Tag: groin pain

3 Rolling Exercises You Should Be Doing

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3 Rolling Exercises You Should Be Doing

*Several of the videos in this articles are large, and take a bit to load. Please be patient.

Going through a general foam rolling sequence is helpful in both increasing circulation as part of a warm-up and in troubleshooting some nagging areas of “stiffness.” Once athletes establish a regular routine of rolling, it can be helpful to show a few different strategies to address specific areas. These are three rolling exercises I show a lot of our more experienced athletes that often have a very powerful impact on how they feel and move afterward.

Hip Rotators

Most people are familiar with how to roll their glutes. While this is beneficial, it’s really only addressing the most superficial level of musculature. Many athletes, and almost all hockey players, are stiff throughout their entire posterior hip, including the rotators that are “deeper” than the glutes.

Hip Rotators
 

When you roll with your knee bent, as I am in the above video, you stretch the glute, thereby increasing the resistance to the ball sinking into the hip. By straightening the leg, you relax the superficial layer and allow the ball to sink deeper, where it can influence the hip rotators.

Because of the size of these muscles, I often recommend a “sink and breathe” technique over actually rolling around. See the video below for an example.

[quicktime]http://www.kevinneeld.com/wp-content/uploads/2015/07/Lax-Ball-Posterior-Hip.mp4[/quicktime]
Posterior Adductor Magnus

The adductor magnus is the largest of the adductors and is an easy muscle to find. It’s basically the mound of meat at the top of your inner thigh. If you grab your high right inner thigh with your left hand, your fingers will wrap toward the back of your thigh. If you sink your finger tips into your thigh a bit you’ll be able to find a natural groove between the back of the adductor magnus and the medial hamstrings. If you follow this groove up toward your hip, you’ll find that things get pretty “gunky” as you get toward the top (in the red circle area in the picture below). The inability to separate these muscle groups is one reason why people have a difficult time squatting to their full depth and is often a contributing issue in athletes with groin pain.

Hockey Training Hip Muscles Circle
[quicktime]http://www.kevinneeld.com/wp-content/uploads/2015/07/Lax-Ball-Posterior-Adductor-on-Box.mp4[/quicktime]
This is another “sink and breathe” exercise. Explore the top ~6″ or so along this groove, then sink into a sensitive spot and just sit and breathe until you feel some of the sensitivity dissipate. From here, you can straighten your knee and then rebend it. This basically keeps the adductor where it is, but stretches the hamstring, creating a relative glide between the two muscle groups.

Rectus Femoris/Vastus Intermedius

There are four separate muscles that comprise the quadricep group. Because they’re so superficial, they’re fairly easy to access with a foam roller.

[quicktime]http://www.kevinneeld.com/wp-content/uploads/2015/07/Foam-Roll-Front-Quad.mp4[/quicktime]
That said, it can be helpful to get into the rectus femoris, and especially BENEATH the rectus femoris into the vastus intermedius with a lacrosse ball.

Rectus Femoris & Vastus Intermedius

Left: Rectus Femoris (the only quad that is also a hip flexor) highlighted in red. Right: Rectus Femoris removed, showing the vastus intermedius beneath it.

If you lay your right hand on your lower right thigh so that your thumb is a few inches above your knee cap and sink your thumb into your quad, you’ll likely be right in the middle of the white area in the image above. If you slide your thumb slightly toward the middle of your thigh, you’ll roll off the edge of the rectus femoris. THIS is where you want to put the lacrosse ball as you lay your leg down on top of it (same positioning as the video above). From here, you can explore along this groove until you’re about mid-way up your thigh. With athletes that have discomfort around their knees, this can often bring a lot of relief.

[quicktime]http://www.kevinneeld.com/wp-content/uploads/2015/07/Lax-Ball-Quad.mp4[/quicktime]

Wrap-Up

Learning more specific self-soft-tissue treatments can help athletes troubleshoot issues on their own over time. These are three exercises I’ve used with a lot of our athletes that can make a big impact on how they feel and move. With all of these, discomfort is expected, but nothing should ever be painful. Start slow and progress pressure as you feel comfortable.

To your success,

Kevin Neeld
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“Kevin Neeld is one of the top 5-6 strength and conditioning coaches in the ice hockey world.”
– Mike Boyle, Head S&C Coach, US Women’s Olympic Team

“…if you want to be the best, Kevin is the one you have to train with”
– Brijesh Patel, Head S&C Coach, Quinnipiac University

Groin Strain Case Study: Assessment

Last week I had a Tier I U-18 player stop in at Endeavor so I could have a look at his hip. I tend to do these types of favors for players that have trained with us in the past and/or play for coaches that I know (in this case, Jared, my boss at Endeavor).

In these situations, my first question is always, “Have you seen a physical therapist about this?”

This is an important first question to ask because they may have already received a diagnose and/or treatment strategies that will provide some insight into what’s going on. It also helps protect me professionally from stepping on the toes of a profession that, in general, is better suited to handle sports injuries.

With that said, this player had been to a physical therapist who (in his words) “showed me a few stretches for my groin.” Naturally, these didn’t help.

As you know, I’m almost ALWAYS against stretching a strained muscle. In most cases, I think it will make the injury worse. In general, strains tend to occur in areas that move excessively and in muscles that aren’t strong enough to accommodate the workload. In many cases, the strained muscle simply lost a “stiffness” battle with a synergistic muscle. This means that the synergistic muscle would likely need the stretching and the strained muscle would likely need strengthening.

Moving away from injury generalities and back to the case at hand, I went through the normal process of asking him what happened and how long it’s been bothering him. Not surprisingly, he pointed to the inguinal triangle as his area of pain. Because the adductor longus is the most frequently strained groin muscle, I was expecting this area to be painful.

I did a quick search for “groin pain” pictures and this came up. I’m not sure why exactly, but to find out I will have to personally assess each and every one of them! (…just kidding Emily)

I did a simple prone and supine hip internal and external rotation ROM assessment, and this revealed something interesting. He had great ROM in both directions on his unaffected side. On his affected side, he had slightly less internal rotation than his other side, but SUBSTANTIALLY more external rotation. As a follow up, I did Craig’s Test” on his affected side, a test that assesses for femoral anteversion or retroversion.

Interestingly, he had a positive Craig’s Test (>15 degrees), which typically is accompanied by excessive internal rotation and limited external rotation (quite the opposite of what we found). I also performed a Thomas Test to assess hip extension ROM, which was positive (limited hip extension, indicative of a hip flexor restriction) on his uninjured side, but negative/normal on his injured side. While this could be interpreted as a good thing (how could full hip extension ROM be bad?), putting it within the context of the rest of our findings painted a drastically different picture.

In this case, the full hip extension is indicative of anterior hip capsule laxity. Basically the ligaments have become overstretched, which allows for both full hip extension and excessive external rotation. In light of a damaged anterior hip capsule (which provides a “check” to hip extension and external rotation), it’s of no surprise that the muscles that also provide a “check” to hip extension and external rotation (the hip flexors/adductors/internal rotators) would be overworked, and (almost inevitably) injured.

Stretching these muscles would be exceptionally counterproductive. My approach was:

  1. STOP stretching the adductors
  2. Strengthen the anterior glute medius to help return some muscular support to the anterior hip capsule (a concept from the Postural Restoration Institute)
  3. Seek treatment from a great manual therapist (in this case, Dr. Tancredi in Broomall, PA)

I often hear people make the argument that certain things (notably the above example) are more in the realm of a physical therapist’s job description than a strength coach’s. I don’t disagree. I don’t necessarily view my role as “diagnosing and treating injuries”, but it’s helpful to have an understanding of some of the tests that PTs use so I can get an idea of what is going on with our injured athletes. This doesn’t give me the go-ahead to treat them, but allows me to make the most appropriate referral and clearly communicate the situation with that professional.

As a closing note, if you’re a player, the big take home from this is to get your injuries checked out immediately. This player hasn’t played in a couple weeks now, and this is the season he’s supposed to finalize an agreement with an NCAA D1 team. I understand you’re a hockey player so you’re supposed to be tough and not feel pain and fight through injuries and all that crap. You’re also not supposed to be a moron and miss several weeks/months of a season because of a minor injury that got out of hand as a result of your stubbornness. If your going to fight through injuries, October/November isn’t the time. Save the tough guy mentality for playoffs.

Kevin Neeld

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Hockey Player Plague: Sports Hernias and “Groin” Strains

One of main topics of the Boston Hockey Summit was the growing problem of sports hernias and “groin” strains within the sport of ice hockey. These injuries are affecting an increasing number of high-level hockey players. I wrote Dissecting the Sports Hernia last summer for StrengthCoach.com outlining some of the research on the topic.

The anatomy involved with these injuries can be very complex, but the concepts involved in preventing them are relatively simple: Maintain balanced strength among the muscles connecting to the pelvis and maintain adequate hip range of motion. Admittedly, these concepts are “simple” in theory, but difficult to implement.

One of the factors associated with hip and lower abdominal injuries is a loss of hip internal rotation range of motion. This can be the result of excessive tightness of the hip external rotators. The stretch below is a great one to maintain hip internal rotation range of motion. Basically you just plant your feet, pull your stomach down toward the floor, and pull your knees toward each other. You should feel this deep in your hips.

 

Knee-to-Knee Stretch

 

Kevin Neeld

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My Hips Don’t Lie

Yup-worst title ever, but it got you this far…

In light of discussing hockey and soccer related groin pain for the last couple weeks, I thought I’d give a personal example that will help illustrate how some of the things we’ve talked about come together.  I’ve had off and on knee and hip problems on the left side.  Basically, I feel extremely unstable at both joints and something just feels off.

I never had any problems with my knee until I took a horrible gravel-related spill demonstrating a double lateral bound into 5-yard sprint exercise (a great drill to teach explosive lateral movement with sharp direction changes).  That brilliant display resulted in:

Nice Knee

Knee hasn’t been the same since.  But I have a history of groin pain on that side and had inguinal hernia surgery on that side as well.  In a nutshell, even with everything I’ve learned about hip and lower abdominal injuries over the last few years, I still thought my left hip was the problem.  

Recently I started high-intensity interval training on a bike.  I found that my hip and knee felt considerably more stable and symmetrical FOLLOWING the interval training.  To give you an idea, I basically fall off the bike, and walk without a knee bend because my quads and glutes are so stiff…but my hip and knee feel better. Hmm.

I did some digging around and some strategic stretching and noticed that my right rectus femoris AND psoas are WAY tighter than the same muscles on the left side.  The psoas is also a lateral rotator of the femur.  Without going into a complex functional anatomy lesson here, basically my rectus femoris and psoas were extremely tight, which resulted in my lumbar spine (the origin of the psoas) pulling slightly to the right, my right femur maintaining a slightly laterally/externally rotated position (which was accompanied by adaptive shortening of the hip lateral/external rotators).  As a result, my left hip was in a slightly medially/internally rotated position, which affected how I walked, leading to a slight hyperextension of my left knee and noticeably asymmetrical movement.  

The Bottom Line: Right Hip Problem Resulted in Left Hip and Knee Symptoms

The fix?  Stretch the hell out of my psoas and rectus on the right side.  Strengthen/shorten my psoas on the left side.  Or, in the interest of saving time while training, do both using the exercise below.


I probably started a bit high in this video, but the idea is that you strengthen/shorten your psoas by maintaining a hip flexion position above 90 degrees, while actively squeezing your glutes on the down side, which facilitates a stretch on your hip flexors.  Better/faster results comes with more time/attention paid to the problem, but if you’re in a time jam, this is a great “bang for your buck” exercise.  

Keep working smart…

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Hip and Core Strength Prevent Groin Pain

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.

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