David Schiller On The Butterfly And Hip Health For Goaltenders

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 goal

tenders, 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