Dec

18

Should You Stretch After You Pull A Muscle?

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Think about the times in your life that you’ve “tweaked” a muscle or slightly strained/pulled it.

What was the FIRST thing you did on your own or were told to do?

If you’re like most people, you immediately stretched the muscle.

The very first thing I tell my athletes if they tweak a muscle is NOT to stretch it!

A muscle strain can range from a slight over-stretch to a complete tear. Assuming the muscle isn’t COMPLETELY torn, it’s likely that there is some micro-damage to the muscle and that the muscle feels tight because it’s guarding against further injury.

This means that most people are attempting to stretch an over-stretched muscle AGAINST the muscles’ contraction.

Not only is this not an effective way to speed up your healing, but it’s probably making your injury worse!

Think about your muscle as a rubber band. Now imagine cutting a small slit in the rubber band with a razorblade.

If you stretch that rubber band now, what’s going to happen?

The small slit is going to expand, getting longer and wider.

Does making a slight tear in your muscle longer and wider seem like a smart recovery strategy?

If you tweak a muscle, DO NOT stretch it. You can ice it if you want (although I’m not convinced that ice does anything either). If you’re going to stretch anything, stretch the muscles that OPPOSE the injured muscle.

Many muscles are overworked or strained because of a relative stiffness imbalance with their antagonists, so stretching the opposing muscle can help bring you back into balance.

Keep training smart!

Feb

23

Hip and Core Strength Prevent Groin Pain

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An overly bold statement?

Not in light of experimental and “in the trenches” experience.  Research has shown that adductor (groin) strains result from a strength imbalance between the hip adductors and hip abductors (or the muscles that pull the leg toward the midline vs those that pull it away from the midline).  There is also research to support a lack of core strength relative to adductor strength as a risk factor for sports hernias, which can also be a source of groin pain.  How do you avoid these issues?  

Create a balanced muscular strength and endurance profile around the hip and core. 

Adequate range of motion is a piece of the puzzle, but ensuring balanced muscular strength and endurance across the hip and core musculature is paramount to preventing groin pain.  

If you think back to the analysis we went over a couple weeks ago, you should have some information on specific muscular weaknesses and imbalances.  The training to help alleviate these problems isn’t overly complex.

Core Stability

If your athlete has insufficient front plank endurance, add 3 sets of front planks to their training.  A progression might look like:

  1. Sets: I generally keep sets constant at 3, sometimes 4.
  2. Time: Start with 3-4 sets of 20s holds.  Progress your athlete to 30s holds, then 45 s holds.
  3. Exercise Complexity: Start with standard front planks.  Progress to single-leg holds, then marches (alternating which foot is on the ground in a controlled manner).
  4. Exercise Selection: Keep planks as part of a warm-up, but progress to more advanced linear core training exercises such as bar rollouts or bar rollout iso-holds.

Side planks would follow a similar progression.  The only difference is if you notice a side to side imbalance during the screening.  In this case, you’d want your athlete to perform their first set on their “good” side, then have them perform 3-4 sets on the other side.  Remember, if you add a balanced training program to an unbalanced athlete, you get an increasingly unbalanced athlete.  The key is to CREATE balance, but catering to your athletes needs.  If they have a lagging side, a program with 1 set on the good side and 3-4 sets on the lagging side will usually help create the balance that will keep them healthy.

Hip Strength

A lack of hip external rotation strength and hip abduction strength can be addressed using:

  1. Side-lying hip abduction w/ external rotation holds
  2. Glute Bridge with MiniBand (Shoulder width stance, hips abducted)
  3. Glute Bridge with MiniBand (Narrow hip width stance, hips externally rotated)
  4. Lateral MiniBand Walk
  5. Backward Monster Walk
  6. 1-Arm 1-Leg DB Stiff-Legged Deadlift (DB in hand opposite to foot on ground)
  7. All single-leg exercises

As mentioned above, if your athlete is noticeably weaker on one side, do NOT train both sides equally.  Have them do 1 set on their good side, and 3-4 sets on their weaker side.  Since some of the above exercises are bilateral by nature, an imbalance will dictate which exercises you include and which you don’t.  Or at least make sure you include one exercise that addresses the imbalance and any others to reinforce the strength bilaterally.

As for hip flexor and adductor strength, thing can get a little more complex there.  Luckily, I’ve already written in depth on this issue.  Rather than regurgitate everything I’ve already written, go ahead and check out my articles at SBCoachesCollege.com.  Part I has a lot of the hip mobility exercises I talked about last week, so it might be a good review.  Part II has the hip flexor and adductor strengthening exercises and progressions that are more relevant to this weeks topic.  I have to give Mike Boyle, Brijesh Patel, and Shirley Sahrmann most of the credit for the ideas and exercises that went into these articles and into my hip-specific analyses and programming.  They came up with most of this stuff, I just found a way to plug it all together into a system that works well for me.  Hopefully it’ll makes sense to you and you’ll have success implementing it with your athletes.

Keep working hard.

Feb

17

Improving Hip Range of Motion in Hockey Players

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Back to cleaning up groin pain issues in your hockey players…

After improving soft-tissue quality through foam rolling, “lacrosse balling”, and manual therapy, the next step is to stretched the newly “released” muscles.  It’s particularly important to focus on the muscles surrounding the hip.

As a reminder, the side-to-side discrepancies in range of motion or strength are the greatest risk factors for injury.  In general, when your athletes have a side-to-side discrepancy, you’ll want to stretch the tight side and strengthen the “looser” side, but use your judgement here based on what you found from your previous analysis.

I’ve posted a few of these videos before, but it never hurts to see them again.  These are all mobilization videos, but almost all of these positions can be held as stretches.  Make sure you’re moving/stretching in all three planes (frontal, sagittal, and transverse), so you aren’t lengthening the same parts of the muscles every time you perform a stretch or mobilization.  This tri-planar movement idea was popularized by Gary Gray years ago during the Functional Training Frenzy, but has since been reinforced by Mike Boyle and Brijesh Patel.  They make a good point-if athletic movements involve movement in all three planes, so should your training.

On to the videos:

Lying Knee-to-Knee Mobilization (If athlete lacks internal rotation ROM)

Rectus Femoris Mobilization This is a good one if your athlete has tight hip flexors (All athletes have tight hip flexors)
You should also perform this without grabbing your back foot and with varying levels of internal and external rotation of the back leg.  In all cases, you’ll want to maintain some tension on your butt of the side of the back leg.  This will help keep your pelvis stable and core tight so you’re mobilizing your hip flexors instead of your low back.

Adductor Mobilization with External Rotation
Like hip flexor restrictions, almost all hockey players have very strong and tight adductors.  This is a great one to loosen up the adductors of the stretched leg, including the gracilis (which doesn’t get lengthened in stretches where the knee is bent) and the medial hamstrings.  It’s somewhat hard to see in the video, but basically all I’m doing is shifting my hips straight back, not allowing ANY movement of the lower back (neutral lumbar spine).  Stop when you feel your lower back rounding or when you reach the end of your range.

Wide Standing Hip Mobilization
It’s important to include standing mobilizations as well since the role of the nervous system changes when you move between lying, seated, kneeling, and standing positions.  Because most sports are played from an upright position, this is the most relevant environment for the nervous system to be trained in.  In a nutshell, it’s not enough to improve mobility in lying, kneeling, or seated positions.  This improves hip rotation ROM.

Diagonal Standing Hip Mobilization
Similar to the above mobilization in concept, this exercise adds a more hockey-specific hip position.  When you rotate away from your back leg, do so my contracting your glutes hard on the back leg.  Remember, everything should be actively pulling your body into these positions.  Nothing is passive or momentum-based at all.

In-Line Split Squat
This improves hip mobility in the frontal plane by taking both hips into relative adduction.  Line up both feet and drop your back knee straight down so that it falls in the same line as your feet.  Keep your hips and shoulders level and square to straight ahead as much as possible.  You can make this more challenging by adding a rotation over your front leg or a side bend to the side of your front leg in the bottom position.

Reverse Crossover Lunge
This is a great exercise I borrowed from Brijesh Patel.  This brings everything together, improving hip range of motion under the control of musculature that’s functional to athletic movement.  You can add a side bend or rotation to this as well, but most people find it difficult enough as is, at least in the beginning.

Try performing these exercises for 8 repetitions on each side in a circuit.  If you feel extra locked up or restricted during any exercise, or on one side of an exercise, repeat it for that side in that exercise only.  I’m guessing your hips will feel “freer” than you’re used to after you go through these.

Keep working hard.

Feb

13

Functional Flexibility Friday

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One of the first steps to dealing with groin pain is to restore proper range of motion (ROM) around the hips.

Side note: ROM is also referred to as flexibility or mobility.  Although joint mobility in physical therapy refers to an involuntary movement of the bones in the joint, the term mobility is often used in non-physical therapy settings to refer to range of motion.

The first question you should have is: What is proper ROM?

Like most things, the answer is: It depends.

In some cases, excessive ROM is actually the problem.  In a recent presentation, Shirley Sahrmann noted that most injuries occur in the area/side of the body with MORE range of motion.  Essentially, injury results at the place of least resistance.  This seems counterintuitive since most people associate feeling tight with injuries.

I think the area for optimal athletic performance lies in the middle of the two extremes.  While tightness could POTENTIALLY minimize injury risk, there is often a given set of ROMs that different joints of the body must go through during athletic competition.  Inability to achieve these ROMs will inevitably lead to decreased performance, or, at a minimum, compensatory movement patterns that lead to an injury in another area of the body.

Through the analysis we’ve gone over for the last two weeks, you should have a good idea of ROM restrictions and/or side-to-side discrepancies.  Your first goal with addressing these is to bridge the gap between sides.  In other words, make the right and left sides even.  If you have 40 degrees of internal and external rotation in your left hip, but 20 degrees of internal and 40 degrees of external rotation in your right hip, your first priority would be to increase internal rotation ROM in your right hip.  Make sense?

In hockey players, decreased hip internal rotation and lack of hip extension (e.g. lack of hip flexor extensibility/flexibility) are often problems and should be addressed through soft-tissue work and specific exercises geared toward improving the ROM.

Will You Respond to Stretching?

In my experience, countless stretching time can be spent with little improvements to show for it.  This can be due to a number of reasons, but two primary ones are inappropriate contraction of the stretched muscle and soft-tissue restrictions.  I address the neural component below.  Regardless, if you find yourself stretching and feel like you’re getting nothing out of it or that your muscles just flat out won’t lengthen, you probably need some soft-tissue work.

Nothing will relieve soft-tissue restrictions as quickly as a visit with a good Active Release Techniques Practitioner.  In the hands of a good A.R.T. therapist, long-standing (years)  restrictions can often be cleared up in a couple visits.  Having said that, good A.R.T. people can be hard to find and, depending on your insurance policy, expensive.

A viable, cheap alternative is to perform self-myofascial release using a 6″ foam roller, 4″ PVC pipe, or lacrosse ball.  For those of you that are unfamiliar with foam rolling and related techniques, I’ve posted a few videos below.  All hockey players benefit from these:

Gluteus Maximus/Hip External Rotators

Hip Flexors (Tensor Fascia Latae)

Quadriceps

Active vs. Static Flexibility

Static flexibility, the ability to move through a given ROM passively (without active muscle contraction) is of little important in athletics.  This is a major downfall of traditional stretching approaches.  The reason should be somewhat obvious.  If you find yourself in a game, not actively contracting any muscles, you’re probably on a stretcher.

Active/functional flexibility is more “sport-specific”, since it encompasses other factors that could potentially limit ROM (notably the excitatory and inhibitory influences of the nervous system).

I don’t mean to dismiss the role of traditional stretching.  In fact, I think most people would benefit from MORE stretching.  The simple change I’d recommend making is contracting/squeezing the antagonist (muscle opposite to that your stretching) while you’re stretching.  This will train yourself neurally for stability by teaching your body to actively pull a joint into a ROM, instead of passively letting it happen.  Due to reciprocal inhibition (a neural process whereby contraction of one muscle leads to an inhibition/relaxation of the antagonist, or opposing muscle), you will also achieve greater ROM improvements using this technique.

Wrapping Up…

This is a long post for a Friday, so I’m going to wrap it up here.  Improving functional flexibility is a necessary step in addressing/preventing groin pain in your athletes.  In the future, I”ll post some more stretches and mobilizations that I’ve found particularly effective in improving functional ROM around the hips.

Enjoy your weekend.

Feb

11

Groin Pain 101: Screen/Assessment Review

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At this point I thought it would be a good idea to recap all the things we’ve discussed over the last week.  Below is a summary of the process I take when an athlete comes to me reporting groin pain.

1. Question about the nature of the pain

  • When did the pain/discomfort start? Was there a specific incidence that caused it?
  • Where is your pain located?
  • What does the pain feel like? Dull aching, sharp, radiating, etc. 
  • What types of exercises/movements cause pain?  Is the pain immediate or does it come afterwards? 
  • Describe the intensity of the pain.  On a scale from 0-10, 10 being unbearable excruciating pain, where would you rate your pain when it first comes, a couple hours later, the next day, etc?
  • How long does the pain last?

2. Posture Analysis

  • Hip Position: Anterior/Posterior Pelvic Tilt, Lateral Pelvic Tilt, Rotation
  • Knee Position: Knee caps pointing in? Relatively in line with femur and tibia?
  • Foot Position: In-/Out-Toed? Flat footed? Check shoes-Note uneven wear on inner (excessive pronation-usually excessive hip internal rotation )or outer borders (excessive supination)

3. Range of Motion Analysis

  • Thomas Test: Extensibility of hip flexors. Note compensatory rotations with lengthening
  • Hip Internal/External Rotation ROM: Test with hips flexed to 90 degrees and with hips extended
  • Quadruped Rocking: Note maximum hip flexion before lumbar rounding

4. Muscle Function Test

  • Seated Psoas Test: Note ROM, strength, and compensatory motion on each side
  • Side Lying Hip Abduction: Note ROM, strength, and compensatory motion on each side
  • Front Plank: Endurance test for time
  • Side Plank: Endurance test for time on each side

5. Movement Analysis

  • Double-Leg Movements: Squat, Deadlift, and Stiff-Legged Deadlift Patterns
  • Single-Leg Movements: 1-Leg Squat, 1-Leg Deadlift, 1-Leg Stiff-Legged Deadlift, and Reverse Lunge Patterns
  • In all movements, note movements of the knee, hip, and lumbar spine, keeping the whole body movement in mind.

By completing the above screen/analysis, I have a better idea of any predisposing factors or resulting functional impairments related to the athletes groin or hip pain.  This will allow me to communicate more effectively with an athletic trainer, physical therapist, or sports physician (if the athlete is lucky enough to have access to any of these professionals).  At a minimum, it will give me an idea of areas the athlete’s abilities and areas that need improvement or areas to avoid.

Next up: How to get back on track following a groin injury…

Feb

10

Groin Pain 101: Movement Analysis

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The final step in our groin pain analysis is to look at a few movement patterns and see if you can pick up on any “abnormal” movement.  

Nothing too complicated here.  Basically we just want to have them perform a couple double-leg and single-leg movements and note the positions of the femurs, hip, and lumbar spine.  

Double-Leg Movements

  1. Squat Pattern (Hands behind head)
  2. Deadlift Pattern (Hands at side)
  3. Stiff-Legged Deadlift Pattern (Hands on front of legs)

Single-Leg Movements

  1. 1-Leg Squat
  2. 1-Leg Deadlift
  3. 1-Leg Stiff-Legged Deadlift
  4. Reverse Lunge

With all the other information we’ve collected at this point, some of the movement impairments should be pretty easy to pick up on.  For instance, if your athlete didn’t have hip flexion above 90 degrees during quadruped rocking, you’ll probably notice some sort of compensatory movement (probably at the lumbar spine) during the double-leg movements when this hip angle is reached and likely some form of rotation during the single-leg movements.  

Two of the other big things to look for are the knees caving in during any of the movements, and the femur internally rotating during the single-leg movements.  In general, this is indicative of poor strength and/or motor control of hip abduction and/or external rotation and will lay the foundation for some of the future training to prevent the reoccurrence of groin/hip injuries.

An important note: Remember that if your athlete ALREADY has groin pain, it’s possible that any movement abnormalities that you observe are a RESULT of the injury/pain and NOT the cause of it.  Frequently the two will go hand in hand, but it’s important that we don’t automatically assume it’s the poor movement causing the pain, and not current pain causing circumstantial poor movement.  

Keep working hard…

Feb

9

Groin Pain 101: Testing Muscle Function

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Coming down the home stretch of the groin/hip pain analysis…

 A couple simple tests I’ve borrowed from Shirley Sahrmann and Stuart McGill to assess hip and “core” strength: The Seated Psoas Test, Lying Hip Abduction Test, Front Plank Endurance Test, and Side Plank Endurance Test.  

The Seated Psoas Test involves testing the strength and function of the psoas major, the muscle that contributes the most force to hip flexion above 90 degrees.  Have your athlete sit down with their feet flat on the ground so that their hip is flexed to 90 degrees and their upper body is perfectly upright (tell them to “sit tall”).  Have them lift one foot off the ground and hold it there.  If they can do that, add a little pressure to the top of their knee and see if they can resist it.  Do this on both sides.  Note inabilities to perform this movement at all, compensatory movement patterns, weakness, range of motion, and side to side differences. 

The Lying Hip Abduction Test: Have your athlete lie on their side with their bottom hip flexed to 90 degrees and their top hip extended fully.  Have them place a hand on their hip and tell them not to let that move at all.  Then have them lift their top leg as high as they can (without their hip or lumbar spine moving).  If they can handle that, apply a little pressure to their foot and see how well they’re able to resist it.  Repeat on the other side.  Note inabilities to perform this movement at all, compensatory movement patterns, weakness, range of motion, and side to side differences.

The Front Plank Endurance Test is really straight forward.  Have your athlete set up in a front plank position (similar to a push-up position but on their forearms with their elbows directly under their shoulders with their hips even with their shoulders).  Have them hold this position for time.  As soon as form starts to break down, the test is over.  In general, you want them to be able to hold the position for at least 60 seconds.

The Side Plank Endurance Test is very similar.  Have your athlete set up in a side plank position (elbow under shoulder, hips stacked and raised off the ground).  Record the amount of time your athlete is able to hold this position with perfect form.  Give them a couple minutes to rest then repeat on the other side.  In general, you want them to be able to hold this position for at least 45s and there should be less than a 10% difference in side to side times. 

I think it’s extremely important to make sure your athletes have proper gluteus maximus (read: butt) function, but I don’t test for it.  Frankly, I’m not sure there’s an athlete in the world that can’t benefit from glute bridges/glute bridge holds, quadruped hip extensions, bird dogs, etc.  Because I know I’m going to program that stuff in anyway, I don’t test it.  I will ask athletes if they feel like they have trouble contracting one or both sides while they do some of the dynamic assessments though, just to get a crude idea of any side-to-side differences. 

That concludes the static assessments.  All that’s left is a few dynamic movements to assess movement abnormalities/deficiencies and putting all this together to see if/how we can address the pain and get athletes back to a healthy status.  Stay tuned…

Feb

6

Groin Pain 101: Quadruped Rocking Disclaimer

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Sahrmann’s Quadruped Rocking Exercise, that I’ve mentioned a couple times in the last few weeks, can reveal a lot of valuable information about hip flexion range of motion.  My interpretation of a conversation I had with Sahrmann is that 8-10 reps of quadruped rocking should loosen up any soft tissue restrictions.  If it doesn’t, the range that they’ve consistently shown is likely all their anatomy will allow for.

While I’ve used this test and found it to be very helpful, it’s probably not as straight forward as “if that’s all they’ve got, that’s all they’ll ever have.”  There’s one particular incidence that you should consider before you jump to conclusions.

Jump to Conclusions

Tightness of the posterior hip capsule (ligaments connecting the posterior femur to the sacrum and hip) can lead to similar range of motion restrictions as hip impingement.  I was talking to Eric Cressey the other day, and he said that, in general, bone will move in the direction opposite of capsular tightness.

Applying that to our hip, that means tightness of the posterior hip capsule will likely result in a forward movement of the femoral head within the acetabulum (”hip socket”).  When attempting to enter into hip flexion, this disadvantageous femoral head position, combined with a tightness of the posterior ligaments, can result in both a restricted range of motion with accompanying hip tuck, AND discomfort in the “groin” area.

Luckily, posterior hip capsule tightness IS a modifiable factor and one that should be explored.  At the hands of a good manual therapist (I’d recommend an Active Release Techniques practitioner), long-standing posterior capsule tightness can be resolved in a few weeks (sometimes a few visits, and if the therapist is REALLY good, sometimes significant progress can be made in a few minutes).

Remember.  Nothing in the human body is as simple as “if you have this, this is why.”  Just some food for thought.

Speaking of food…Yesterday was my second ReFeed Day, since starting my calorie restricted diet.  I weighed in yesterday morning at 163.  After finishing a cottage cheese, ground flax seed, chocolate protein powder, peanut butter, and deluxe mixed nuts concoction in the shower last night, I weighed out at 173.  Yes, it was a great day.  And yes, I eat in the shower.  What do you mean that’s weird? If Kramer can make a salad in the shower, I can eat dessert in the shower…

Kramer Stop

Keep working hard.

Feb

4

Groin Pain 101: How’s Your Range of Motion?

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The next step in analyzing groin pain and hip pain is to take a look at the range of motion around the hip.  The four primary ranges of motion you want to concern yourself with are hip flexion, hip extension, hip internal rotation, and hip external rotation.  

A couple important notes:

  1. While it’s best if you use a goniometer, or some sort of other device, a less accurate “eyeballing” can still give you a lot of valuable information about your athlete.
  2. Check hip internal and external rotation in both a hip flexed (to 90 degrees) and hip extended position.  In the hip extended position the hip capsule is taut, so it’s important to look for similarities or differences in range of motion in the two positions as it will provide some insight as to whether the restriction is hip joint position specific, and whether it may be due to bony, capsular, or soft-tissue restrictions.

If you find that your athlete has significantly more hip internal range of motion than external range of motion in both the hip flexed and hip extended position, it’s likely that your athlete has hip or femoral anteversion, which is an anatomical characteristic of the hip that CANNOT be adapted through training.  In other words, they will ALWAYS have more internal than external rotation, are probably significant limited in external rotation.  

For those with groin pain and hip pain, I also lie them on their back and slowly move their hip into flexion, adduction, and internal rotation (think of pushing their knee toward their opposite shoulder).  This is the provocative test for CAM impingement.  If this is painful and or extremely restricted, it’s likely that they have some sort of hip impingement issues, which are typically accompanied by hip labral tears.  Again, you aren’t diagnosing anyone here, just getting an idea of what the problem is to understand your training limitations and what to communicate to an athletic trainer, physical therapist, physician, etc.

To test hip extension range of motion, lie them on a table so that their knees can drape off the end.  Have them pull both of their knees to their chest, then straighten one leg out and lower it as low as possible.

If the back of their thigh stays above the table, they likely have a shortened iliopsoas complex.  If the back of their thigh touches the table, but their knee doesn’t bend very far, they likely have a shortened rectus femoris (one of the quadriceps muscles that acts to flex the hip AND extend the knee).  If their thigh seems to pull out to the side, they likely have a shortened tensor fascia latae (TFL).  It’s not always this straight forward, but understanding these things is a good starting point.  Typically these “restrictions” adapt to a well-structured flexibility/mobility routine after a few weeks.

Lastly, to assess hip flexion range of motion, have them perform quadruped rocking.  Set them up with their knees on the ground immediately below their hips, with their hands on the ground immediately below their shoulders.  They should have a neutral lumbar spine and their eyes should be looking straight down on the floor. Have them use their arms to provide a slight push as they shift their hips straight back to “sit on their heels” while MAINTAINING A NEUTRAL LUMBAR SPINE!  All caps for emphasis.  Note the hip flexion angle that their lumbar spine begins to move.  Have them perform 8-10 reps and see if they get more range of motion.  According to a conversation I had with Shirley Sahrmann a few months back, if they meet restriction at the same point in the range after 8-10 reps, it’s likely that it’s a joint structure limitation and not adaptable through training, meaning that’s all the range they have, and will ever have.

Now you should have an idea of the nature of their injury, their posture, and their hip range of motion.  We’re starting to make some progress!

Feb

2

“Groin” Pain 101

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At least once a week I get a question from an athlete, parent, or coach involved in soccer or ice hockey about “groin” pain.  I put groin in quotations because the groin is often referred to as one muscle, although the injuries people refer to as groin strains typically involve several, usually the adductor brevis, adductor longus, pectineus, TFL, and/or iliopsoas complex (although the term “groin” could technically include the adductor magnus and gracilis, these muscles aren’t typically the ones that cause pain).  

Unfortunately, addressing groin pain is far from simple, as it almost never involves isolating a single problematic muscle and strengthening (or lengthening) it.  Typically the pain is a result of a combination of factors including movement impairments, causative or resultant muscle weakness, overly long muscles, and anatomical abnormalities.  Complicating the issue, groin pain can actually be referred from trochanteric (lateral hip), sacroiliac (where the spine meets the hips), lumbar (lower back), and lower abdominal issues, meaning the site of the pain may not be the site of the problem.

This week I’ll go through the things that I look for when an athlete reports with pain in/around the inner thigh or inguinal crease area.  The first step, before moving into any physical analysis, is to get a better idea of the nature of the pain.  A few questions to ask your athletes include:

  1. When did the pain/discomfort start? Was there a specific incidence that caused it?
  2. Where is your pain located?
  3. What does the pain feel like? Dull aching, sharp, radiating, etc. 
  4. What types of exercises/movements cause pain?  Is the pain immediate or does it come afterwards? 
  5. Describe the intensity of the pain.  On a scale from 0-10, 10 being unbearable excruciating pain, where would you rate your pain when it first comes, a couple hours later, the next day, etc?
  6. How long does the pain last?

Getting answers to these questions will provide some insight into the location, severity, and nature of their injury/pain.  If the injury/pain seems sufficiently severe, my recommendation is to not let them practice/play.  Odds are we’re just making the injury worse by allowing them to push through it (albeit-this is very much a judgement call).  I also find these questions make it easier to communicate with athletic trainers and physical therapists, who, when available, should be a go-to resource whenever an athlete reports an injury.  

That’s it for today.  Tomorrow I’ll get into more of the specific physical assessments.  

Happy Monday.

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