Athlete with Bilateral CAM Impingement

This video is of a Division I lacrosse player I've worked with over the last several months at Endeavor. He has undergone 4 separate operations (2 on each side) to address his CAM impingement and associated labral damage, and a bilateral athletic pubalgia (sports hernia) repair. He also has significant retroversion, bilaterally. When he first came in, he wasn't able to jog (let alone sprint), shuffle, or do anything high impact or explosive. In fact, I would say he was generally cautious about movement in general. He's in his 4th month of training now and can sprint, transition, and move explosively as well as ever. We were able to start moving him toward these types of exercises about 4-6 weeks into the training process. Each week, for the last month, he's told me that he feels better than ever. I wanted to post this video to demonstrate how important it is to recognize each athlete's individual limitations. Can you imagine if this athlete was told to squat to full depth, deadlift off the floor, do high box jumps, etc.?

I recognize this athlete's case is a bit extreme, but the overwhelming majority of the hockey players we work with will be somewhere between this athlete and what is taught as normal. In other words, most players will have some sort of structural deviation that will need to be appreciated in your assessment of their movement quality and exercise technique. In this example, we spent a lot of time early on going through how he would need to move to to stay within his individual confines, but still accomplish what he needs to on the field. After grooving and improving these patterns for several weeks, he now does them without conscious thought, which is the ultimate goal if he's to be successful.

A few things to look for in the video:

• When he sets up in a quadruped position, his lumbar spine is already in a state of slight flexion secondary to hitting hip flexion end range. Attempting to drive further into hip flexion results in a SIGFNICANT spinal compensation.
• He can only squat to about 45-50 degrees of hip flexion beefore his lumbar spine begins to flex.
• His hip only flexes about 45-50 degrees during the wall drill, which will have implications for how he runs.
• He is still able to sprint, but he must maintain a more upright posture and de-emphasize his knee drive more than would typically be recommended.
• He has almost no hip internal rotation on either side. The left appears to be slightly better, but this is because his pelvis is not neutral. When I measured this with a goniometer when he first started, he was under 20 degrees on each side.
• Not having internal rotation will have significant implications for rotational movements, which are of paramount importance in most team-based sports (especially one like lacrosse). Notice how, when he steps behind during the med ball exercise, he maintains a slight position of external rotation and how he opens up instead of rotation OVER the front leg like most athletes would. Both of these patterns were intentional, and ones that took time to groove.

Athlete with Bilateral CAM Impingement & Retroversion