The first training session with the Vermont Lumberjacks this fall, I asked the group if they’ve ever felt hip flexor or groin pain. Literally every single hand went up. In my role as the strength and conditioning coach for the Vermont Lumberjacks, I’ve been able to witness how over forty 16-20 year old hockey players move. Just about all of them have the same postural imbalances as a result of being on the ice since young childhood, and these imbalances explain why hip flexor and groin injuries are so prevalent. So, it has been one of my goals to arm our players with tools to prevent or minimize groin and hip pain throughout the season.
In explaining this, I’m going to take an oversimplified approach. The anatomical nuances are not essential for the athletes to understand as long as they understand the goals and principles behind what we do. I must give two professionals full credit for making this a part of our training program, and ultimately keeping our athletes healthy. First, Oliver Hall at Inspire Physical Therapy. When I was struggling with chronic hip pain, I went to him. He armed me with the tools to keep my body healthy, and in the two years since, I have rarely had any hip pain. Olly has taken the time out of his day on multiple occasions to come watch the lumberjacks train, and then gave me the guidance to make this a part of our program. Secondly, Michelle Boland brought the concepts that Olly had taught me into a gym setting at her presentation at the NSCA Vermont State Clinic last year. Since then, her resources have been incredibly valuable. Both Olly and Michelle are certified with the Postural Restoration Institute.
Understanding Hockey Posture
The posture of every hockey player that I have worked with exists on a spectrum of the same postural phenomenon. They all have a tendency towards an anterior pelvic tilt and externally rotated hips.
Neither of these are surprising when we think about hockey. It’s played with the hips flexed basically all the time, and requires powerful hip external rotation and abduction with every stride. Furthermore, external rotation is coupled with extension in every paired bone in the body when we inhale, which explains why the tendency to be externally rotated and extended is paired together. If you want to, you can prove this to yourself by taking a few slow breaths and focusing on what your body does. As you inhale, your ribs, chest, and hips will want to open up, while on the exhale everything will want to close down. With our athletes, we focus on pairing internal rotation and flexion with our exhales in order to offset the bias towards external rotation and extension.
The differences among athletes lie in the degree of this imbalance, and the severity of it on each side of the body. Some athletes are balanced, and able to fluidly shift their weight from side to side. Others have a tendency to shift their weight to the right, while others are so stuck in external rotation they they struggle to shift weight to either side without excessive back extension.
An athlete in balance is able to simultaneously externally rotate and abduct their stride leg, while shifting their weight to the other side and internally rotating on the stance leg. The problems arise when the hip can’t internally rotate adequately, causing the body to compensate by tilting the pelvis forward and extending the spine. On the side(s) that cannot adequately come out of external rotation or extension, we see weak abs, hamstrings, and adductors, which all play a role in posteriorly tilting the pelvis and internally rotating the hips. When these muscles are weaker on the left side, which is common, it leads to a right side bias. The weaker left hamstrings and adductors cause more of an anterior tilt on the left side of the pelvis, which make the left hip flexors overworked and more susceptible to strains. The Postural Restoration Institute calls this pattern left anterior interior chain (left AIC). So, our goal is to first identify where they exist on this spectrum of being being neutral, tight on one (almost always the left) side or tight on both sides. No player is perfect, they all exist on this spectrum.
In bilaterally tight athletes, tight hip flexors, an excessive anterior tilt, and weak internal rotators lead to overuse of both hip flexors. Groin (adductor) strains are also a risk, because they are lengthened and weak relative to external rotators and abductors. In individuals who exhibit a stronger left AIC pattern, the right groin is constantly working, as weight is constantly shifted to that side. In these individuals the right groin is overworked and tight, and the left groin is lengthened and weak, leading to groin strains. Most guys came in with very little understanding of any of this, so we started with the basics and have worked our way towards more specific exercises.
Step 1: Learning the posterior pelvic tilt
I have talked about this in depth here. I start with these methods, rather than PRI methods because they’re simple. Especially in a group setting, it is important that we start with the most basic concepts first, and then build off of it.
Step 2: Teaching internal rotation activation of adductors, hamstrings, and gluteus medius therefore restoring hip internal rotation.
To understand the reason for focusing on restoring internal rotation and adduction at the hip, we must remind ourselves that internal rotation is coupled with flexion as part of respiration. With hockey players, we want to get them out of this extension and external rotation bias. That’s why, after they’ve reached proficiency with basic pelvic tilt methods, we work on teaching them how to internally rotate their hips to help them avoid overusing the low back. Those with more bias towards the right side (left AIC) still learned this so that they understood the process on both sides before moving on to unilateral work. Those who were tight on both sides spent more time focusing on this.
Here are some of the exercises, from PRI, that have helped us work on this.
For each exercise, the important cues are the same. We’re bringing our pelvis to neutral, internally rotating our hips as we exhale slowly and fully.
Slow exhales – on exhales round lower back, engage abs, hamstrings, groins.
Flatten low back against the wall or floor.
Dig heels into ground to engage hamstrings.
Step 3: Addresses left and right side imbalances – continue to work on internal rotation on the left side, and hip abduction on the right.
In this phase, we work on addressing the left to right differences. The human body has a bias to shift our weight to the right due to the body’s natural asymmetries. When this happens the right hip hikes up, and the left pelvis shifts forward. The right abs and right adductors become comparatively much stronger, and the right glute medius becomes weak as a hip abductor. On the left side, the left abs and adductors are weaker. This imbalance can manifest itself symptomatically in a few common manners. First, your left hip flexor may hurt because of the stress placed on it due to the anterior tilt on the left. The right quadratus lumborum (a low back muscle) may become sore, because the right glute med will be unable to overcome the strong right adductors in order to abduct the hip with the pelvis in the slanted position. So, we will get fake hip abduction via the QL. And of course, these issues can lead to other upstream and downstream problems. The right stride will be weak, because the athlete will not be getting optimal hip abduction, so fixing this imbalance also has performance enhancement implications. All of our exercises in this phase focus on activating the left abs, left adductors, and right abductors while inhibiting the right abs, right QL, and right adductors.
For these exercises, we still want to maintain a flat back and use slow exhales. But now, emphasize the side to side differences.
- Hike your left pelvis up into your rib cage by using your left abs and left groin.
- Think about pushing the right arch away.
- Dig the left heel into the ground (wall with reach) or bring it slightly towards your butt (belly lift and right leg reach)
Step 4: Transferring it all to dynamic movements
These static exercises are all great, but if they don’t transfer over to the ice, then athletes are going to always deal with their posture and pain issues. At this point, it’s about taking all the concepts and methods and applying them in more dynamic situations. For us, this is always happening, even from day one. I can’t wait until our posture is “normal” to let them actually lift weights. We’d never strength train. It is a continual process of slowly improving posture and function, and then applying it to more sport-like scenarios. With step one, teaching the pelvic tilt, I am strict. Nobody is doing a heavy goblet squat or an ab wheel until they can show me they can flatten their back. The risk of causing back pain outweighs the benefit. But beyond that I know that I just have to slowly work with them where they’re at. Over time, weak muscles that we worked on will begin to work more during strength training exercises, and eventually dynamic exercises like cleans and jumps without the athlete thinking about it. Admittedly, there are better ways to approach helping these concepts transfer to more sport-like movements. But, we have not had time to learn many of the exercises that bridge the gap between static exercises and a hockey stride. But, we have emphasized the same cues during our split squats, stiff-leg deadlifts, and hex bar deadlifts, to name a few.
All four steps are always happening at the same time. Some days, we need basic neutral pelvis cues on our squats and ab exercises. Although over the course of the program we’ve spent more time on one phase after another, we continually review all four phases.
This is far from a scientific study, but since November 1 we have only lost two man games to hip and groin soft tissue problems (which were the result of a freak play, not overuse). The captain of our junior A team, Mason Emoff said “I have never had the training to prevent hip flexor and groin injuries until this year. This is my first time in three seasons of junior hockey that I haven’t had to sit out mid season due to hip flexor or groin pain.”
For more hockey-specific training content, head over to hockeystrengthandconditioning.com