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1 Running Header: CRITICAL REVIEW OF JOURNAL ARTICLE Critical Review of a Journal Article: At-Risk Positioning and Hip Biomechanics of the Peewee Ice Hockey Sprint Start Kasey L. Powers Wayne State University

2 CRITICAL REVIEW OF JOURNAL ARTICLE 2 Justin D. Stull, Marc J. Philippon, and Robert F. Laprade performed a study on the hip biomechanics of young hockey players found in The American Journal of Sports Medicine, dated June 27, This article, At-Risk Positioning and Hip Biomechanics of the Peewee Ice Hockey Sprint Start investigates the different positioning that youth hockey players display in their hockey gait that may essentially lead to femoroacteabular impingement (FAI). Because FAI is becoming increasingly predominant in adolescent overuse injuries, these doctors of the Steadman Philippon Research Institute in Vail, Colorado attempted to determine the exact biomechanics that would cause such impingement and perhaps aid in the prevention of these common chronic overuse injuries. This study provides insight to how non-contact hockey injuries are misdiagnosed as groin or abdominal strains when in actuality can be due to the flexion and extension during internal and external rotation respectively. Although this may be accurate, several limitations must be considered when reviewing and interpreting these findings. Dr. Marc Philippon and Dr. Robert LaPrade of the Steadman Philippon Research Institute are reputable sources with no conflicts of interest in the authorship or publication of this article. Twelve uninjured hockey players, of peewee age, years old, were evaluated. Skaters were suited with 35 reflective markers which would be record three-dimensional Motion Analysis with 10 high speed cameras. This study would take place on an acrylic skating surface, not on actual ice. The methods are clearly explained and could be duplicated by anyone who had the technology and resources to do so. The results of this study are measured in degrees of hip angles, comparing extension, external rotation and adduction, next to flexion, internal rotation and abduction. The results are somewhat in line with the aim of the research. The researchers state that several average maximum values were recorded for the period of the sprint start under observation. The results

3 CRITICAL REVIEW OF JOURNAL ARTICLE 3 cover the different average, and peak values for the degrees of internal rotation and flex in the lead leg, and external rotation in the push leg. In Figure 4, a chart is presented highlighting the highest risk positioning for the recovery phase of the sprint start, as well as for the push-off phase. Table 2 then shows the group averages and individual minimums and maximums for the observed hip motions. Majority of the results included in the study were very wordy and contained measurements of angles and were hard to follow and decipher. Regardless, there do not appear to be any gaps in the results, all items are commented on and accounted for. The discussion of this study verifies that the hockey sprint start accounts for a majority of the at-risk biomechanical hip positions, especially during the initial push-off and all recovery phases. That being said, youth hockey players can develop FAI as well as chronic labral tears or articular cartilage damage. The positions discussed are similar to the positions adult hockey players use in their skating gait. If FAI is acquired asymptomatically in a child, and the child continues to pursue the sport of hockey, an increase in speed, maturity and muscle mass will increase the hip forces, and rates of rotation which will increase the likelihood for a more severe non-contact injury in the future. As speed and range of motion increases in the stride, the skater is more susceptible to the at-risk positioning as well. The four periods of the sprint start, the start period, the push off period, swing period, and the even period all demonstrated different degrees of risk. The start period displayed little risk, with only slight external rotation. The push period exposed the peak internal rotation and flexion in the lead leg. The swing period contained many instant changes in the hip joint. Maximum values were observed in push leg flexion, push leg internal rotation, and lead leg external rotation. Finally, the even period showed the greatest change rates in flexion and internal rotation.

4 CRITICAL REVIEW OF JOURNAL ARTICLE 4 The authors of this article state that coaches and trainers should avoid excessive training, drills and practices where skaters would be repetitively executing these at-risk positions. Power skating drills and resistance band drills overstress the hip range of motion, over time creating a chronic hip problem. In general, this scholarly article was great in theory. The idea behind the research is certainly something that would benefit the youth in the hockey and overall athletic world with chronic hip injuries as well as a correct diagnosis. Unfortunately, however, the research was very limited. The researchers only used 12 subjects to perform their research and used a very small population: males, age 10-11, from a small town in Colorado. Future studies may use a broader range of the population to solidify and authenticate their findings. Next, this research was done only observationally. In future studies, these same doctors research this same obstruction, FAI, by viewing MRI hip studies in young, asymptomatic male hockey players in comparison with peer skiers (Philippon et al). This article is also very informative, in regards to the prevalence of chronic, non-traumatic, hockey hip injuries, but leaves much to wonder. Combining these two studies into one may be the most insightful and lucrative idea for preventative hip care in adolescents. This may be a study where observational study of a hockey players gait is recorded and then compared with his own MRI findings. These results can then be compared with other athletes gait and MRIs from different age groups and locations. Also, females were omitted from this study. With the rise in women s sports, injury is just as prevalent in women as in men, if not more. Because women s hip angles and position is different than men, it would also be interesting to see how the hockey sprint start affects their hips. There are not many recent studies in regards to hockey player hip impingement, so more research would certainly help the always growing world of competitive sports.

5 CRITICAL REVIEW OF JOURNAL ARTICLE 5 As far as the structure of the study, it was mostly easy to read; the language was easy to understand and structured in a way that flowed nicely. Unfortunately, some of the results became hard to understand with so many angles listed one after another. Parts of the study were also very redundant, repeating the same comments throughout. Table 2, 3 and 4 were simple enough to understand, but did not really provide any significant information. Figure 3 when compared to Table 1 was somewhat hard to decipher; it was not clear which picture was to be paired with which description of the sprint stride. Figure 2 assisted in showing exactly where the spherical markers were placed, making this easy to duplicate. In summary, this study may be conclusive in the sense that the biomechanics of the ice hockey sprint start and skating gait can lead to FAI and essentially convert to labral tears or articular cartilage damage. However, this study was limited in the fact that only a small sample group was used, from only one geographical area, and from one age group. This study has provided enough insight to perhaps initiate further investigations which should examine a broader range of athletes, including multiple age groups, genders and geographical locations and couple an observational study along with a medical imaging study.

6 CRITICAL REVIEW OF JOURNAL ARTICLE 6 References Philippon, Marc J., Charles P. Ho, Karen K. Briggs, Justin Stull, and Robert F. LaPrade. Prevalence of Increased Alpha Angles as a Measure of Cam-Type Femoroacetabular Impingement in Youth Ice Hockey Players. The American Journal of Sports Medicine 41, no. 6 (June 1, 2013): doi: / Stull, Justin D., Marc J. Philippon, and Robert F. LaPrade. At-Risk Positioning and Hip Biomechanics of the Peewee Ice Hockey Sprint Start. The American Journal of Sports Medicine 39, no. 1 suppl (July 1, 2011): 29S 35S. doi: /

Relationship between the FABER Distance Test and the radiographic alpha-angle in patients with FAI

Relationship between the FABER Distance Test and the radiographic alpha-angle in patients with FAI Christiano A.C. Trindade, MD Karen K. Briggs, MPH Kiyokazu Fukui, MD, PhD Marc J. Philippon, MD Christiano