USA Hockey Magazine

What is the initial treatment for a hockey player with hip impingement and labral tear? With these injuries, we try to exhaust all our non-surgical options. First line treatment begins with rest, activity modification, as well as anti-inflammatories such as ibuprofen. We also add in physical therapy with an emphasis on core, lower back and hip strengthening. There are frequently some muscle imbalances around the pelvis that we can correct to help offload the hip joint. Finally, we can sometimes consider the use of an ultrasound-guided steroid injection to help with pain relief that will allow us to maximize physical therapy. If a hockey player still has pain after non-operative treatment, what is the next plan of action? We would then consider surgery in the form of a hip arthroscopy or "hip scope." This is a surgery that allows us to look inside the hip joint, fix the torn labrum and shave down the hip impingement. This is a same day surgery that takes just under 90 minutes. We work through three small little incisions around the hip. What does the recovery look like after a hip arthroscopy? When might a player expect to get back on the ice? After surgery, the patient will be partial weight bearing with the assistance of crutches for two to three weeks. The player starts physical therapy the day after surgery. We work on gentle range of motion and begin the player on a stationary bike. From there, we have a very progressive program to help strengthen the muscles around the hip with a progression into a pool around four weeks. This is then followed by getting on to the elliptical at six weeks and a return to running at 12 weeks. We will generally look to get the athlete back skating between that third and fourth month and a goal of a return to play between five to six months. How do hockey players do after this surgery? Hockey players tend to do very well after the surgery! By fixing the labrum, the player's pain is gone and we help to increase the range of motion around their hips by shaving the bone. Players will typically feel that their hip is freer and allows them to do things on the ice that they were not able to do previously. P When a hockey player comes in with hip pain, what should they expect when they see you in the office? At this initial evaluation, we get a thorough history of the player's hip pain followed by a physical exam to help us determine the source of the pain. Additionally, we'll get X-rays of the hip to look for hip impingement. If there's any concern for a hip labral tear, then we will proceed with getting an MRI. This MRI helps us to get a better look at the labrum and cartilage inside the hip joint as well as muscles, tendons and ligaments surrounding the hip. WHAT ARE SYMPTOMS OF HIP IMPINGEMENT? Deep or low groin pain at the front of your hip along the groin crease Sharp stabbing when you turn, twist, or squat. Dull ache when you turn, twist, or squat. Pain that gets worse when you go from sitting to standing. Stiffness and limping. AUGUST 2023 USAHOCKEYMAGAZINE.COM // 37 T H E D O C I S I N A N D R E A D Y T O A N S W E R Y O U R H O C K E Y M E D I C A L Q U E S T I O N S CLICK HERE to email your question for Dr. Hockey. ? A labral tear is typically fixed with 3-5 suture anchors to spot weld the labrum back to the bone.

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