Hip Injuries

in Hockey
Players

Hip Flexor Strain

KINE 3P80: Injury Care & Prevention

March 29th, 2017

Josh Ribeiro (#5613948) & Jordan Langille (#5653407)

Brock University
Just like other fast paced and contact sports, many injuries can occur from playing ice hockey due to its required special
combination of speed, power and agility. One of the most common areas of injuries in hockey is known to be hip injuries,
which can occur at both a recreational or professional (NHL) level. In this instance, hip flexor strains will be focused on
hockey players, aged roughly 20 to 35, and will also be discussed in detail so that you may have a better understanding of
this common injury in terms of; what is damaged, how it happened, the signs and symptoms, the treatment and
management and the prevention methods.

Anatomical Structures Involved:

- A hip flexor strain occurs due to a stretching or tearing of any of the flexor muscles in the hip.
- There are six muscles that are involved with flexion of the hip which include:
o Iliopsoas (Iliacus + Psoas Major)
o Pectineus
o Rectus Femoris
o Sartorius
o Tensor Fasciae Latae
- Out of these six hip flexor muscles, you will commonly see the iliopsoas, which is made up of the two muscles
called the iliacus and psoas major, being strained, especially in hockey. However, that does not mean that any of
the other four flexor muscles can’t be strained. The iliopsoas muscle starts at the lower back pelvis and ends
around the thigh bone (femur). The location of the other four muscles can be seen on the diagram below.

Mechanism of Injury:

- Hip flexors allow you to bend your knee and flex your hip. A hip flexor strain most often occurs due to a forceful
contraction of that muscle.
- Improper skating mechanics usually results in hip flexor strains due to the sudden contraction of the hip muscles.
- The sudden contraction that could lead to stretching or tearing could be caused by any sudden movement or
change in direction, in this case, skating in hockey or “butterfly” stance for hockey goaltenders.
- Other factors such as direct impacts to the flexor muscles or stiff/weak muscles can lead to strains as well.

Grades of Hip Flexor Strains:

- Grade 1 Tear  A small number of fibers are torn, resulting in some pain, but allowing function.
- Grade 2 Tear  A significant number of fibers are torn, resulting in a moderate loss of function.
- Grade 3 Tear  All muscle fibers are ruptured, resulting in major loss of function.
Signs & Symptoms:

- Pain, cramping and/or pulling in the groin area or front of the hip  reduced range of motion
- Little strength when lifting the knee against resistance  weakness
- Muscle spasms
- Unable to walk without limping
- Bruising, swelling and/or tenderness around the hip or thigh
- Deformity (any bulging of muscles)

Treatment & Management:

- When the injury occurs:
o Rest, Ice, Compression, Elevation (RICE) which reduces any pain, inflammation and swelling.
o When applying ice, apply 15-20 minutes, 3-4 times a day for the first 24-72 hours. Do NOT apply ice
directly to the skin; use a bandage as a layer in between.
o Crutches may be needed.
- Several days after:
o Use of non-steroidal anti-inflammatory drugs (NSAIDs) after several days such as:
 Acetaminophen (Tylenol)
 Ibuprofen (Advil/Motrin)
 Naproxen (Aleve, Naprosyn)
o Talk with your health care provider before using pain medications if you have any illness in the past.
- If individual is in severe pain and unable to stand without assistance, either call 911 or bring them to a physician
yourself immediately. The individual should also see a physician as soon as possible if it is a suspected grade 2 or
3 strain.
- If individual is having mild pain (grade 1 strain) but can still stand or walk, a physician should still be seen either
that day or a couple days after the injury happened.
- The physician will also give the injured individual several exercises and stretches to strengthen the muscle.
- The athlete will most likely be ready to return to play when they have a full range of motion (strength on
uninjured side = strength on injured side); however, you should still consult with your physician before returning
to play.

Prevention:
- Proper stretching and lengthening exercises before practicing or partaking in any game scenario.
- Use proper skating mechanics and posture while practicing and playing.
- Foam rolling may also decrease the chance of causing a strain.

NHL Players Recently Diagnosed with a Hip Flexor Strain:

- Semyon Varlamov (Colorado Avalanche), Patrick Sharp (Dallas Stars), Andrew Ference (Edmonton Oilers),
Ryan Callahan (Tampa Bay Lightning)
References:

Anderson, M. K., & Barnum, M. (2017). Foundations of athletic training: prevention, assessment, and management (6th
ed.). Philadelphia: Wolters Kluwer Health.

Anderson, M. K., Strickland, M., & Warren, R. (2001). Hip and groin injuries in athletes. American Journal of Sports
Medecine, 29(4), 521-533. doi:10.1177/03635465010290042501

Iliac Crest Pain [Digital image]. Retrieved from http://kingbrand.com/Hip_Pointer_Injury.php

Severity of Hip Flexor Injury [Digital image]. (2015, July 29). Retrieved from http://gohockey.com/wp-
content/uploads/2015/06/sp-06-2015-2.jpg

Sidney Crosby Stretches His Hips To Make A Play [Digital image]. (n.d.). Retrieved from http://finishfirsthp.com/part-1-
healthy-hockey-hips/#prettyPhoto[gallery4130]/0

Szczerbowski, T. (2013, February 16). Toronto Maple Leafs right wing Phil Kessel (81) is hit by Ottawa Senators center
Zack Smith (15) at the Air Canada Centre [Digital image]. Retrieved from http://cdn.fansided.com/wp-
content/blogs.dir/96/files/2013/02/7048936.jpg