Vail Health Magazine 2013 - page 49

Screening players
at high risk
Dr. Marc Philippon of The Stead-
man Clinic & Steadman Philippon
Research Institute designed a
study to determine if specific tests
used during a screening program
could identify youth hockey
players who are at risk for labral
tears due to FAI. To show that
hockey players had an increased
risk of factors associated with FAI,
SPRI conducted a study comparing
youth hockey players and youth
alpine skiers.
The research team recruited
61 youth hockey players and 27
youth skiers for the study. The
athletes underwent screening for
the impingement test and the
FABER ( flexion abduction exter-
nal rotation) distance test. In ad-
dition, researchers measured their
hip range-of-motion. To validate
these tests, each young athlete
underwent an MRI to determine
the hip alpha angle (AA) and if
there was any damage to the hip
labrum or cartilage.
To determine if these players
develop FAI as they play more,
the hockey players were grouped
according to their USA hockey
classification: as peewees (ages
10 to 12), bantams (ages 13 to
15) and midgets (ages 16 to 19
years). The testing started with
the peewee-aged cohort because
this is when they start playing
at a competitive level, with the
introduction of body checking, and
typified by increased on-ice time.
Research found that these youth
hockey players had significantly
higher alpha angles, which is one
of the key diagnostic character-
istics of FAI, compared with the
skiers tested. Hockey players were
4.2 times more likely to have an
alpha angle indicating FAI com-
pared with skiers. This difference
was greatest when comparing the
older hockey players (midgets) to
the older skiers. Among the hockey
players, 93 percent of the players
had damage to their hip labrum.
This study showed that as young
hockey players reach the midget
level, they are at significantly
higher risk of developing findings
commonly seen in patients diag-
nosed with cam impingement. To
prevent further damage to the hip,
development of new injury preven-
tion programs is needed.
Dr. Philippon presented the
findings at a 2011 meeting of the
International Olympic Commit-
tee (IOC) World Conference of
Prevention of Injury & Illness
in Sport. He concluded that
this screening protocol is likely
to identify developing hockey
players with a higher alpha angle,
which may put them at greater
risk for damage to their hips. Dr.
Philippon also recommended that
hip screening utilizing the Faber
impingement test, for assess-
ment of hip internal rotation, be
conducted at the initial screening
of athletes with hip pain, to assess
for symptomatic FAI.
Dr. Philippon, a pioneer of the
modern technique of treating
FAI, suggested that prevention
efforts should focus on the risk
to young players participating
in intense skating before bodies
have fully developed.
“We have to determine if ice time
at a young age is related to alpha
angle issues,” he says. “It may be
that, like we do with pitch counts in
baseball, we need to limit ice time
in young hockey players.”
Goaltender padding
In a second study, SPRI research-
ers set out to: 1) determine hip
kinematics (motion of the hip
apart from mass and force con-
siderations) during the butterfly
movement; 2) ground impact
forces of that movement; 3) evalu-
ate how those factors are affected
by recently mandated changes in
the width of goaltender pads. The
previous width was 12 inches; the
current regulation is 11-inch pads.
(To date, researchers have not
quantified the butterfly movement,
or investigated the exact mecha-
nisms by which injury occurs.)
Ten experienced male goal-
tenders, with an average age 18,
performed butterfly movement
while wearing three different sets
of pads, each of different widths:
standard (11 inch), 12-inch-wide
pads, and their own “broken in”
11-inch pads. The SPRI researchers
used motion-capture technology
to measure hip angles, drop-down
time (how long it takes to assume
the butterfly position), and peak
ground forces, for each of the three
sets of pads.
They found that the butterfly
movement placed the goaltenders
at their passive limits of hip inter-
nal rotation and involved forces at
the knee 1.45 times body weight.
There were no effects of the reduc-
tion in goalie pad width on hip in-
ternal rotation and ground impact
forces. Also, the pads did not affect
hip kinematics/motion.
However, the SPRI group did
find that the butterfly movement
involves large internal rotation
angles at passive range-of-mo-
tion limits, and that high impact
forces may put goaltenders at an
increased risk of hip injuries.
Practical implications
These findings have practical
implications for hockey players,
parents of players and coaches.
The first test showed that
screening young hockey players
could determine if they are at risk
for hockey-related hip injuries.
The second test demonstrated
that the demands of hockey
goaltending may increase the
risk of hip injuries, and that
ways to reduce the risk warrant
further investigation.
1. The American Journal of Sports Medicine has accepted this paper for publication. Co-authors of the study in addition to Dr. Philippon include Dr. LaPrade, Dr. Ho, Justin Stull and Karen Briggs.
2. The findings will be presented at the 2013 annual meeting of the Orthopaedic Research Society in San Antonio, Texas. Co-authors of the study include Dr. Philippon, Dr. LaPrade and Dr. Wijdicks.
3. SPRI would like to thank Vail-Eagle Hockey, Ski and Snowboard Club Vail and all other participants in our studies for making this research possible.
Screening young
hockey players
could determine
if they are at
risk for hockey-
related injuries.
Photos by Barry Eckhaus
Dr. Marc Philippon is a specialist in sports medicine and hip disorders at The Steadman Clinic.
As co-chair and board member of the Steadman Philippon Research Institute, he shares the
organization’s mission of keeping people of all ages physically active through orthopaedic
research and education in the areas of arthritis, healing, rehabilitation and injury prevention.
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