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

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!

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