T Nation

Issues with Hockey Player - Post Career


#1

So, these problems aren't about me, but rather one of my clients. I am just going to post everything that has happened between him and I in the last couple of years I have known him. Any help would be GREATLY appreciated.

Client is 40 years old. Came to me 2 years ago complaining of constant knee pain. Has not played competitive hockey in the last year or so due to the pain. He told me that his legs were quite atrophied compared to what they were before he stopped playing. (He also had ACL surgery when he was 15) So, we cleared up his tight IT and TFL and started working on strengthening his VMO. His mobility was great in his ankles, hips and thoracic spine. Since he rode his bicycle a lot in the offseasons, he did have incredibly tight hip flexors. We did a lot of glute activation and also worked on his flexibility. We also foam roll every session.

He holds and extra 20 pounds or so, and most of it is at his midsection. The problem we are having now is that the pain is somehow getting worse, and he has acquired a popping/clicking pain on the lateral posterior surface of his patella. It's almost along the lateral hamstring tendon, and if I place my hand there, I can feel it "pop" during knee extension.

Now, we have gotten to the point that he is having a lot of pain at his SI joint, especially after we do lunges. We can do almost any bilateral movements, and I can actually load that up quite heavy, but as soon as we try unilateral movements, he is out of commission for a few days. I have sent him to physio, but they just send him back to me and tell him to do some pilates.

  I've been noticing his hips are a little tighter than they were before, but we are very limited in our hip mobility exercises, as we can't get him in a split stance. It's pissing me off because we are sticking to only upper body exercises (as per physio's request) but it is not addressing the problem and it is just getting worse.

He still coaches his daughter's hockey 3/4 nights per week and is now a plumber, so is quite active all day. I know some of the pain in his knee is arthritis, but I want to know what the rest is. As for his back, I know some of it still has to do with his hip flexors, as he has been in hip flexion most of his life.

Sorry about the novel, but I have never been this stuck with a client before.

If anyone could help me out, I will praise you forever.


#2

One thing I noticed that you didn't evaluate or address would be his hip adductors. Try some hip adductor mobility drills, it can't hurt.

I'd also recommend reading up on Mike Boyle's work as he has had a lot of success with hockey players.


#3

We've foam rolled the hell out of his adductors, and as far as mobility drills, do you know of any I can get him to do while supine? Last time we tried lateral lunges, he was out for a few days.

I got a bit of info from Boyle's FSC3 - but not enough to solve this problem. I think I have read and watched almost all of Boyle's stuff, as well as Cressey and Robertson. I can usually solve these problems on my own, and have before, especially with the typical symptoms. But, I've got nothing..

Thanks for the ideas though, I'll keep trying. If you think of anything else, I'll try it!


#4

The ones I have used a lot in the past are
1) Spiderman Lunges - here is one variation (http://www.youtube.com/watch?v=IReNdyJ4rn4)
2) 1/2 kneeling hip adductor dips ( http://www.tonygentilcore.com/2010/09/exercises-you-should-be-doing-half-kneeling-adductor-dips/ )
3) Kneeling Hip Adductor mobs (http://www.youtube.com/watch?v=eJb5dObKVk8&feature=related).

Not sure if your client will tolerate some of these if lateral lunges increase symptoms, but worth looking into.

Where does he get the pain that keeps him out of activity after the lateral lunges? Where is his pain located in the hip? Or it is only around the knee? If he hasn't seen an ortho physician, I'd recommend he sees one to get an updated MRI to rule out any labral pathology at the hip.


#5

His entire low back flares up. When he points to it, it looks like SI, but he is literally bed-ridden for 2 days.

He actually saw an ortho around here with a VERY good reputation, but he said that until he loses 20 pounds, he wont even look at him..

I will definitely try those drills, it might work since I can get him kneeling.

Thanks a lot, and I will post with updates.