Two Players. Two Head Injuries. Four Bad Hips. Is There a Connection?

Over the past little while, I’ve been looking closely at the injury histories of Brad Marchand and Alex Pietrangelo. I started with Marchand because of his recurring problems through the hips, groin and abdominal region. Pietrangelo caught my attention for a different reason: his hip problems became so significant that bilateral femur reconstruction was eventually discussed.

I looked at each case separately. But when I put their histories beside each other, there was a similarity I couldn’t completely ignore.

Both had significant head trauma earlier in their careers.

Both went on to experience other injuries and enormous amounts of NHL load.

And both eventually developed significant problems involving both hips.

That doesn’t establish a connection. But it does make me curious.

So what if we look at the two histories together?

Two very different timelines

Marchand’s timeline gives us something particularly interesting because we can retrospectively estimate when his hip and groin problems began.

He sustained a documented concussion in 2013 and another in October 2015. Following bilateral hip surgery in 2022, Marchand said it was the first time in six or seven years he’d played without pain through his hips, groin and legs. Working backwards, that places the beginning of those symptoms somewhere around 2015 or 2016.

The timing is difficult not to notice.

His problems then continued to develop. He underwent sports hernia surgery in 2020, arthroscopic surgery and labral repair on both hips in 2022, further groin and abdominal surgery in 2024, and another procedure involving his hip and sports hernia in 2026.

Pietrangelo’s timeline is different.

His significant head trauma occurred almost immediately after he entered the NHL. In October 2008, at only 18 years old and playing his second NHL game, he was checked from behind into the boards and subsequently missed six games with what was reported as a head injury.

We need to be careful about calling that a concussion because the contemporary reporting I’ve found describes it as a head injury rather than providing a definitive concussion diagnosis. But there was clearly enough concern following the impact to keep him out of the lineup.

Pietrangelo then went on to have lower-body problems at different points in his career, including foot and lower-body issues and a significant right knee injury in 2016. Eventually, the hips became the major problem. By 2025, both had deteriorated to the point that bilateral femur reconstruction was being discussed.

Unlike Marchand, we can’t work backwards and confidently establish when Pietrangelo’s hip symptoms began. Pietrangelo himself has suggested the problem probably started a long time ago.

So these aren’t identical cases.

But the destination is remarkably similar.

The bilateral finding is what really gets my attention

If Marchand had suffered a traumatic injury to one hip and Pietrangelo had developed arthritis in one hip after years of hockey, I’m not sure I would have made much of the comparison.

Instead, Marchand eventually required surgery on both hips, including bilateral labral repair.

Pietrangelo developed severe pathology involving both hips, to the point where reconstruction of both femurs was discussed.

That doesn’t mean there has to be some central explanation. Hockey itself provides an obvious one. Skating creates enormous repetitive demands at the hip, and structural factors such as femoral morphology and impingement can be bilateral. Add thousands of practices, games and training sessions and there is no shortage of conventional explanations for bilateral hip pathology.

Those explanations need to remain at the top of the list.

But bilateral problems make me ask a slightly different question than I would with an isolated injury.

What has been influencing both sides?

That’s where the histories before the hip diagnoses become important.

What happens after a concussion?

One reason I’m reluctant to completely dismiss the earlier head injuries is that research has increasingly demonstrated an association between concussion and subsequent musculoskeletal injury.

Athletes with a history of concussion appear to experience a higher incidence of lower-extremity injury after returning to sport. Proposed explanations include persistent changes in neuromuscular control, gait, balance, reaction time, proprioception and visual or vestibular processing.

That’s important because it changes the way we might think about “recovery.”

An athlete can become asymptomatic, complete a return-to-play protocol and perform at an elite level again. That doesn’t necessarily tell us whether every component of movement organization has returned precisely to its pre-injury state.

Maybe it has.

But what if something very small hasn’t?

A subtle change in head position. A slightly different visual or vestibular strategy. An alteration in cervical proprioception. A small change in where the athlete carries their centre of mass or how the trunk organizes itself over the pelvis.

None of those things necessarily creates pain.

The athlete may not even know it’s happening.

But now put that athlete on skates for another decade.

Small adaptations become more interesting when they’re repeated millions of times.

The injuries in between matter too

I also wouldn’t draw a straight line from either player’s head injury to his hips.

There are too many events in between.

Pietrangelo’s subsequent lower-body injury history is particularly interesting because concussion research gives us reason to at least consider whether early changes in neuromuscular control could influence later lower-extremity injury risk. But once another injury occurs, that injury can create its own adaptations.

A knee injury changes loading.

A foot or ankle problem can influence tibial and femoral rotation.

A groin injury can change pelvic mechanics.

A hip problem can change the way the athlete uses the trunk.

One compensation can become the starting point for another.

So rather than:

head injury → hip injury

I think a much more interesting possibility is:

head injury → adaptation → lower-body injury → further adaptation → repetitive load → tissue consequence.

Even that is only a hypothesis.

But clinically, it’s a much more realistic way of thinking about complex injury histories.

Where the cranial–sacral relationship becomes interesting

My osteopathic background adds another layer to the way I look at these cases.

The cranium, cervical spine, spinal canal, sacrum and pelvis aren’t completely independent regions. There are anatomical, neurological, fascial and mechanical relationships connecting them. The cranial and spinal membranes are continuous, extending from within the cranium through the spinal canal, with important attachments through the upper cervical region and relationships extending inferiorly toward the sacrum.

I’m very careful about what I infer from that.

I’m not suggesting that Marchand or Pietrangelo sustained a concussion, developed a restriction in the cranial system and eventually damaged both hips because of it.

We simply can’t make that claim.

What I am asking is whether a significant disruption at one end of the system could influence how the rest of the body organizes itself.

If head trauma changes cervical mechanics, visual processing, vestibular function or postural control, what happens below?

Does the thorax adapt?

Does breathing strategy change?

Does the pelvis begin organizing itself differently underneath the trunk?

Does sacral mechanics change?

And if the pelvis is functioning differently, does that influence how force is distributed through both hips?

That’s where these two cases become particularly interesting to me.

Not because they prove the connection, but because they give me a reason to look for it.

There may be another layer of load

Pietrangelo’s history also reminds me that an injury history shouldn’t be limited to orthopedic diagnoses.

In 2017, Pietrangelo and his wife went through an extraordinarily difficult period when their infant daughter became critically ill with a rare neurological condition. He stepped away from hockey to be with his family while she was fighting for her life.

Fortunately, she recovered.

I’m not suggesting that emotional trauma caused his hip pathology. But I also don’t think we should pretend physical and emotional load exist in completely separate worlds.

Stress affects autonomic function, sleep, recovery, breathing, muscle tone and pain. For an athlete already managing extraordinary physical demands, those factors belong somewhere in our understanding of the whole person.

Marchand and Pietrangelo have obviously experienced completely different lives. We don’t know most of what either man’s body has had to adapt to away from hockey.

That’s precisely the point.

A medical injury list only tells us part of the history.

What if they were standing in front of me?

This is ultimately where theory has to become clinical.

If I had Marchand and Pietrangelo in front of me, I wouldn’t assume their heads were causing their hips to move poorly just because I’d studied their histories.

I’d test it.

I’d want to understand the mechanisms of their previous head injuries and assess the cranial base, upper cervical spine, cervical proprioception, visual and vestibular systems and balance. I’d work through the thorax and diaphragm, lumbar spine, pelvis and sacrum before assessing how each femur interacts with the pelvis.

Then I’d start making changes.

If I address something around the cranial base and nothing changes below, that’s useful information.

If I improve thoracic mechanics but hip rotation remains exactly the same, that’s useful too.

But if I address something seemingly unrelated to the hip and immediately see a change in pelvic mechanics, hip rotation, balance or movement strategy, then I’ve found a relationship worth exploring.

It doesn’t prove what caused the pathology.

It tells me what may be influencing the athlete today.

That’s an important difference.

Two cases don’t prove anything

It’s important not to get carried away with an interesting pattern.

Two athletes don’t establish causation. Plenty of hockey players have sustained concussions without developing severe bilateral hip problems. Plenty of athletes develop bilateral hip pathology without a meaningful history of head trauma.

Marchand and Pietrangelo also spent decades playing hockey at the highest level in the world. Their hip anatomy, skating mechanics, training histories, previous injuries and sheer volume of competition could explain much or all of what eventually happened.

The responsible conclusion isn’t that concussion caused their hip pathology.

I don’t believe we have evidence to say that.

What these two cases do is make me question the way we sometimes separate injuries from one another.

We tend to look at an injury history as a list.

Concussion. Recovered.

Knee injury. Recovered.

Groin injury. Recovered.

Hip surgery.

But the body doesn’t necessarily start over after every injury. It adapts to what happened before and carries those adaptations forward.

Most of the time, it does that remarkably well.

Until perhaps one day it can’t.

Maybe we’re asking the wrong question

When an athlete reaches the point where both hips require major intervention, the obvious question is:

What’s wrong with the hips?

We need to answer that.

But I think there’s another question worth asking.

Why did these particular hips become the place where the system eventually failed?

Maybe the answer is anatomy.

Maybe it’s decades of skating.

Maybe it’s accumulated lower-body injuries.

Maybe earlier head trauma played some role in how the athlete subsequently organized movement.

Maybe physical and emotional loads accumulated in ways we don’t fully understand.

More likely, it’s some combination of factors unique to the person standing in front of us.

I don’t know whether Brad Marchand’s or Alex Pietrangelo’s head injuries had anything to do with what eventually happened to their hips.

But if either athlete walked into my clinic, I wouldn’t ignore that part of the history simply because it happened years earlier and seemingly far away from where they hurt today.

The body doesn’t experience its history as a collection of separate diagnoses.

Neither should we.

That’s one of the fundamental ideas behind Reconditioning.

Don’t assume the latest injury is where the problem began.

Go back through the history. Look at the relationships. Test what you find. Make a change and reassess.

Sometimes you’ll discover the previous injury has nothing to do with the current problem.

And sometimes you may find a connection nobody thought to look for.