Femoroacetabular Impingement (FAI) in Hockey Players: Causes, Symptoms, Prevention, and Treatment

What Is FAI? (Brief Hip Anatomy & Impingement)

Definition: Femoroacetabular impingement (FAI) occurs when abnormal bone shape in the hip causes the femoral head (ball) and acetabulum (socket) to rub, creating painful pinching and joint irritation.

Cam vs. Pincer:

• Cam: Extra bone on the femoral head/neck grinds cartilage inside the socket.
• Pincer: Overcoverage of the socket rim pinches the labrum between bones.
• Combined: Many athletes have features of both.
• Joint Damage: Repeated impingement can tear the labrum and wear cartilage, accelerating osteoarthritis if not addressed.

Why Hockey Players Are Susceptible

Skating Mechanics: Deep hip flexion with internal rotation (crossovers, stride, goalie butterfly) increases contact between the femoral neck and socket edge.

High Cam Prevalence: Studies report very high cam-type morphology in elite hockey players, including NHL populations.

Youth Training Load: Year-round skating during skeletal development may stimulate cam formation (bone adapts to load).

Not Always Symptomatic: Many athletes show cam/pincer morphology without pain; FAI becomes problematic when it drives labral or cartilage injury.

(At Ghost Rehab & Performance in Grand Rapids/Byron Center, MI, we routinely assess hockey players for these risk factors and tailor prevention plans to their schedule and position.)

Common Symptoms and Warning Signs

• Groin or front-of-hip pain provoked by skating, pivots, deep squats, or prolonged sitting.
• Stiffness and limited motion, especially flexion and internal rotation; difficulty maintaining low stances.
• Clicking, catching, or locking, often with labral involvement.
• Pain with prolonged sitting or post-game flare-ups.
• Limping or stride changes; toe-out walking to avoid painful ranges.
• “C-sign” pain description: hand cupping deep hip joint.

Risks of Leaving FAI Untreated

• Labral tears with instability and painful catching.
• Cartilage wear and early osteoarthritis.
• Chronic pain and loss of function in sport and daily life.
• Reduced performance (power, ROM, acceleration, agility).
• Compensatory injuries to the opposite hip, knees, or low back.

Prevention Strategies for Hockey

• Thorough dynamic warm-ups (aerobic ramp + hip-focused mobility).
• Hip mobility (rock-backs, deep lunge, figure-4, adductor mobility; banded hip distraction as tolerated).
• Strengthen support (glutes, hamstrings, core) to optimize pelvic control and hip mechanics; train pain-free ranges.
• Avoid overuse/early specialization in youth; encourage seasons off, multi-sport participation, and load monitoring.
• Technique coaching to minimize excessive, repetitive extremes.
• Address symptoms early; modify drills and strength work if groin/hip pain emerges.
• Off-ice posture hygiene (break up sitting, hip flexor relief, core/posterior-chain balance).

(Our team in West Michigan integrates warm-up templates, mobility circuits, and strength progressions into team and individual programs for hockey athletes.)

How FAI Is Diagnosed

• Clinical evaluation: History, FADIR/FABER tests, ROM, gait/stride observations.
• Imaging:
  • X-ray (alpha angle >~55° suggests cam; look for pincer signs and arthritis).
  • MRI/MRA to assess labrum and cartilage; CT for pre-op 3D planning when needed.
• Diagnostic injection: Image-guided intra-articular anesthetic (± corticosteroid) can confirm intra-articular pain sources.

Treatment Options

Conservative (Non-Surgical)

• Activity modification & rest from provocative ranges; smart in-season adjustments.
• Physical therapy: Restore ROM, strengthen glutes/core/rotators, improve mechanics (hip hinge, stride), reduce front-hip overload.
• NSAIDs for short-term symptom relief as medically appropriate.
• Injections: Corticosteroid for temporary relief/diagnosis; sparingly used in young athletes.
• Ongoing management: Maintain mobility/strength routine, progressive load, symptom monitoring.

Surgical

• When to consider: Persistent pain despite rehab or imaging-confirmed structural injury limiting function.
• Hip arthroscopy: Cam/pincer resection, labral repair/debridement, chondroplasty; typically outpatient.
• Outcomes: High return-to-play rates in elite hockey; earlier intervention before advanced cartilage loss yields better results.

Returning to Play

• Commit to rehab: Phase-based restoration of ROM → strength → neuromuscular control → skating-specific progressions.
• Gradual on-ice progression: Non-contact skill → intensity/changes of direction → controlled contact → full play.
• Criteria-based clearance: Symmetry of ROM, ≥90% strength, sport-specific tasks at speed without pain (e.g., Vail Hip Sports Test).
• Typical timelines: Weeks–months for conservative care; ~4–8 months post-arthroscopy (individualized).
• Psychological readiness and post-return maintenance (mobility/strength “keepers,” periodic check-ins).
• Smart adjustments (e.g., goalie butterfly volume, off-ice workload) support longevity.

Key Takeaway

FAI is common in hockey due to sport-specific loads, but with education, early recognition, and a structured plan, athletes can prevent escalation, treat symptoms effectively, and return to high-level play. Addressing issues early protects careers and long-term hip health.

(If you’re in Grand Rapids or the greater West Michigan area and suspect FAI, Ghost Rehab & Performance in Byron Center provides evaluation, imaging coordination, and hockey-specific rehab to keep you on the ice.)

References

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