The Cause and Treatment of Groin Injuries in Hockey Players – Part 1

By Nunzio Signore (BA, CSCS, CPT, NASM, FMS)

Injured Hockey Player

Hockey players and groin injuries go together like rice and beans…

Rice and Beans

In a great article by Mike Reinold, he referenced a few great studies that really shed some light on possible reasons why many strength coaches try to treat groin strains with very little to no success.

  • A 1999 study by Emery et al. found that “the impact of groin and abdominal strain injury at an elite level of play in hockey is significant and increasing. Furthermore, the recurrence rate was 23.5%, this study also found that upwards of 90% of all groin injuries were non-contact in nature”.
  • A 1978 study by Sim et al. concluded that “ice hockey players are at high risk for non-contact musculoskeletal injuries because of the excessive force generated during the acceleration and deceleration phases of skating”.

Sports physicians, physiotherapists, and strength coaches, who fall under this category, often prescribe stretching of the groin musculature to remedy the issue.

  • The study by Tyler et al., however, found that preseason flexibility of the hip adductors did not differ between NHL players who went on to sustain groin strains and those who did not.

Huh

This indicates that:

  • Stretching of the groin may not be the answer for preventing or even treating groin injuries.

What to do:

  • Find the cause (pain source) don’t treat the symptoms (pain site).

Possible Causes:

What the Tyler et al. study did find was that:

  • Preseason hip adduction strength of the players who sustained groin injuries was 18% lower than that of the healthy players.
  • Adductor strength was 95% of abductor strength in the uninjured players, compared to only 78% in the injured players.
  • This suggests that a strength imbalance between the propulsive muscles (abductors) and stabilizing muscles (adductors) has been proposed as a mechanism for adductor (groin) muscle strains in athletes.

Thigh Muscles

The first concept to understand is the biomechanics of skating.  During the powerful skating stride, the hip extensors and abductors are the prime movers, while the hip flexors and adductors act to stabilize the hip and decelerate the limb.  Due to the movements’ specific to hockey, players generally present during their assessments with an anterior pelvic tilt which is caused by:

  • Tight erectors (Q.L.) due to massive amounts of time in extension
  • Tight hip flexors (time spent in a forward lean)
  • Long hamstrings (from being in anterior tilt)

Groin Injury Hip Arroes

The lengthened hamstrings put them at a leverage advantage, forcing them to take on more of the load in extending the hips than the glutes.  The glutes then become under active and relatively weak, as does the anterior core.  And we end up with something that looks like this.

Groin Injury Spine Image

How does all this play into groin injuries?

PRI:  While muscles are often prime movers in a single plane, they must actually be considered as having an effect on movement in all three planes—sagittal, frontal, and transverse.  The nature of the skating stride tightens both the external rotators and abductors (glutes) and pulls the hips into chronic external rotation and abduction, or in other words causes them to become “flared”.  This lengthens the adductor muscles like the adductor magnus, which also contribute to internal rotation, and like the hamstrings in the sagittal plane, are put at risk for injury.  This in turn creates the imbalance mentioned above.

What does all this tell us:

  • Pelvic alignment and the anterior tilt are at the root of groin injuries
  • We must address muscular imbalances with the tri-planar perspective in order to effectively prevent injuries of this nature

Stay tuned next time when we’ll get into the nuts and bolts of treating the “king of all hockey injuries”.

See ya’ in the gym…

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