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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