help to provide the stability necessary for the athlete’s larger muscles to absorb the constant impact and stress that the position demands.
Image 3 left and image 4 right