David Schiller On The Butterfly And Hip Health For Goaltenders

David Schiller, DC, DACNB, FABBIR, CCSP
Board Certified Chiropractic Neurologist
Fellow, American Board of Brain Injury & Rehabilitation
Certified Chiropractic Sports Physician

Lower extremity injuries and specifically hip injuries in hockey players, particularly goaltenders, is one of the most prevalent injuries in that sport. Specifically, the butterfly save in hockey goaltenders exposes the hips to excessive flexion, abduction and internal rotation. It is important to note the fact that femoral acetabular impingement (FAI), a common cause of osteoarthritis, is more often caused by hip joint movement that is brought into flexion, abduction and internal rotation as well. Prevention of hip injuries in hockey goaltenders can prolong the athlete’s career as well as avoid unnecessary suffering. Injury prevention programs should include biomechanical considerations of the offending movements, proper strengthening and conditioning, and appropriate screening of the athlete as it relates to neuromusculoskeletal balance. To prevent injury, the number of repetitions the athlete is asked to perform during practice drills as well as conditioning exercises needs to be considered since there is no control over how many times the goalie will perform the maneuver during a game.

Strengthening exercises should be centered on movements that contribute to the athlete’s conditioning but do not further compromise an already stressed joint. If the butterfly save is performed during practice drills, then minimizing similar movements during strength and conditioning exercises is recommended. It has been noted by other authors that deep squats should be avoided. It has been suggested that other forms of leg strengthening exercises should be performed such as one-legged squats. I would have to agree with this assertion because this form of exercise does not bring the hip into deep flexion. Additionally, performance of single leg strengthening exercises makes it possible to discover imbalances within the lower extremity kinetic chain by the strength coach or athletic trainer. By uncovering imbalances that have the capacity to predispose the athlete to increased wear and tear on an already exposed joint, a therapy program can be prescribed in order to minimize the possibility of further injury.

Injury prevention programs should not just be isolated to strength and conditioning. Pre-season and off season evaluation of the athlete should include biomechanical examination of structural balance which includes range of motion-particularly internal range of motion of the hip joint. If imbalances in range of motion are discovered, measures can be taken to improve them with the proper therapy. Athletes should be screened for these imbalances and prescribed the appropriate therapies that will correct these findings.

Proper neurophysiology can contribute to injury prevention as it relates to musculoskeletal control. If there are imbalances in lower extremity strength from one side to the other, it may not simply be a weakness to muscles corrected by exercise, but an imbalance in how the muscle is “fired” by the nervous system. Neurophysiology dictates that there must be a contraction of the stability muscles (core musculature) before extremity mobility. Without appropriate proximal hip joint stability, the movement of the limb to perform the butterfly save position, can produce undue stress on the hip joint, contributing to excessive wear and tear. Since hockey players are subjected to various collisions, it must be recognized that the nervous system and joint soft tissues can be injured which in turn can influence the balance of lower extremity muscle strength, structural balance and range of motion. These injuries can remain subclinical and be present without symptoms for a period of time. Therefore, a proper evaluation is the only way of uncovering these findings prior to symptom presentation. Examination of the athlete’s brain function as it relates to spatial perception may be one way of identifying why the athlete has any imbalance in the first place. The athlete’s awareness of where they perceive themselves in space is key to the athlete’s control of stability and mobility to the extremity. This awareness is under the direct control of the vestibular system. The vestibular system is a multimodal system utilizing vision, proprioception and vestibular receptors to assess where they are in space and where their environment is in relation to them. In this case, the goaltender’s perception of their lower extremities in the butterfly save position, is contingent upon the proper proprioceptive signaling coming from those joints and muscles, their vision and vestibular receptors. If malfunctioning, the athlete runs the risk of exposing the joints and muscles to unnecessary stress.

As a Chiropractic Neurologist and Sports Physician, I consider the role of the central nervous system as it relates to spatial perception and body awareness in order to provide a comprehensive program of injury prevention. Further explanation of these neurophysiological concepts as well as improved overall performance of the athlete can be explored in future articles.

David Schiller, DC, DACNB, FABBIR, CCSP
Board Certified Chiropractic Neurologist
Fellow, American Board of Brain Injury & Rehabilitation
Certified Chiropractic Sports Physician