November 2015

Out on a limb: Hockey gets hip to FAI

1Limb-JordanaJordana Bieze Foster, Editor

Despite evidence of significant lower extremity injury risks associated with ice hockey, even at youth levels, preventing those types of injuries has never been a priority in that sport. But that may be starting to change.

According to a recent report from CBS Sports, five members of the Dallas Stars professional hockey team—including Jamie Benn, the league’s leading scorer last season—have undergone surgery for femoroacetabular impingement (FAI) in the last year. Rather than let players continue to play through the pain and functional limitations of FAI, which historically has been the way many injuries are managed in hockey, team medical personnel have decided to take a more aggressive approach in hopes of prevent­ing worse disability—and more lost ice time—in the longer term.

The clinical merits of such an approach are probably debatable. But what’s clear is that the more professional hockey players who undergo surgery for FAI, the more coaches and parents of youth hockey players will realize that the risk of FAI is something they should be taking seriously.

The more professional hockey players who undergo surgery for FAI, the more youth hockey will start taking the risks seriously.

Marc Philippon, MD, hip surgeon to the stars, and colleagues at the Steadman Philippon Research Institute in Vail, CO, documented this risk in a 2013 study that found 75% of youth hockey players had alpha angles associated with cam-type FAI, compared with 42% of similarly aged skiers. More recently, an October 2015 study from Switzerland found that, on magnetic resonance imaging, 68% of male youth ice hockey players had FAI-related bony deformities.

When presenting the preliminary data from his study in Monaco at the 2011 World Congress on Prevention of Injury and Illness in Sport (see “Screening has benefit, but Philippon calls for more action to save hips in hockey,” May 2011, page 25), Philippon called for youth ice hockey leagues to manage players’ ice time—in much the same way as youth baseball leagues manage players’ pitch counts—to help reduce the risk of FAI. But that hasn’t happened.

Like baseball, ice hockey is a sport in which many kids are encouraged to specialize at a very early age, a factor that itself dramatically increases the risk of overuse injury in those who continue to play through high school. To be fair, ice hockey is a more physical sport than baseball, even at youth levels, and most youth hockey leagues are rightly focusing their prevention efforts on concussion and other traumatic injuries.

But baseball is also a much higher-profile sport than ice hockey, at least in the US. Pitch counts for youth baseball players weren’t implemented just because sports medicine experts said it was a good idea; they were implemented because an increase in the number of professional players undergoing Tommy John surgery brought the problematic practice of overusing young arms into the public spotlight.

If more hockey teams start focusing on FAI at the professional level, it will go a long way toward increasing awareness at lower skill levels, where intervention can really make a difference. That’s something players, parents, coaches, and fans at any level should be able to root for.

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