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I’m Not Just Pulling Your Leg! With fall sports come new injuries (or old nagging injuries!). Groin injuries are very common at this time of year with sports like soccer, football, rugby and hockey. Running, jumping and activities that involve quick changes of direction all pose a risk to the soft tissue structures in the groin area. Groin injuries are a common problem in sports due to their high incidence, chronic symptoms and high rate of recurrence. This area of the body has many anatomical structures and is complex in nature. Muscles involving the pelvis, hip, and knee, ligaments of the pelvis and hip joint and the surrounding bony structure all play a role regarding the groin region. The hip joint may be vulnerable for a few reasons. It is the largest weight bearing joint in the body. It is designed to absorb shock, generate force, and be flexible through a wide range of motion. Due to the repetitive nature of certain activities and the forces this joint is subjected to, muscle strains and repetitive injuries are common. It is important to understand the major culprits involved in this common injury in order to effectively diagnose, manage and prevent recurrence. A 2013 study in the Britain Journal of Sports Medicine, researched groin injuries in soccer players over a 10-month period. They found the adductor muscles of the thigh, the iliopsoas muscle and abdominal related injuries were the most common. Both age and previous history were found to be significant factors. Other factors were identified as the player’s dominant side and previously injured sides to be more vulnerable to injury. Longer term, it was found that adductor muscle strains were the slowest to recover. When it comes to muscles, a “pulled muscle” is properly referred to as a muscle strain. There are three degrees of severity. In a grade 1 strain there is typically pain in the groin and inner thigh, but little loss of strength or mobility. A grade 2 strain is has more tissue damage and may present with bruising, swelling, pain with movement and loss of strength. A grade 3 strain is a complete tear in the muscle. This requires immediate medical attention! There is typically extensive bruising (often locally and distally down the leg as gravity tends to do), pain, and a significant loss of strength and function. Oftentimes, the pain may be less in a 3 rd degree tear compared to a 2nd degree as the muscle has been completely torn and there is a lack of sensation between the two ends. During the acute phase of a groin injury, the first 72 hours, it is important to follow the RICE principle. Rest, ice to reduce inflammation – every 3 hours for 10 minutes, compress the area with a tensor bandage or compression shorts (figure eight the bandage from the lower thigh up towards the groin) and elevate. It is important to maintain some mobility with gentle range of motion of the hip. Seeking treatment early on can help to identify which structures are affected and help to speed healing. Manual therapy, such as active release technique and massage therapy can help to take the pressure off of compensatory muscles in the area, facilitate circulation and reduce pain. After this initial phase of healing, proper exercises are essential for a complete recovery and to reduce the chance of re-injury. Stretching, strengthening the core, hip, and lower back, and proprioceptive/balance retraining are important elements to address. Why, you ask? Well, during the initial 6 weeks following a soft tissue injury, collagen is developing to repair the injured area. As you gently stretch and move the affected tissues, the collagen will remodel in the same direction the tissue is being stretched. This enables the tissue to be stronger and function properly. Otherwise the collagen remodels in random patterns, leading to weaker tissue that is vulnerable to reinjury. Lateral lunge and forward lunge stretches are good examples. This collagen remodeling also depends on the forces imposed on it. Up to 12 months following an injury, collagen fibers continue to increase in size, diameter and strength. With appropriately graded exercises, the tissue will adapt to the demands placed upon it, preparing your body to return to sport and reducing the chance of re-injury. Typically 5 days post injury (of grade 1 or 2 strains) is a good time to start some easy, pain free exercises. Lateral squats, lunges, and resisted hip flexion exercises would be beneficial. Gradually introducing plyometric exercises such as jumping, bounding, and zigzag shuttle runs. Proprioceptive exercises, or balance retraining, targets surrounding neurological structures that are affected during an injury. Muscle spindles (sensors within a muscle that detect changes in length), joint receptors and golgi tendon organs (sensors within tendons that detect changes in muscle tension) all play a role in controlling joint position and stability. Single leg balancing, theraball and wobble board work are examples of proprioceptive exercises. Time frames on when to return to your activity can vary. Depending on the degree of your injury and the demands of your activity. It is important to cross train during the recovery phase to keep up your cardiovascular fitness – biking or swimming for example. If your sport involves running and sprinting, build up to light jogging for 20 minutes pain free before gradually increasing speed and intensity. For grade 2 injuries, this process may take 6-8 weeks. Whatever you do, don’t rush things! See a professional, follow a personalized rehab program and mentally give yourself the time and energy to heal properly. This will benefit you for years to come.