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The butterfly is ravaging goalies

Of all the butterfly goaltenders in the NHL, Patrick Roy likes the style of Jean-Sebastien Giguere the best. It is immense praise for Giguere, 31, the Anaheim Ducks netminder who can remember plopping in front of the TV as a kid in Montreal to watch his idol Roy change the course of goaltending history night after night.

It was 1986, and Roy, a mere rookie, was leading the Canadiens to their first NHL title in seven years -- a long drought for a club that had hoisted the Stanley Cup six times in the '70s. Roy was just 20 years old, but he was confounding the NHL's most adroit scorers with his butterfly technique: constantly dropping to his knees and splaying his pads along the ice to barricade the lower portion of the net.

The butterfly had been used sparingly during the previous two decades, but Roy -- 6 feet, 2 inches tall, flexible and fearless -- could cover practically any attack from his knees, and he inspired a generation of goalies to do the same.

"When I was a kid," says Giguere, "I think everybody I know in Quebec modeled themselves after Patrick."

As Giguere watched those '86 playoffs, Roy gave up a scant 1.93 goals per game, and the underdog Canadiens stormed to the Cup. Roy was swiftly beatified and canonized in Montreal as "Saint Patrick." Across the frozen ponds of Canada, goal was no longer the spot for the chubby kid who was usually stuffed in front of a tipped-over garbage can for a game of shinny. While America's most athletic boys were pounding the blacktop to be like Mike, Canadian kids were flocking to goaltending camps to butterfly like Patrick.

Giguere went as close to the source as he could get: the Ecole de Hockey Co-Jean, where he and thousands of others over the years would learn from Roy's mentor: Canadiens' goaltending guru Francois Allaire, who is now a consultant with the Ducks. "That's when I really started playing like Patrick," Giguere says.

By the time Roy retired in 2003, having amassed a record 551 wins with the Canadiens and Colorado Avalanche, 12 of the 30 starting goalies in the NHL were Quebecois, including Giguere, and nearly all 30 used the butterfly at least on occasion. What neither Allaire nor Giguere nor the throngs of youth imitating Saint Patrick could see, though, was that Roy's style had been steadily ravaging his hips.

"All that going up and down at high speed," says Pat Karns, a former Avalanche trainer. "We really had to work on Patrick daily [to keep his hips healthy]."

With each drop, the butterfly excavated the cartilage in Roy's joints. It would be worse for his disciples, the goaltenders who started using his style as children and have dropped to the ice thousands of times. Those boys are all grown up now, and for many of the brightest among them -- Giguere, Rick DiPietro of the Islanders, Antero Niittymaki of the Flyers and Vesa Toskala of the Maple Leafs among them -- a scar on their surgically-repaired hips marks them as the butterfly generation. But from pee wee to the pros, butterfly is firmly entrenched.

"It's incredible how they can spread their legs from post to post and cover the whole net," says Kings coach Terry Murray. "That has to put a tremendous amount of stress on the body." It sure does.

"It's part of the history of the players now," Murray adds, "and I don't see us going back to any other style of goaltending."

If so, more goaltenders will bear the scar with each passing season.

Perhaps the hip epidemic was set in motion when Roy was eight and his swim-coach mother forced him to practice the breast stroke before he could hit the ice. The frog-kick, with its locked knees and wide-flung toes, was perfect training for the butterfly. But until 1985, when Roy met Allaire while both were with Sherbrooke, the Canadiens' AHL affiliate, he had been scolded by coaches for flopping to his knees and told to stand up, like traditional goalies.

"I remember Jacques Lemaire asking me if I need a pillow and a blanket," Roy says of the Canadiens' coach at the time he was drafted.

But Allaire could see right away that the butterfly worked. "Patrick was a naturally flexible guy, and he wasn't shy to stop pucks with his upper body," he says, "so I said, 'Wow, there's enormous potential here.'"

To bolster his hunch that playing low was an advantage, Allaire began analyzing game film in earnest. "Fifty percent of shots were near the ice and 85 percent from the [mid torso] down," he recalls.

Allaire had Roy practice a dozen situations that recurred on game films -- among them passes from the corner to the circle for a shot, and passes from the corner to a defenseman to another defenseman who gets a screen -- and the pair found ways to use the butterfly to defend all of them, leaving only a sliver of top shelf for the shooter. The more proficient Roy became at moving on his knees, the more standard the butterfly became at all levels.

"These days, around 11 or 12, you can see their level of technique is already so much better than it used to be," Allaire says. It was at Allaire's camp that Giguere, 11, started on his path toward the NHL -- and hip surgery.

Butterfly is a recipe for hip damage in the 10-to-20 percent of the population that, like Giguere, has a structural problem with the femur, the thigh bone that runs from the knee to the hip. The head of Giguere's right femur -- the part that fits into the cup on the side of the pelvis to make the hip joint -- was not cue-ball-round as it should be.

Picture Giguere, in 2004, eyeing forward Jarome Iginla as the feared Calgary goal machine flies down the ice, heading for the crease. Iginla shoots, the puck whistles through the air an inch above the ice. As Giguere explodes down into the butterfly to stop the shot, his femur, the longest bone in his 6'1," 200-pound body, becomes a lever. Powered by his formidable muscles, the aspherical ball atop his femur is jammed into the cup of his hip joint with force akin to an Olympic weightlifter performing a clean and jerk, this according to research by McGill University and hockey equipment maker Nike Bauer. As Giguere flares his toes to wall off the bottom of the goal, the ball rotates inward, scraping away at the cartilage that pads the interior of the cup. Multiply that by 500 repetitions a day -- Giguere's estimate -- and you start to feel sorry for the cartilage.

By the end of the 2003-04 season, Giguere's hips were constantly sore or tight. "Every time I was going down on the ice," he says, "I was fighting against my hip."

After the season, Giguere sought out Marc Philippon, a surgeon at the Steadman Hawkins Clinic in Vail, Colorado, who guesses that he has operated on two dozen NHL goaltenders in the last decade. Philippon explained to Giguere that he had a classic case of femoroacetabular impingement, or FAI. That's orthopedic lingo for, essentially, a square peg in a round hole. The condition is insidious because there are no nerves -- thus no pain -- in the cartilage. That enables a goalie to wear down the natural padding until bone scratches bone. By then, a hip replacement is the only treatment.

Philippon has seen a 25-year-old player who has already needed a hip replacement -- surgery that is more befitting the young man's grandparents. If a goaltender with impingement is lucky, relatively speaking, he will see a doctor in time to avoid such a drastic measure, thanks to chronic groin pulls caused by muscles around the hip straining to make the head of the femur fit into the socket, or the pain of a torn labrum -- a band that rings the hip joint, securing the head of the femur.

Giguere was lucky. Philippon arthroscopically fixed his torn labrum and shaved the head of his femur into a sphere before his hip was destroyed or his career impeded. Jordan Parise, the older brother of Devils' winger Zach Parise, was unlucky.

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.

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."

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.

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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