Download Groin Article - Bragg Creek Physiotherapy

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.