Groin strain (knots) - How to stretch right

yop

Folks,
Having a lot of issues with my groin now for 12 months. Got a bad tear last year keep me off training for about 8 weeks. Then it was okish.

Now after every time I train or play a match the knot returns and I have to ice the hell out of it and push the knot out with my thumb and fingers. I have been to physio and he has worked on it, sound for about 10 days and then flares up again.
I do all the "standard" stretching but is there any pointers you guys might have on "better" stretching??

I also did my ankle ligaments last year and suffer from shin splints ALL on the same side as the groin issue.

I know this aint a med forum but I am just after stumbling across this forum so hope you maybe of assistance.

Thanks

thirtyfoot

yop wrote: »

Folks,
Having a lot of issues with my groin now for 12 months. Got a bad tear last year keep me off training for about 8 weeks. Then it was okish.

Now after every time I train or play a match the knot returns and I have to ice the hell out of it and push the knot out with my thumb and fingers. I have been to physio and he has worked on it, sound for about 10 days and then flares up again.
I do all the "standard" stretching but is there any pointers you guys might have on "better" stretching??

I also did my ankle ligaments last year and suffer from shin splints ALL on the same side as the groin issue.

I know this aint a med forum but I am just after stumbling across this forum so hope you maybe of assistance.

Thanks

There is only one answer as this is so complex. Groin issues, especially ones that have lingered for 12 months, don't go away overnight.

I know all about groin issues having ripped adductors off the bone on both sides in the last few years. Slow, patient rehab or surgery are the usual answers. They don't go away with the odd rub and a bit of stretching.

yop

Ouch, that sounds painful!!!

The tear last year was sore for sure but after weeks of physio I had full flexibility with it.

What is odd is that during matches or training I rarely feel anything in it, only time I felt it when we were doing preseason in the swimming pool.

It usually within a few hours or next day that this lump appears between my groin and hip, its like a marble, I ice it and roll the Sh*TE out of it and it flattens out, the next day I am generally sound again.

I can't explain it to be honest with you.

thirtyfoot

The only answer is go to a physio who will give you a proper rehab programme. There may be other weaknesses as a result of the injury which would need to be assessed also.

pgibbo

I would have thought that some strength work would have been recommended by the physio also. I know SFA about groin strain thankfully but as Tingle points out a full rehab program sounds like the best approach.

I was well impressed by a sports injury talk given by Paul O'Grady at the weekend. He is based in Castlebar yop. I reckon your GP would have his details. He has worked with some serious teams (All BLacks, Irish Soccer Team, Super 14 teams & the Mayo footballers too - his one downfall!!)

yop

pgibbo wrote: »

I would have thought that some strength work would have been recommended by the physio also. I know SFA about groin strain thankfully but as Tingle points out a full rehab program sounds like the best approach.

I was well impressed by a sports injury talk given by Paul O'Grady at the weekend. He is based in Castlebar yop. I reckon your GP would have his details. He has worked with some serious teams (All BLacks, Irish Soccer Team, Super 14 teams & the Mayo footballers too - his one downfall!!)

You made your money in Mayo, dont be slagging it now!!

Paul O'Grady, they are doing some course are they in sports rehab or something.

I would want to get it sorted out now, sick to the face of it at this stage.

Racing Flat

Some recent research has shown that stretching acute groin strains can lead to tendinopathy....i.e. in the first few days after 'pulling your groin' stretching may lead to damage which may lead to long lasting chronic groin strain/pain. So current advice would be not to stretch an acute groin strain, maybe not in keeping with what you might think elsewhere in the body.

Tingle is right in that there is a big difference between an acute groin strain (pulling your groin by overstretching for a football or something) and groin pain that goes on for 12 months or so. Unfortunatley many people do not see this difference and so they continue treating a troublesome chronic groin problem like a simple muscle strain.

You might be as well to look up 'adductor tendinopathy' where you will see that chronic groin problems (although there are a few different types) are often to do with degeneration within the tendon due to overuse. Stretching does not tend to be of use in these cases. Eccentric strengthening has been shown to be effective for Achilles tendinopathy (what most people possibly refer to as Achilles tendonitis), and for some other tendinopathies around the body. Therefore it might be reasonable that such exercises would be effective for the groin, but eccentric exercises for the groin have not been studied yet as far as I am aware.

In brief, people used to think that tendon problems were due to inflammation (hence 'itis' at the end of the tendon) however, it is now realsied that in the majority of cases, inflammation is not present, but degeneration is. However this can be reversed. Sometimes rest alone will do it, but as I said above eccentric strengthening has been shown to be effective in some body parts

However I know from personal experience of groin strain/adductor tendinopathy/chronic groin pain/osteitis pubis, whatever you want to call it giving up soccer (the twisting movements were too much), and doing certain exercises resolved the problem. NB wearing a compressive belt (one that pregnant women wear:eek: google Serola belt) allowed me to continue playing soccer without pain. This indicates that to get your muscles to do what the belt was doing (it kills me to use the phrase but for want of a better description, what people refer to as core exercises) would help solve the problem. So that's what I did. Lots iof stabilising exercises aimed at the groin and pelvis and it's fine now. From a stage where I could barely get out of bed due to the pain.

yop

Thanks for that detail.

When you say stablisher exercises, what do you mean?

lizanne83

Hi Yop, this is merely just a suggestion but you shouldn't rule out anything... it could easily be a pelvic stress fracture... because this feels exactly the same as groin muscle strain. In fact pelvic fractures ( eg: pubic ramus sfx, femoral neck sfx, Osteitis pubis, lumbosacral etc.... ) have all the feelings of groin muscle strain... but the stress fracture is only identified in MRI /isotope scans. Again, this is only a suggestion. I still have an "inferior pubic ramus stress fracture after running Berlin marathon last September. I still have this now 7-months later. I have been unable to run since and the initial 3-4 months caused so much groin pain during and mainly after any cross-training exercise attempts.

Even if you don't have a pelvic stress fracture (please god you don't as they are most notoriously slowest healing injury!), serious groin muscle tears and pelvic groin stress fractures like mine usually take a full year before recovered. I have been following complete and total rest since January. No other choice because even walking was painful. Still the same today.

What had felt like and was initially thought of as groin problems... turned out to be a pelvic stress fracture... and this is the same experience with fellow pelvic sfx runners. Again, this is only advice and suggestion. There are details and experiences shared of this on our 'pelvic stress fractures blog" (below) if you're interested in reading fellow runners experiences (like mine) with such long-term injuries. It is worth suggesting it to you're physio anyway. Oh and RE your previous question on exercises: Core stretching/strengthening exercises are the only type of exercises you should do for such injuries

pelvic stress fractures group blog for runners: http://pelvicstressfractures.blogspot.com

Core exercises to strengthen core/groin area: http://www.brianmac.co.uk/corestabex.htm

Best of luck and I hope it is not actually a pelvic/groin sfx!

Racing Flat

yop wrote: »

Thanks for that detail.

When you say stablisher exercises, what do you mean?

So hard to describe in writing...the one I would advocate would be - lie on a gymball, or couch or bed so that only your head and the top of your shoulders are on the surface. Facing the ceiling, your body should form a straight line, with your feet on the floor and your knees at 90degrees (ie your knees, through your thighs, pelvis, trunk to your shoulder should form a flat surface). Iniitially just maintaining this position might be difficult, particularly on the ball.

Once you have mastered this, progress to straightening 1 knee (your good side), while keeping your bad leg foot on the floor. So now your good leg side whole leg should form a straight line with your trunk all the way to the shoulder and should still be parallel to your thigh. Hold this for a while, then swap legs, repeat to fatigue.

Racing Flat

lizanne83 wrote: »

Hi Yop, this is merely just a suggestion but you shouldn't rule out anything... it could easily be a pelvic stress fracture...

Good point Lizanne, I suppose ultimately the advice is to get a diagnosis first and then appropriate management can be decided upon.

Just in relation to pubic stress fractures, I know someone who had a pubic ramus stress fracture.

On examination at the time of the pubic stress fracture she was told she had the bone density of an 80 year old and that it would take a year to reverse. A year later, the bone density was the exact same. Although she was devastated, the medics were delighted as apparently stopping the rot can be the hard bit. And they were right, one year later again she was back within normal age related limits.

However, she was running almost the whole time. Initially after the fracture she had to avoid running for 2 months until it healed, but after that they prescribed weight bearing exercise 3 times a week - so the medics encouraged her to run 3 times a week for 20-30mins initially, gradually building to an hour, on the proviso that it was done on soft surfaces like grass and supportive trainers were worn, and there was no pain. So while the first 2 months were frustrating aftre that she gradually got back into it and gradually increased race distances back to half marathon. They were concerned about her doing a marathon, but now they've said if she wants to she can, just to be extra careful.

In terms of treatment they had her on 1litre of supermilk a day and red meat 3 times a week, rare if possible.

So while such stress fractures may be frustrating, people can also have good outcomes from them and it doesn't have to hinder trainign and racing too much. Best of luck with it.

Gentle Touch

Hi
Look up a Sports Rehabilitator or a sports therapist in your area. They are better equiped to deal with a groin strain than physio. Shin splints may have to do with the way you are placing your feet when running again a sports therapist is your best bet for relief and rehabilitation.

thirtyfoot

Gentle Touch wrote: »

Hi
Look up a Sports Rehabilitator or a sports therapist in your area. They are better equiped to deal with a groin strain than physio

I presume this is again based on personal opinion so OP take this piece of advice with a pinch of salt and make up your own mind where you want to go. Unless of course Gentle Touch has some scientific backup and evidence to show that a sports therapist will work better than a physio on groins. Do they not do groins in physio school? I've been to a few physio with groin issues and they understood the area and got me sorted ahead of schedule. They must have been moonlighting in sports therapy:D

lizanne83

Hi Racing Flat, thanks for reply. Trust me, I have sought all the professional help I can get. Here is overview, may be of help if anyone unlucky enough to ever get pelvic sfx. Long distance runners, mainly women, are most affected;

October 2008 physio and MRI confirming pubic ramus stress fracture

November - December: Gently gym cross-training. Pain would occur after 30-45 mins of elliptical / spinning so limited activity. Limping out of gym and pop a diafen anti-inflamm!

January: Still no attempt of jogging and failing the “one legged test” - much pain. Referred to orthopaedic consultant. Isotope bone scan mid-January confirmed same injury, no improvement. Total rest is only option.

January - March: Crutch(es) mostly to reduce all weight bearing. Constant rest. Gym cancelled, unable to even swim, minimal walking A-to-B. Highly frustrating but 8-12 weeks total rest instructed. Sitting on the bone sore, uncomfortable driving

April - feeling little pain, started “aqua jog therapy” for injuries with Catherina McKiernan in national aquatic centre. Lasted 2 sessions with minimal after math pain. 3rd attempt and the pain and limping returns full-force. Devastated.

Catherina McKiernan and fellow coaches advised me onto Professor of Anatomy and sports science Trinity College and chairperson of The Irish Osteoporosis Society who is based in Dundrum

Bone density scan (DEXA) showed no osteoporosis thank-god.
Prof prescribed me high calcium + Vit-D tablets, put on gluten-free & greatly fibre reduced diet to aid absorption of vits & minerals.

Prof referred me to Pearce St physio. This is the latest update. I continue to do stretching/strengthening core exercises only.


This injury will take at least a year apparently and from what is shared by fellow sufferers on Runners World injury forum.
Racing Flat - trust me that running is the worse advice (unfortunately) but thanks for the suggestion. Even a running action of 3 steps will send daggering pain right into pelvis and groin!

I will get there eventually. To simply get out for a walk/cycle in these summer months would be oh so wonderful. YOP don’t worry you probably don’t have this so don’t let me scare you. But DO see physio and suggest MRI simply because it is one of the most accurate diagnostic scans. X-ray will not pick up everything…..

Racing Flat

lizanne83 wrote: »

Professor of Anatomy and sports science Trinity College and chairperson of The Irish Osteoporosis Society who is based in Dundrum

Bone density scan (DEXA) showed no osteoporosis thank-god.
Prof prescribed me high calcium + Vit-D tablets, put on gluten-free & greatly fibre reduced diet to aid absorption of vits & minerals.

Prof referred me to Pearce St physio.

Racing Flat - trust me that running is the worse advice (unfortunately) but thanks for the suggestion. Even a running action of 3 steps will send daggering pain right into pelvis and groin!

lizanne, you are in perfect hands. These same people are the ones who advised my friend that she must run as part of her rehabilitation, so it just goes to show that although 2 poeple can have a pubic ramus stress fracture, they can have very different cause and effets and will hence require different management. The problem with yours it sounds is that it is or was very slow to heal, or perhaps healed incorrectly or with complications considering you are failing the step test. But in cases completely different to yours (but perhaps more common), ie osteopenia driven pubic stress fractures, once the stress fracture has healed, weight bearing exercises will be prescribed to provide a necessary stimulus to the bones to lay down more bone in the right line, or essentially return them to normal.

Best of luck with yours, nothing lasts forever, so hang in there.

lizanne83

Racing Flat... oh thank you for words of encouragement. I didn’t suggest this not to scare anyone (mainly YOP!) but I've spoke to people with pelvic stress fractures who have gone months thinking it was just groin muscle strain which was mis-diagnosed as groin strain through Xray so they kept exercising and attempting runs when should be totally resting. The sfx was not only getting worse by doing this but also of course pro-longing recovery time. If they had known that it was sfx (by MRI) they could have saved a lot of time & pain.

To say that these past 7 months since getting this injury after Berlin marathon have been difficult (particularly since January) is an understatement! Living such a sedentary lifestyle (completely inactive since January) has been more than frustrating. You know well as a fellow running & fitness enthusiast that this is our outlet, our stress release, our passion, love and its ingrained in our character completely. It's like a chunk of your personality taken out of you. Injuries resulting in inactivity is completely bearable and fine for a few weeks or months..... mostly you can do things like swimming at least. But not with pelvic sfx due to the nature and location. This type of injury takes up to a year or more! Well there's only so much reading, TV, study and similar sedentary activities one can do to keep distracted and sane after a long day in the office! Especially in times of sadness. I have lost 2 very close family members both this year and last year. Being unable to run yet alone do any exercise to release sadness through the adrenaline rush, the runners high... etc oh wow.

But there aRe positives you're right, nothing lasts forever. All our injuries (despite how short/long term) wiLL get better. And such experiences can only help make us stronger people & put other things into perspective. When I'm able to walk properly and be able to get outdoors again I will be so grateful. It's amazing how much we normally take for granted! I'm still always lurking the athletics threads knowing that I will be able to contribute to the race reports & such one day again :-) When I do return, I'll be a total newbie though. Will continue with the physio core & groin exercises and going back to Prof. O' Brien for blood results in few weeks to ensure no osteopenia that u also mentioned and see how deficient in calcium & Vit D I am etc as this will hinder bone repair

EnjoY running to you all. I’m no longer jealous and envious... that feeling only lasted for the first few months. I no longer see other runners go by when I'm driving to and from work and hope that they trip or fall! I will catch up with u in running again by end of the year please god YOP, best of luck. As Tingle suggested, you can take this with a pinch of salt.. but I do strongly suggest the MRI, again, just to reassure yourself it’s nothing more than groin strain or something

http://lizannebarnwall.blogspot.com/