RICE & MICE: Labrum tears…It’s all in the hips

Ok, so there’s a labrum in the shoulder, but I’m talking about hips so, for right now, it’s all in the hips.

It seems that hip injuries are all the rage these days and not just in the NHL. Hip labrum injuries can also occur in golf, baseball, soccer and basketball as well as hockey. However, hip labrum tears are almost an epidemic in hockey over the past several years.

Goaltenders are especially prone to labrum tears.

This can be attributed in part to the butterfly style that most goalies use, however it’s not an injury that’s excusive to butterfly goalies. In the last 5 seasons, Tim Thomas, Michael Leighton, Antero Niittymaki, J.S. Giguere, and even the young Josh Harding are among the goalies that have undergone surgery to repair the labrum.

This particular injury isn’t exclusive to goaltenders in the NHL either. Matt Walker, Braydon Coburn and Ville Leino are among the Flyers skaters that had surgery to repair acetabular labral tears in just the past 2 years. This season alone, the New York Islanders have had three players suffer labral tears: Andrew MacDonald, Mike Mottau, and Mark Eaton.

The hip and shoulder are both ball-and-socket joints. The labrum is a flexible cartilage that lines the socket of these types of joints to allow a smooth range of motion in a variety of directions. The labrum in the shoulder is called the glenoid labrum, named for the socket of the shoulder, the glenoid cavity. Likewise, the acetabular labrum lines the socket of the hip, or the acetabulum.

With the development of arthroscopic techniques to surgically manage the hip joint, there has been increased recognition and awareness of hip labral tears accompanied by a more efficient surgery to repair these tears, which could possibly explain why these injuries seem to be so common nowadays.

The popularization of butterfly style goaltending across all levels of hockey play has hastened the development of labrum injuries in younger and younger goalies. The popularity of the butterfly style combined with strict enforcement of leg pad parameters for goaltenders leads to a large amount of wear and tear on a goalie’s hips.

The labrum is usually damaged in one of 2 ways: either there is repetitive wear and tear on the hip or there is a tear that results from trauma in sports or falls or accidents.

If the hip dislocates, there may be a labral tear that results. Typical symptoms of a hip labral tear include groin pain, clicking and snapping sensations in the hip, and limited range of motion of the hip. Pain may be sudden pain at the front of the hip or gradual and difficult to pinpoint. Sometimes there’s an underlying hip problem called femoroacetabular impingement (FAI) that contributes to the labral tear. FAI is basically where the ball and socket don’t fit together perfectly because the ball is not round.

When FAI is present the muscles have to work harder to move the joint in certain positions, which puts an even greater amount of stress on the hip and subsequently, the labrum. Over time the labrum wears down, unless it is surgically repaired.

An MRI arthrogram is the best method to detect labral injuries.

Dye is injected into the hip joint and an MRI is taken to evaluate the cartilage and ligaments of the joint. If a labral tear is diagnosed, surgery is required, since the labrum does not heal itself. Some goalies will elect to finish a season of play before treating the torn labrum. Labral tears are repaired surgically using an arthroscopic technique to trim or repair the labrum. If there is evidence of FAI at the time of the surgery, the femoral head (ball of the ball-and-socket) can be shaped in order to improve mobility and decrease the likelihood of recurrent labral tears.

Rehabilitation of the hip after the surgery requires careful step by step guidance and is outlined based upon the surgery that was performed. Most athletes can recover fully in 4-6 months.

Disclaimer: Information on found in RICE & MICE  on flyersfaithful.com is not intended to be medical advice. Any information or materials posted on the web site are intended for general informational purposes only, and should not be construed as medical advice, medical opinion, diagnosis or treatment. Any information posted on the web site is NOT a substitute for medical attention. See your health-care professional for medical advice and treatment.

  • http://flyersfaithful.com Marcello D

    Nice Happy Gilmore reference.

  • http://flyersfaithful.com Marcello D

    Nice Happy Gilmore reference.

  • richrath

    Good post! I really worry about the wear and tear on goalies’ hips if the end of their femur is not especially round.

    SI did an article a while back on butterfly goaltending and hip degeneration. More detail since it’s longer, but a good read. Backs up what you’re saying here. Hope you don’t mind if I link it:

    http://sportsillustrated.cnn.com/2009/writers/david_epstein/03/18/butterfly.hip.injuries/index.html

    • http://flyersfaithful.com pavialax

      Thanks! I agree about the wear and tear on hips too and especially with guys that use a wide butterfly and since they changed the regulations on leg pads for the goalies. In Leighton’s case, I wonder if his residual leg weakness from the herniated disk caused him to change his mechanics resulting in the labral tear.

  • richrath

    Good post! I really worry about the wear and tear on goalies’ hips if the end of their femur is not especially round.

    SI did an article a while back on butterfly goaltending and hip degeneration. More detail since it’s longer, but a good read. Backs up what you’re saying here. Hope you don’t mind if I link it:

    http://sportsillustrated.cnn.com/2009/writers/david_epstein/03/18/butterfly.hip.injuries/index.html

    • http://flyersfaithful.com pavialax

      Thanks! I agree about the wear and tear on hips too and especially with guys that use a wide butterfly and since they changed the regulations on leg pads for the goalies. In Leighton’s case, I wonder if his residual leg weakness from the herniated disk caused him to change his mechanics resulting in the labral tear.