Hips Don't Lie: Femoroacetabular Impingment (FAI) in Ice Hockey Athletes

 What is FAI?

Femoroacetabular Impingement (FAI) occurs when either the ball of one's hip (femoral head) or their hip socket (acetabulum) come too close together and make contact with one another. This contact can cause damage the hip joint and surrounding anatomical features as well as causing a decrease in range of motion at the hip, hip pain, and hip muscle weakness. There are three forms of FAI:

• CAM Type: Abnormalities in the ball of one's hip (femoral head) causing excess contact with the hip socket. 
• Pincer Type: Abnormalities in the hip socket (acetabulum) causing excess contact with the ball of one's hip. 
• Combined Type: Abnormalities in both the ball and socket of one's hip causing excess contact between the two surfaces.

Who is at risk for FAI?

Everyone! FAI can begin developing in youth athletes and is prominent all the way up to elite level ice hockey athletes. For the sake of this discussion, elite athletes are anyone playing at or above the collegiate or Junior C level. Studies performed on youth ice hockey athletes aged 12-20 years old found a 68% occurrence of FAI related deformities. Another study on youth athletes utilized alpha angle measurements, which are highly indicative of CAM Type FAI when >50 degrees. 75% of the youth players in the study were found to have an alpha angle over 55 degrees, indicative of a CAM Type FAI. Studies on older elite level athletes yielded similar results. One study on NHL players found that 69.4% of them were positive for FAI. A group of 16-30 year old elite ice hockey athletes were assessed as well and showed a mean alpha angle of 54.2 degrees, again indicative of a CAM Type FAI. 

What can we do moving forward?

Studies show that hockey players are 10 times more likely to develop FAI due to the unique hip motions required constantly in skating and goaltending as well as the high impact nature of the sport. So what can we do about this? One study found that a younger age and shorter duration of symptoms at time of corrective surgery correlated with a greater length of playing career post operatively. Though it may not be possible to prevent FAI all together due to the demands ice hockey puts on an athletes body, awareness and early detection can help keep athletes healthy and increase the length of their playing career. As the title implies, hips don't lie, so listen to your hips! As aforementioned, symptoms of FAI are hip muscle weakness, hip pain, and a decreased range of motion.

• Youth athletes: Parents/Guardians of these athletes should focus on awareness of symptoms of FAI and early detection of the injury. Any consistent symptoms call for a trip to the doctor's office.
• Adult athletes: Similar to youth athletes, focus on detecting symptoms and seeking help if they are consistent. Visiting a doctor can be the difference between retiring from the game or enjoying a long, healthy career.

Future implications.

As awareness of the injury increases, future studies should be focused on prevention and screening protocols for ice hockey athletes. Providing screening protocols for athletes of all ages would identify individuals with characteristics putting them at risk for developing an FAI or potentially catch an FAI in its early stages. Interventions could then be performed for these athletes aiming to adapt the athlete to their range of motion and reduce the frequency of impingements. Studies also suggest that biomechanical remediation may help to prevent joint conditions (like FAI) in athletes, more research must be done in this field as well. 

About the Author:

Nicholas Askins is a senior at Westfield State University majoring in Movement Science with a  concentration in Sports Medicine. Nicholas plans to attend a masters program in Occupational Therapy and practice in the field upon graduation. He can be contacted at naskins0504@westfield.ma.edu.

References:

1. Ayeni, O., Banga, K., Bhandari, M., Maizlin, Z., Sa, D., Golev, D., Harish, S., & Farrokhyar, F. (2014). Femoroacetabular impingement in elite ice hockey players. Knee Surgery, Sports Traumatology, Arthroscopy, 22(4), 920–925.
2. Lerebours, F., Robertson, W., Neri, B., Schulz, B., Youm, T., & Limpisvasti, O. (2016). Prevalence of Cam-Type Morphology in Elite Ice Hockey Players. American Journal of Sports Medicine, 44(4), 1024–1030
3. Brunner, R., Maffiuletti, N. A., Casartelli, N. C., Bizzini, M., Sutter, R., Pfirrmann, C. W., & Leunig, M. (2016). Prevalence and Functional Consequences of Femoroacetabular Impingement in Young Male Ice Hockey Players. American Journal of Sports Medicine, 44(1), 46–53.
4. Menge, T. J., Briggs, K. K., & Philippon, M. J. (2016). Predictors of Length of Career After Hip Arthroscopy for Femoroacetabular Impingement in Professional Hockey Players. American Journal of Sports Medicine, 44(9), 2286–2291.
5. Larson, C. M., Giveans, M. R., Stone, R. M., Ross, J. R., Kuhn, A. W., Bedi, A., Fuller, D., & Rowley, D. M. (2017). Radiographic Hip Anatomy Correlates With Range of Motion and Symptoms in National Hockey League Players. American Journal of Sports Medicine, 45(7), 1633–1639.
6. Philippon, M. J., Ho, C. P., Briggs, K. K., Stull, J., & Laprade, R. F. (2013). Prevalence of Increased Alpha Angles as a Measure of Cam-Type Femoroacetabular Impingement in Youth Ice Hockey Players. American Journal of Sports Medicine, 41(6), 1357–1362.