Continuing on yesterday’s discussion on the groin injuries that plague hockey and soccer players…The second step in analyzing an athlete’s groin pain is to do a crude posture analysis.  I don’t advocate strength coaches or sport coaches pretending to be physical therapists, but there are some pretty basic posture assessments that sometimes provide a lot of insight into the nature of groin pain (and other hip and knee pain for that matter).  

It’s usually best if you can just snap a few photos and do this analysis at home to avoid the awkwardness of staring at your athletes intently while they stare back at you impatiently.  But if you can’t do that, have your athlete stand BAREFOOT in front of you.  It’s VERY important that they are barefoot as shoes can have a profound effect on posture.  You’re going to want to look at them from the front, each side, and the back.  

The two primary things you’re looking for are hip and knee position.  Look for an anterior pelvic tilt (top of hips forward compared to bottom).  This is usually accompanied by an increased curvature of the lower back.  You’ll also want to note any rotation, meaning if one side of the hip seems to be in front of the other, or lateral tilt, meaning one side is higher than the other.  Of course, it’s important to make sure their feet are aligned evenly to avoid faulty foot positioning throwing off your analysis.

The next thing to look for as femur positioning.  Because this is difficult to do, a reasonable estimate of femoral rotation can be obtained by looking at the knee.  While it’s possible that your athlete has externally rotated femurs (compared to a ‘neutral’ position), that’s not usually the case.  Typically athletes, especially females, will have noticeably internally rotated femurs, meaning their knee caps will appear to point in.  I’ve found it’s easiest to pick this up from the back.  As a word of caution, sometimes this doesn’t mean they have internally rotated femurs.  It’s also possible they have excessive antetorsion of the femur (the bone itself is twisted-think of grabbing the top and bottom of the femur and twisting in opposite directions).  There are many potential causes of this, that are well beyond what we need to go into today, but I thought I’d let you know about it so you weren’t too quick to jump to conclusions.  

It’s also worth checking out your athletes shoes (which they shouldn’t be wearing) and/or the bottoms of their feet.  Extra wear on the inside of their shoe/foot (think big toe area) may indicate that they over-pronate (think foot rolling in too far), which can be related to excessive femoral internal rotation.  

That’s it for today.  The best way to familiarize yourself with these things is to practice.  Scan all your athletes for these things and see if you can start to pick up on subtle (or not so subtle) posture faults.  

The next stages of groin pain assessment get a little more interesting…I promise.