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  • Lionel Pannunzio PT / SCS


Introduction


Groin pain in Soccer Players has always been very difficult to treat because it’s hard to assess where the pain can be coming from. The picture below shows the different types of Groin Injuries (Doha Classification) as is what professional Soccer Team use all over the wold to identify these injuries and treat them accordingly.

Knowing the Source of your pain is a key factor in the recovery process.

Types of Groin Pain




Acute muscle strains are a common cause of groin pain in athletes.


The muscles typically involved are the Adductor longus also called Adductor Strain or Adductor related pain which is the most common groin injury, and the Iliopsoas, second most common, also called Hip Flexor Strain or Psoas related Groin Pain.


Also, Youth soccer players should be assessed for possible pubic apophysitis of Iliac Bone avulsions because these immature structures are the last part of the human skeleton to mature and can be injured with the strong demands of soccer on these tissues.

Other causes of Groin pain not included in this classification can be hip related (FAI - Femoroacetabular Impingement for example) or low back related.




Mechanism of Injury



Kicking , change of directions , stretching situations and sprinting are the most common mechanisms of injury for Groin Pain.


Knowing the cause of your pain is a key factor in the  recovery process.


At White Bay Physical Therapy we have been efficiently solving groin pain because we go to the root of your problem.


A typical rehabilitation program for Groin Injuries will include:

  • Mobility workouts to restore Hip and Spine Range of movement .

  • Strengthening exercises for the groin and core muscles .

  • A comprehensive return-to-play program where we simulate all the movement and skills necessary to go back to play.

Knowing the mechanism of injury of Groin muscles allow us to rehearse them over and over until you feel 100 % safe to return to play.





Shoulder I rest it to get better ? ... I don't think so ...


Rest alone will not help with your Groin pain , you have to progressively challenge these muscles in order for them to get better and stop hurting This Video shows a simple mobility drill for your Adductor muscles and inner thigh to help improve your hip movement and length of your inner tight muscles Just move as tolerated, feeling a mild stretch on the affected groin. As the muscle warms-up you will be able to go deeper in the movements If you repeat it daily that tightness and pain you feel will improve significantly so the next step is to make your inner thigh muscles stronger.






The usual suspects: Inner thigh and the Adductor Longus


Research shows that from all the Groin injuries, the Adductor Group ( inner thigh muscles) accounts for 40 % of them. The adductors are a group of 5 muscles: the adductor longus, adductor magnus, adductor brevis, Pectinus and Gracilis.


62 % of Adductor Tears occurs in the Adductor Longus, that thick vertical muscle in your inner thigh. For the purpose of this educational article we will differentiate 3 types of injuries to these muscles: a simple strain or small, a Medium tear and large tear.

1 Adductor Minor Strain or Small Tear The minor strain is just a very tiny dent in the muscle and very easy to recover from, Usually resting alone will be enough to return to Play . 2 Adductor Medium Tear The Medium tear is a different " animal" . There is structural damage of the muscle fiber and the body will repair the injured muscle with scar tissue. This type of injury, when not treated properly can become chronic , that’s why We advise Soccer Players to go through a comprehensive rehabilitation program before returning to Play.

3 Adductor Large Tear Large Tears are severe and very painful. There could be an avulsion (detachment of the muscle from the bone at its insertion site) or complete tear of the muscle. With this injury you will have to seek medical assistance and a good rehabilitation program is mandatory to return to Play.

How long will it take to heal ?

Again to simplify, because every case is different , we can say that Small Tears will heal in 4-6 weeks and Large Tears can take up to 10-12 weeks to heal.





Chronic Groin Pain





Chronic Groin Pain is when Soccer Players develop progressive Inner Thigh Pain, Lower Abdominal Pain or Pain in the front of the Hip Joint that last for + 6 Weeks.


At that point one of the main findings of the physical therapy exam, is Muscle Weakness in the Adductor Group.

But weak Adductors is not the only finding, this Pain is also associated to Weak Core Muscles and weak Hip Flexors.


With all these weak muscles, we can say that the Player loses the fine balance between the Thigh and Abdominal Musculature and the tissues surrounding the hip, groin and inguinal area become very irritated by any physical activity.

Therefore, to recover from this debilitating condition, one must first, help athletes to correct these muscle imbalances.  For example, during the rehabilitation process we teach our athletes to engage the core musculature before activating the powerful Adductors.

Groin Pain , do this exercise first


The first exercise I prescribe to people with groin pain is the Ball Squeeze for many reasons 1. Reproduces patients’ pain allowing them to regulate the amount of squeezing put into the exercise 2. Can be combined with a core activation first to reduce pain and increase pressure applied to the ball 3. Easy to implement 4. Can be used in the very early stage when other exercises are very painful to do .

Supine Hip Adduction - “Ball Squeeze “


Setup * Begin lying on your back with your legs bent, feet resting on the floor, and a soft ball positioned between your knees. Movement * Engage your core musculature by Bracing with your abdominal muscles * Squeeze your knees together into the ball, then release and repeat. Tip * Make sure to keep your back flat against the floor during the exercise.

Then repeat the same exercise with your knees straight following the same cues and sequence as before: core engagement, adductor contraction, adductor relaxation, core relaxation.









Groin and Core Strengthening : The Jackknife Exercise

Jackknife with soccer ball - Level 1

Setup * Begin lying on the floor with your legs straight. Movement * Position the soccer ball in between your knees and squeeze it as tolerated * Cross your fingers behind your neck, lift your Head and shoulder only to engage Core Muscles then lift your feet from the ground. Maintain this position for a second or two . As you familiarize with the exercise you can lift head and legs all together. Tip * Make sure to keep your back straight and your core muscles engaged during the exercise.


Jackknife with soccer ball - Level 2

Setup * Begin lying on the floor with your legs straight. Movement * Position the soccer ball in between your Ankles and squeeze it as tolerated * Cross your fingers behind your neck, lift your Head and shoulder to engage Core Muscles at the same time you lift your feet from the ground. Maintain this position for a second or two. Tip * Make sure to keep your back straight and your core muscles engaged during the exercise.





Late Stage Rehabilitation

Post-activation potentiation Technique for Adductors



This training technique refers to a short-term improvement in performance (e.g. cutting) as a result of using a conditioning exercise (e.g. side lunge). .

Many conditioning exercises, for example back squats, deadlifts, and even isometric contractions have all been shown to improve subsequent performances. In the case of this video the side lunge with weight “activates “ the Adductor Muscles and “potentiates” the lateral jumping and cutting.


This sequence will demand full use of your Adductor Muscles to produce force into the drill. . Recommended 5️ to 8 repetitions of Side Lunge with a dumbbell and 4-6 lateral High-Knees with cutting and quick change of Directions. It always good to work both sides and not only the affected extremity.

At present, there is no common agreement on what causes the muscles to experience this ‘potentiated’ state, though several neurophysiological mechanisms have been suggested – with some bearing more evidence than others.



Conclusion:


  • Groin Pain is a complex condition that requires a progressive approach to restore movement and strength in the Hip muscles in general and inner thigh muscles in particular.

  • Solving this condition requires a comprehensive approach to correct all deficits that can be causing the Groin pain .

  • Research shows that Physical Therapy and Strengthening exercises is the best approach for Acute and Chronic Groin Pain




Download our Groin Pain Recovery E-book here



Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:

Facebook Page


Instagram Page


where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.




Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

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Introduction


FAI is a pathological hip condition characterized by abnormal contact between the acetabulum ( socket ) and femoral head / neck junction ( ball).


Femoroacetabular Impingement (FAI) is generally used to describe symptoms pertaining to the ball and socket joint of the hip.


This can occur within the normal physiological range of motion as a result of osseous abnormalities ( bone overgrowth ) described as either CAM or PINCER deformities.





There are 2 types of hip impingement; they may occur alone or together.


1. Pincer-Type Impingement:


This condition affects men and women equally; symptoms often begin early, appearing at any time between 15 to 50 years of age.


In pincer-type impingement, the hip socket (acetabulum), which is usually angled forward, may be angled toward the back.


The overgrown bone or incorrect angle of the socket causes the labrum (a rim of connective tissue around the edge of the hip socket) to be pinched.


Over time, this leads to inflammation and eventually could result in a labrum tear.



2. Cam-Type Impingement


Here the shape of the bone around the head of the femur the ball at the top of the bone in the thigh is misshapen with an overgrown bone formed at the top and front. The nickname “pistol grip” deformity is given to the appearance of the bony overgrowth on x-rays.


This also leads to pain or can cause the labrum to  become worn, frayed, or torn.


This condition affects men to women at a ratio of 3 to 1; symptoms often manifest during the teen years and 20s.


Most individuals with FAI experiencing discomfort with hip flexion ( bringing knee up towards the chest) , adduction, and internal rotation.



A recent study found that 87% of teens and adults with hip pain showed evidence of hip impingement on diagnostic images taken of their hip joints.


To have a diagnosis of FAI it is not a sentence to a life of pain. Many patients get better with a comprehensive rehabilitation program.


Surgery is an option when the conservative treatment has failed


That’s why it’s important to assess the person and their goals and not solely base the prognosis on x-rays or MRIs.



FAI diagnosis is obtained through a combination of  symptoms + clinical signs + diagnostic imaging





SYMPTOMS






Hip impingement may cause:


Stiffness or deep aching pain in the front or side of the hip or front of the upper thigh while resting.


Sharp, stabbing pain when standing up from a chair, squatting, rising from a squat, running, "cutting," jumping, twisting, pivoting, or making lateral motions.


Hip pain described in a specific location by making a "C" with the thumb and hand and placing it on the fold at the front and side of the hip, known as the "C-sign."


Pain that most often starts gradually, but can also remain after another injury resolves.

Pain that increases with prolonged sitting or forward leaning.


Feeling less flexible at the hips, including a decreased ability to turn your thigh inward on the painful side.



To the physical exam patient with FAI will show:


Reduced ROM


Positive Hip Impingement Tests.

Several test can help with the diagnosis of FAI , for example “log roll” test where the therapist gently roll your leg in and out, or bend your hip up and in while turning the lower leg out to the side (the "FADDIR" test) to assess your condition.


Diagnostic Imaging ( Xrays ):

Antero-posterior radiograph of the pelvis and a lateral femoral neck view of the symptomatic hip to identify pincer or cam morphologies, and identify other causes of hip pain.


If further diagnosis is needed, your doctor may order diagnostic tests to help identify any joint changes, including x-rays, magnetic resonance imaging (MRI), or diagnostic injections. Hip impingement can occur at the same time as low back, buttock, or pelvic pain, or from conditions such as bursitis or groin strain.


The final diagnosis of hip impingement may take some time, especially when other conditions are present




Treatment of Femoro-Acetabular Impingement - FAI



Exercise-based treatments are recommended for people with hip-related pain. Exercise-based treatment should be at least 3 months duration.


Physical Therapy Interventions:










1. Improve the strength of your hips and trunk.


Strengthening of the hips and trunk can reduce abnormal forces on an already injured joint and help with strategies to move pain-free.


People with FAI will benefit from a comprehensive program that addresses all the imbalances in the hip - pelvis - lumbar area that may be causing the impingement.


A very important point to consider with FAI patients is to select exercises that don't get the hip in the position of the impingement for example dip squat positions most likely will aggravate the condition.


Furthermore, the position of the pelvis is crucial to avoid or decrease the amount of contact between the femur and acetabulum.


Therefore a combination of  core +  hip  strengthening along with postural exercises are necessary in people with FAI.


The goal here is to create stability at the lumbo-pelvis complex to allow a normal movement of the hip


2. Improving hip muscle flexibility and joint mobility


As we mention before restoring some movement back into the hip is very important.


Feeling less flexible at the hips, including a decreased ability to turn your thigh up outwards or inwards on the painful side is very common in patients with FAI.


stretching and mobility exercises must be selected carefully because if patients push too hard into the stretch it may be exacerbate their pains.



3. Improving tolerance of daily activities through activity modification


Analyzing your job and the recreational activities you do to maintaining postures that are healthier for your hip and. Often this involves limiting the amount of bending at the hip to avoid further hip damage.


Tips for stretching with FAI


Warm up with aerobic exercises ( elliptical / treadmill ) .


Don’t force the movement too much, just get to the end and push a tiny bit more


Work on repetitive movements more than pushing hard .


Keep core muscle active throughout the mobilization to avoid excessive strain in lumbar spine




Conclusion:

  • FAI is a problem of the hip joint or its components: the ball or socket of the hip

  • Treatment of FAI requires a general approach with core and all aspect of the hip included.

  • Research shows that FAI is a common finding among athletes and soccer players and its only when painful that the FAI becomes a problem.

  • Conservative treatment with Physical Therapy for 12 weeks is the first line of treatment of this condition. In Adults ( + 40 y/o) surgey need to be considered only when the Physical Therapy has failed because of the Poor to Fair results of the Surgery in the long run

Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston,  where he treats Soccer Player, Runners and Athletes of all ages

Finally we would like to invite you to follow us  at our:

Facebook Page

Google Plus Page

Instagram Page

where you will receive information about your condition and other services we offer, always with the idea of keeping you healthy and fit to enjoy your favorite sport.

Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

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Updated: Feb 16, 2019


Our hips are the power source for so many soccer movements.

In order to reduce risk of injuries or to achieve maximal performance, Soccer Players need optimal range of motion and hip mobility.


Hip mobility is mandatory


Soccer require us to move in and out of athletic positions quickly and easily. Sometimes

that's a matter of muscle strength, but more often there are restrictions from tightness.


From sprinting, to cutting, to jumping adequate flexibility and hip mobility plays a key role in performing our best.


Fortunately, if you are a soccer player with tight Hips, it doesn't have to take hours of dedicated practice time to remedy most of your Hip Stiffness. You just need to get your hips moving in the best range of motion possible.


Get your hips Moving


If you have Tight Hips, these 2 mobility-exercise videos below can either restore what you've lost, or prevent those losses from happening.


Note: these exercises are intended only for tight muscles, like for warm up or after games.

Do not try these if you have pulled or strained any of your hip muscles.


Adductor Mobility Drill



The first video is for Hip Tightness located in your Inner Tight area.


  • Often times after games and workouts you will feel sore muscles along this area. Other times, the Adductor muscle group will compensate other weaknesses in the hip ( like weak Glutes) and become tight as well.


  • The most common injury associated to tight Adductors is an Adductor Strain where this muscle is so tight and stiff that it will get injured by kicking , change of directions or sprinting. Other problems associated with this condition are Low back pain, Lower abdominal pain, Pubic pain and knee pain.


Internal and External Rotation Mobility Drill



The second video shows how to improve both Internal and External Rotations, both extremely important for soccer Players.


  • Lack of internal rotation is a very common finding in people with groin pain, low back pain, hamstrings / adductor strains that’s why this second drill is so important.


  • This is very important to do between back to back games or several times weekly to restore as much rotation possible before the next physical demand for optimal performance and injury risk reduction.


Conclusion


Tight Hips in Soccer Players can and will lead to injuries in the Groin Area. A good way to reduce the risk of injuries is to perform mobility work ( no passive stretching) regurlarly to maintain and optimal range of motion at the Hips


Use these 2 exercises, before and after games and in days between your games, practices or workouts.


#Groinpain #HipPain #AdductorPain #AdductorStrain #PulledMuscle #Soccerinjuries #publagia #sportshernia #Soccergroinpain #soccerpubalgia #westonsoccer #westonhippain #hippainsucks #westonflorida #westonfloridaphysicaltherapy #daviefl #coopercityflorida #pembrokepinesfl #miramarflorida #weston #physicaltherapy #southwestranches #westonfitness #livinginweston


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