Groin Pain 101: Testing Muscle Function

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…

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