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Butterfly and hip injuries: Backstrom back to surgeon

Butterfly and hip injuries: Backstrom back to surgeon

Wild goalie says NHL rule changes led to surgery two years ago

Minnesota Wild Goalie Niklas Backstrom

Niklas Backstrom stretches before a recent game, but it wasn't enough to prevent another hip injury that may require surgery. (Photo by Kevin Woodley)

Less than two years after blaming NHL rule changes for needing hip surgery, Minnesota goaltender Niklas Backstrom is heading back to the surgeon after injuring the same left hip.

As first reported by Star Tribune reporter Michael Russo Saturday, Backstrom will travel to Vail, Colorado early next week to see renowned hip specialist Marc Philippon. He hopes the diagnosis is different from the end of the 2008-09 season, when Backstrom told InGoal Magazine that Phillipon said a torn hip labrum could be linked to the NHL decision to thin out goalies’ knee stacks, which are sometimes called the landing gear.

(Editor’s note: the Star Tribune reported Tuesday that Backstrom only has a strained hip flexor, and only needs rest before possibly returning as early as next week).

The renewed enforcement of a one-and-a-half inch limit on the thickness of knee stacks – the padding goalies land on when they drop into the butterfly – going into the 2008-09 season was part of a series of reductions in flaps around the perimeter of the pads designed so it would take NHL goalies a little longer to get down flush to the ice, and so that seal was broken sooner as they got back up or moved laterally.

“Backstrom told InGoal Magazine that [Dr.] Phillipon said a torn hip labrum could be linked to the NHL decision to thin out goalies’ knee stacks, which are sometimes called the landing gear.”

For many goaltenders it also meant traveling a little further every time they went down. And for the majority that use the butterfly style, that meant the top of the femur, or thigh bone, had to rotate more inside the hip socket, an unnatural motion that can cause the bone to grind away cartilage.

Considering equipment manufacturer Bauer, in a joint effort with McGill University, had done research that equated the force of the butterfly drop motion to an Olympic weightlifting clean and jerk, and given NHL goalies will drop to their knees hundreds of times a day in practice, it was little wonder that a rash of knee, groin, and hip injuries followed the changes early in the 2008-09 campaign.

“I felt it really much in the beginning,” Backstrom told InGoal last season after revealing his surgeon’s comments about the link between the equipment change and the injury. “It’s tough on your knees and your hips, because your knees go too far down to the ice. It’s really tough on your body.”

Minnesota Wild Goalie Niklas Backstrom

Minnesota goalie Niklas Backstrom, seen here stretching out during a warm up save before a game in Boston on Thursday, has re-injured his left hip. He blamed a thinner knee stack, seen under his left knee in this picture, for needing hip surgery two seasons ago. (Photo by Scott Slingsby)

Boston’s Tim Thomas also originally suffered his hip injury in 2008-09, but played through it well enough to win the Vezina Trophy that season before finally having to undergo surgery on his hip this past summer.

When InGoal talked to Thomas this summer about his recovery, the Bruins’ star wasn’t willing to draw a direct line between his surgery to repair two bad labrum tears and remove bone chips and the reduction in the thickness of knee stacks two years ago. But he was worried about what injuries might result from the NHL’s move this season to a sizing chart and shorter pads for some goalies.

Goalie Tim Thomas

Boston goalie Tim Thomas underwent hip surgery last summer. (Photo by Scott Slingsby)

“We’ve already run into the law of unintended consequences, and that’s the thing I am most afraid of,” said Thomas, again pointing out he had no direct evidence linking equipment to his surgery. “They changed the knee lift height that the goalies land on and there’s been lots of goalies having hip surgeries and the hip doctors are saying it’s related to the fact the knee lifts got lower and it’s putting more stress on the hips.”

Ryan Miller told InGoal two summers ago that “it was a little irresponsible to reduce the inner knee landing area without testing how that effects the body,” adding that played a role in the NHL Players’ Association resisting this year’s pad-height restrictions for a full season.

In defense of the NHL, it’s worth noting they were just re-enforcing a rule goaltenders had long ignored, in part because thicker knee stacks made them taller when they were on their knees, allowed them to flair their legs out wider in the butterfly with less resistance in the hips, and got the pad flush to the ice faster. And increasing that resistance hasn’t changed how goalies play, which brings us to the inherent risks of a butterfly style that seems to lead to hip injuries in most, if not all, puck stoppers.

The issue was back in the news this week when reporter James Mirtle of Canada’s Globe and Mail newspaper took a close look at the impact the butterfly was having on injured Maple Leafs goaltender Jean-Sebastien Giguere.

“Every time you go on your knees, you hit the ice so hard,” Giguere told the Globe and Mail. “With that force, you can imagine, you’re maybe two or three feet from the ice and you hit it so hard, every time. It drives through your bone, hits the hip bone and there’s always a bone spur that’s formed. That can be really, really painful.”

Mirtle’s piece also mentioned a previous examination of the issue in Sports Illustrated that was widely overlooked. It’s a story InGoal was happy to have contributed research, quotes and anecdotes to, and is a worthwhile read for every goaltender. Even legendary Leafs goaltending guru Francois Allaire sent an email saying he learned something new from the piece written by SI medical and science specialist David Epstein.

There were plenty of horror stories, including a common misdiagnosis that left one-time New Jersey Devils’ prospect Jordan Parise with labrum torn so badly it had to be anchored to the bone in three places (the labrum acts like an “O-ring” gasket to secure the top of the femur inside the hip joint). But perhaps the most interesting revelations in Epstein’s story was estimates 10 to 20 per cent of the population had the same problem as Giguere: a femur was not perfectly round at the top, where it fit into the hip joint.

As Epstein wrote, it essentially created square-peg-round-hole situation in Giguere’s hip joint, with the abnormal edge atop the femur accentuating the digging away of the cartilage every time he dropped into the ice. And while the reasons for a misshapen femur aren’t clear – in addition to genetics, some doctors believe heavy loads on growing bones can play a role, so young goalies should ease up on the squats – the possibility it can be diagnosed before it becomes problematic is an intriguing one in hockey.

Think the New York Islanders would have given Rick Dipietro that 15-year contract if they’d been able to take a closer look at the shape of his femur with an X-ray or MRI before his hip required surgery? Given the fairly quick recovery time – Thomas was ready for the start of the season after having surgery in late May – it’s also possible some goaltenders might decide to have the procedure, which can include shaving the top of the femur to create a smooth, friction-free surface inside the hip, on a precautionary basis.

“By shaving the bone, you’re improving the movement,” Philippon, who has treated dozens of NHL goaltenders as well as baseball stars like Alex Rodriguez, Olympic figure skater Michelle Kwan, and others from a variety of sports, told Sports Illustrated. “You’re basically resolving the conflict between the ball and the socket, and making it fit better.”

In other words, hip surgery could actually have performance benefits, helping goaltenders widen out their butterfly while also avoiding future injuries, both in the hip and groin muscles attached to it.

With that in mind, it might not be long before some are seeking out Phillipon for preventative maintenance, rather than flying to Vail like Backstrom will next week, worried his season might be over early.

About The Author

Kevin Woodley

Kevin Woodley is a rec-league target and former contributing editor of the Goalie News magazine. He has written about the Vancouver Canucks and NHL for The Associated Press, USA Today, Sports Illustrated and The Hockey News for the last decade, and covered the 2010 Olympics for The AP.

3 Comments

  1. paul szabo

    Here we have yet another example of the NHL braintrust erroneously thinking that tinkering with goalie equipment will have a significant impact on the results of the game. Well, they have had an impact I suppose- that is, more injuries. It must be pointed out that the butterfly style is inherently not good for the body (just like throwing curves, sliders and screwballs for a living and wrecking your elbow joint), so the injuries are almost inevitable. However, the knee stack issue is a legitimate cause for complaints amongst goalies.

    Remember thigh boards? Overdrive blades? Curtis curve goalie sticks? All of these are outlawed, yet goalies are more efficient at stopping the puck than ever. I think that making the external pad dimensions uniform for all goalies would simplify things, plus the same for the pants and chest protectors, which is where there has been more exaggeration, in my opinion.

  2. Rob L

    Totally agree with Paul on this one. What a short sighted fool Kay Whitmore is. I’m sure someone had a great reason for decreasing the size of the knee stacks, but I can’t think of what that might be. Take it a step further and realize that when the NHL makes changes to gear, manufacturers make changes to all their gear. That means a child who is a goalie today is using NHL legal pads. If that child makes it to the college or above level, that’s tens of thousands of hours of dropping down on inadequate knee stacks. Think of all the careers shortened b/c Kay Whitmore said “hey, let’s like, shorten the knee stacks”. Terrible and short sighted.

  3. John Baldwin

    I would relish using thicker knee stacks. Such would enable quicker transition into/out of the butterfly and thus maximize time actually ON one’s skates. Anything intelligently addressing the reduction of abuse to the knee and hip at this position should be implemented immediately. I write this awaiting multiple surgeries on my left knee, injuries sustained as a result of rising and rotating on one leg from one too many butterfly saves.