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Posted: Wednesday March 18, 2009 1:43PM; Updated: Wednesday March 18, 2009 5:52PM
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Butterfly injuries (cont.)

The dead give-away

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Future goalies are unlikely to emulate the safer stand-up style of all-time NHL wins leader Martin Brodeur.
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Parise started using the butterfly at age 12, and four years later added heavy squats to the training load borne by his hips. Exactly what causes a person's femur to be misshapen is not entirely clear, but doctors suspect genetics and the influence that heavy loads can have on growing bones. For Parise, 26, it culminated in September 2007 when his Lowell Devils -- New Jersey's AHL affiliate --faced off against the Portland Pirates.

Going down for a save, Parise felt like "everything in my left hip kind of released and then retracted real quick." Over the next few months, as his season spiraled into an abyss, team doctors and trainers stretched and massaged Parise for every manner of groin and hip strain. "I'm letting in shots from outside the blue line," he says, "and I can't figure out why I can't close my five hole."

His inability to fully rotate his hip inward should have been a dead give-away. "If you see that, you can almost be sure that something is not OK with the hip joint," says Mario Bizzini, a Swiss doctor who has operated on European hockey pros. But a team doctor told Parise that the pain was in his head. "He said the only people that tear their labrums are people in car accidents," Parise says.

Team trainers stretched Parise more thoroughly, which only made the problem worse. As Philippon says, "if you're stretching, and the ball doesn't fit in the socket, you're going to accentuate the conflict."

Parise continued to play and finished the season having given up 3.55 goals per game, compared to 2.68 the prior year. An MRI arthrogram -- an MRI after a dye injection that seeps into joint cavities to highlight damage -- revealed the worst. By the time Parise found Philippon in February, his labrum was so torn that it had to be re-anchored to the bone in three places.

"[Philippon] said he couldn't believe I could even walk," says a crestfallen Parise, who feels fine now, but his poor 2007-08 season forced him to take his game to EC Red Bull Salzburg in Austria's Erste Bank Hockey League.

Brodeur's alternative

You can almost hear the disdain in his voice when Martin Brodeur is asked about butterfly. He will never use it, he says. One of the few remaining classic stand-up goalies, Brodeur has supplanted Roy this season as the winningest netminder of all time. He knows that some of the best goalies in the NHL use the butterfly, but he believes that "if you have good mobility and you're able to skate really well, you don't need to go down on your knees all game long."

And yet: "It's just the way goaltending is being taught now," Brodeur says. "Patrick started it, but it's gotten to a different level. Younger goalies use it, and companies are making pads for guys playing that style now. It would be really hard to go a different way."

Not to mention, as Allaire notes, that it has proved the most impregnable shield in hockey history. "In the '80s, being under three goals-against was fabulous," he says, "but now everybody has to be under three."

And unless Brodeur has a Roy-like trickle-down effect on young goaltenders, inspiring them to remain on their skates, labrums will keep ripping. Perhaps, as the epidemic grows, butterfly goaltenders will begin to have the shapes of their femurs screened with X-ray or MRI, and cut appropriately before any damage is done. The surgical fix of shaving the femoral head is generally not only permanent, but has a performance benefit, not unlike Tommy John surgery for pitchers.

"By shaving the bone, you're improving the movement," Philippon says. "You're basically resolving the conflict between the ball and the socket, and making it fit better."

The good news

Sean Burke, 42, tended goal for 20 years on nine NHL teams before retiring last fall and becoming the Coyotes' director of prospect development. Burke had surgery in 2003, and says it was like having a ball bearing in his hip oiled for the first time. "After rehab, I think my flexibility was better than before the surgery," he says.

So why, then, did he retire? "At some point the phone doesn't ring anymore, and that's the way it all ends," he says. "I didn't retire because of the hip. The hip felt great."

Good news. Though certain motions in sports, like a butterfly drop, are especially rough on the hips, impingement is coming to be recognized as the root of all sorts of previously mysterious pains in athletes, as well as in more sedentary folk. Philippon once operated on a woman with back pain so excruciating that she was relegated to a wheelchair. She had an MRI that showed no damage, and visited several surgeons who told her that her pain was from an old injury. Finally one doctor suggested that she get an arthrogram, which revealed multiple tears in her labrum. After Philippon operated, the woman was eventually up and walking, pain-free.

As he has helped to spread the word about FAI, Philippon has treated not only hockey and baseball players -- most recently Alex Rodriguez -- but also, among others, football players, skiers, golfers (Greg Norman broadcast his surgery live on his Web site) and figure skaters. Remember Michelle Kwan's tearful departure from the 2006 Olympics with groin trouble? Turns out that the problem was actually her hip, and she was under Philippon's knife soon after the Games.

But even as hip impingement is increasingly recognized, getting the correct diagnosis remains the most imposing hurdle, particularly for high level athletes who are loathe to succumb to chronic pain.

Toskala's painful lesson

When the Maple Leafs' Toskala started having left hip and groin pain in '04, he went for an MRI of his hip. It came back negative. Stretch it out, he was told. The pain got worse. It was only after an arthrogram that the tear in his labrum was highlighted.

"I want to say to everybody who thinks they have hip problems, when they go to take an MRI, you might not see anything if they don't put the dye in," he says. But even Toskala, as knowledgeable about hip injuries as he is now, hid from his team the pain that flared up in his other hip this season. As his performance deteriorated, general manager Brian Burke criticized his work ethic.

"Obviously, I haven't been 100 percent," Toskala said when he finally admitted to his right hip problem and had surgery this month.

"We have to educate not only the trainers but the owners. We have to educate everybody," Philippon says. "If they keep playing [without surgery], they can end up with arthritis and then they can't play at all. They're done. Unfortunately, I'm sure that was the case with a lot of players in the past."

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