Peak MSK Blog

GROIN PAIN

26/2/2020

Do you Suffer from Groin Pain?

Although there are many causes of groin pain one of the most common is a groin strain. This is a layman’s term for a muscle strain of the adductor muscles. A strain can be soreness from unaccustomed exercise or due to damage to the muscle structure including the bony attachment and tendon⁽¹⁾.

For more information on muscle injury classification systems see our earlier blog, here:

https://www.peakmsk.com.au/blog/munich-beerhalls-and-muscles.

The muscles in your groin help bring your legs together, steady the ball in socket position of the hip joint and assist the hamstrings. The most common muscle that gets injured in a groin strain is the adductor longus⁽²⁾. A groin strain usually occurs with high-speed activities such as kicking, change of direction or sprinting. This suggests poor control of you lower body dynamics. That may be a skill or sport specific issue, but usually also includes the body's motor coordination system (motor control) and retraining this is paramount to re-injury prevention.

Groin Pain - Symptoms

• Groin pain and tenderness⁽²⁾

• Pain when stretching the painful leg out to the side⁽²⁾

• Pain when bringing the leg inwards (soccer kick motion) ⁽²⁾

• Difficulty standing, walking or running without groin pain⁽²⁾

Groin Pain - Treatment

After suffering a groin strain, you should immediately follow the P.E.A.C.E. protocol for the first 48 – 72 hrs which stands for protect, elevate, avoid anti-inflammatories, compression and education⁽³⁾. If walking hurts, it is wise to use crutches for a day or more.

Physiotherapy management following a groin strain aims to promote tissue healing, restore movement, maintain or improve pelvic stability, restore muscle balance, prevent further injury, and aid in return to sport⁽⁴⁾.

A graded pain-free rehabilitation program is essential in effectively healing the injured muscle and includes gentle and appropriate exercises to restore hip range of motion and strength⁽²⁾. Exercise is used to remodel the healing scar tissues so that the healing fibre tears are aligned in the direction of movement. This includes reforming and improving your motor control. Click on the link below for a video demonstration on some effective exercises to commence following a groin strain.

References
1. Mueller-Wohlfahrt, H.W., Haensel, L., Mithoefer, K., Ekstrand, J., English, B., McNally, S., Orchard, J., van Dijk, C.N., Kerkhoffs, G.M., Schamasch, P. & Blottner, D. (2013). Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med, 47(6), 342-350.
2. Thorborg K, Reiman MP, Weir A, Kemp JL, Serner A, Mosler AB, HÖlmich P. Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. J Orthop Sports Phys Ther 2018;48(4):239-249.
3. Dubios, B & Esculier, J. Soft tissue injuries simply need PEACE & LOVE. BMJ. 2019:Retrieved from https://blogs.bmj.com/bjsm/2019/04/26/soft-tissue-injuries-simply-need-peace-love/
4. Haroy J, Clarsen B, Wiger EG, et al. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine 2019;53:150-157.

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THE THORACIC SPINE ENIGMA

7/2/2020

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THE THORACIC SPINE ENIGMA

A well-functioning thoracic spine can accelerate your running and promote pain-free living.

The thoracic spine is the mid-back between the neck and the waist (lumbar-region). The ribcage attaches to it. This special part of our spine gets less attention in science journals than other spine areas. It an important source of local or referred pain for spine, hip and shoulder problems. This is due to its unique nerve supply and mechanics as a junction between the upper and lower body.

“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

As an important mechanical lever of the body, taking 47% of body weight ⁽¹⁾, the curve of the thoracic spine impacts on shoulder girdle movements ^(2-3) and the lower limbs. For example, walking and running rely on thoracic rotation to store and generate momentum. In turn, the thoracic spine is very stable alongside its partner, the ribcage, affording protection to vital organs. Consequently, it is less mobile than the neck or low back.

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

Motion of the shoulders relies on rotation and side bending in the thoracic spine ^(2-3). If this part of the spine loses the little flexibility it has, more load is placed on the shoulder joint, girdle and rotator cuff. The compressive forces from a lack of spine flexibility can set up problems elsewhere in these other tissues.

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”

Walking and running uses to-and-fro arm swing and shoulder motion, whilst simultaneously the thoracic spine winds up and down via twisting motions. This enables balance and, like a spring, enables energy transmission to the arm swing to propel the body forwards. In fact, to increase speed when running, you need to increase your thoracic twisting motion ⁽⁴⁾. You can compensate for this via the hips or overarching the lumbar back, but for how long?

The nerve supply of one thoracic vertebral segment is also known to include several levels, meaning a mixed nerve supply. A problem in one area can refer to many seemingly unrelated regions of the arms, buttocks and legs. Occasionally, when counterfeit symptoms resembling organ pain are from thoracic joints, physiotherapists will judiciously examine for key features of musculoskeletal involvement, being pain on movement, tenderness and tightness of musculoskeletal structures ⁽⁵⁾. If these musculoskeletal features are absent, then the case requires further consultation from a medical practitioner.

References
1. White, A. A. 1969. Acta Orthopaedica Scandinavica Suppl: 127, 8-92.
2. Tsang, S. M. H., Szeto, G. P. Y. & Lee, R. Y. W. 2013. Manual Ther: 18, 431-437.
3. Crosbie, J., Kilbreath, S. L., Hollman, L. & York, S. 2008. Clin Biomech: 23, 184-192.
4. Tojima, M., Osada, A. & Torii, S. 2019. J. Phys. Ther. Sci.: 31, 661-665.
5. Harding, G. & Yelland, M. 2007. Aust Fam Physician: 36(6), 422-3, 425, 427-429.

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Back to Back Cricket

12/1/2016

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Now midway through the cricket season and post the Christmas innings, our work at SecondOpinion.Physio continues to ensure people are able to remain active and healthy when playing cricket and their other chosen summer sports.

Most common cricket injuries are quads and hamstring muscle strains (1). That legendary West Australian bowler, Dennis Lillee came back from a horrible back injury in the seventies. This was a low back stress fracture (a.k.a. ‘stressie’). We know now that fast bowlers are more at risk this type of back injury and other injuries overall compared to the rest of the cricket eleven (2).

Research funded by Cricket Australia has demonstrated a link between sudden work load increases and injury risk (3). Doubling the workload in terms of bowling or effort compared to the players' average workload increased the risk of injury between 3.3-4.5 times.

An MRI scan study of fast bowlers and swimmers over a 2-4 year period identified that too much fast bowling was directly associated with bone stress, especially at the fourth lumber vertebra. For young bowlers (15-17 year olds), this involved the non-bowling arm side (3). Therefore timely treatment of the right kind is vital for the season and to prevent future problems.

This highlights the importance of gradual build up for anyone involved in exercise and sport-specific programmes. Developing the right muscle strength and technique is critical for ensuring bone and muscle health. If you have had a break over Christmas or are just starting your season, 'the reset button' on training is a good idea.

Key Points

Increases in workload above the average can significantly increase the risk of developing injurues.
Fast bowlers are at greatest risk for cricket injuries.
Correct bowling and sport technique is critical for ensuring the correct forces through the body.
The clinic offers cricket specific preventative screening to help identify and reduce the risk of injury.

1. Engstrom, C. M. & Walker, D. G. (2006). Pars interarticularis stress lesions in the lumbar spine of cricket fast bowlers. Medicine & Science in Sports & Exercise,39(1),
28-33.
2. Hulin, B. T., Gabbett, T. J., Blanch, P., Chapman, P., Bailey, D., Orchard, J. W. (2014). Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. British Journal of Sports Medicine, 48, 708-712.
3. Orchard, J., James, T., Kountouris, A., Blanch, P., Sims, K., & Orchard, J. (2011). Injury report 2011: Cricket Australia. Sport Health, 29(4), 16.
4. Ranson, C., Hurley, R., Rugless, L., Mansingh, A., & Cole, J. (2013). International cricket injury surveillance: a report of five teams competing in the ICC Cricket World Cup 2011. British journal of sports medicine, 47(10), 637-643.

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GROIN PAIN

THE THORACIC SPINE ENIGMA

THE THORACIC SPINE ENIGMA

“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”

Back to Back Cricket

Luca Scomazzon-Rossi APAM

Jayce Gilbert FACP, APAM

Archives

Categories

Contact Us

Support

Connect With Us

GROIN PAIN

THE THORACIC SPINE ENIGMA

THE THORACIC SPINE ENIGMA

“If you have unresolved issues of other areas of the body, your thoracic back is the link to examine."

“Back, hip, flank, neck and even arm pain may have their source from the mid-back."

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.” ​

Back to Back Cricket﻿

Luca Scomazzon-Rossi APAM

Jayce Gilbert FACP, APAM

Archives

Categories

Contact Us

Support

Connect With Us

“The thoracic back has the unique quality of an energy-storing spring and a counterbalance.”

Back to Back Cricket