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Tuesday, August 31, 2010

A soccer player with a chronic groin injury

Anterior Hip MusclesImage via Wikipedia
I was reading up on cortisone shots and came across a post on your blog from 2006. Here is a little back story on my injury. I am 20 years old and I play in the premiere soccer league in XXX. I play for XXX FC. I went through a period earlier this year where I was training twice a day 5 days a week with a game on the weekend. Of course I kept pushing through fatigue and muscle soreness thinking I was young and that my body could take it, what ignorance! Anyway I developed a niggle in my left groin at the insertion point for the adductor longus, this was about 2.5 months ago now.
So I handled it with strengthening exercies and a neoprene sleave. This seemed to do the trick. Then one day I felt a sort of pull at the insertion point and what resulted was a lot of weakness in my left groin. There was no real pain and hasn't been throughout this whole thing, just discomfort, and a dull ache. This happened 6 weeks ago. So I saw my physio, XXXX, and I also went to the XXXX Sports clinic that is tied with XXX University, I saw XXXX. Their diagnosis was a groin strain, that had not quite developed into tendonitis yet.
So I was given exercises to do (mainly the Holmech exercises), and when I was pain free I could start a walk/jog program. Now during this whole time of rest I was told I could maintain my fitness through using a stationery bicycle. Thinking that I could reaggravate it, I decided to wait until I was pain free. Last Monday, I hoped on the cycle for 45 minutes, going at a casual pace with moments of intensity here and there. Everything was fine, I felt a little fatigued, which seemed normal to me considering the muscle had been injured. However, 30 minutes later a very dull ache began at the insertion point. It then traveled down my adductor, and up into my hip flexor.
I feel that I may have developed Iliopsoas tendonitis. I also feel that this may have been an underlying cause the entire time, because after 5 weeks of rest I felt that I should have made much more progress. So I am thinking the course of treatment could have been wrong. Now I am getting this dull ache in any sort of position, rest/laying down/standing up. My whole left side of the pelvis feels quite weak. There is no pain with the squeeze test for the groin. No pain with coughing. Just a really irritating dull ache, as well as the weakness.
I know it is hard to diagnose something without seeing it yourself, but if there is any chance you could give me your thoughts on this, as I value all opinions. As an athlete I am itching to get back into action. My diet is also not the greatest, something I need to improve on. I see that you are knowledgeable on this and would appreciate some guidance here too.
 The injury that you are describing is one that I frequently see in running athletes.  It is common in soccer due to the combination of kicking, lunging and sprinting.
When dong actions like lunging these groin muscles must lengthen at great speed while maintaining tension.  These are easily strained if they fail to lengthen at a rate sufficient to allow a controlled release while not tearing.
As the muscles tire from excessively arduous training or insufficient recovery due to, say, poor diet and training sessions too close together, then the possibility of injury increases.   And, when injury does occur, healing may be slow and incomplete.  Especially if anti-inflammatory medications are used.  Please read my article here about the downsides of using these unnecessary drugs.
Acupuncture, ultrasound, core exercises and brief deep tissue massage are mostly a waste of time with this injury.  Here is what works:
  •   Deep tissue massage of all the muscles of the legs, including the gluteals.  Do both legs - at least 30 minutes on each leg.  With the injured leg, locate the most tender spots and concentrate additional attention on these. Massage for 10-15 minutes until the pain has abated.  Repeat the massage once weekly only.
  • Do gentle yoga style stretching once daily of all of the muscles about the hip, low back and legs.  Try some of these for a start: Stretching exercises for people who run  and these:Toning and Mobility exercises for runners
  • You can aid recovery by taking ICL Reparen and ICL Algotene.  Take 4-6 of each spread over the day until recovered.
  • Ensure your diet is suitable for a professional athlete.  This means not going for more than about three waking hours without some quality protein.  Everything that goes into your mouth should be nutrient rich.  This does not include sports drinks which are mostly unhealthy products.  The exception is Balance Recovery Stack which you can use before and after training and competition and on recovery days in addition to a protein shake.  Here is some good quality protein.  Eat a wide variety of fruit and vegetables daily and avoid sugar and refined grains, including noodles and pasta - These have no nutritional value, despite being marketed to athletes as sports fuel.
  • You may benefit from a course of magnesium, pyridoxine and zinc which may help reduce any tendency to muscle spasm and may aid healing.  Contact me here if you want some sent to you.

Cycling is not going to fix anything and does not prepare the kind of muscular fitness required for soccer. Not doing anything risks a loss of condition and you may find yourself more at risk of further injury.  Rest for more than about 3-5 days is not an option for an athlete.  A long layoff such as the one you are in risks you losing your position on the team.  

You are better off getting into a shallow pool immediately and doing controlled and repeated simulations of all the dynamic moves of soccer, including lunges and kicks. You can do this one day and then get onto the field the other and begin training on your own - not with others - practicing soccer drills, including dribbling and kicking. Work within your limits and gradually build back up to competition speed,  Stop before you seize up. Get back into the pool the next day no matter how good you feel.  

Keep doing all of the above for as many weeks as it takes to make a full and final recovery.   Do not rush to get back into squad training.  Go back once you are in the best level of fitness possible and wow the team!

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Anonymous said...

I especially like the idea of doing soccer motions in a shallow pool. Quick side note, the physio has made another assessment and has said I have minor osteitis pubis. What do you think? This is a common overuse injury from what I have read.

Gary Moller said...

I thought there might be a degree of osteitis present. The longterm solution is to reduce the muscle tension pulling on the origin of the adductors and to enhance the healing processes. The Reparen is especially important along with the massage, pool exercises, diet and the rest of what is recommended in this article.

Let us know how you get on.

Anonymous said...

hey Gary, so the pool exercises seemed to have really helped and the off day running/working out. i also took calcium supplements to help bone repair in that area, it seems to have helped as well. all signs of groin injury or OP are now almost gone and this was shown by the mri which i will explain below.

last week i had an arthroscopy of my hip to see if i had a labral tear. it turns out that the head of my femurs have a small outcrop which are causing impingement on both my hips. i also have two labral tears in my left hip. i have been recommended to a orthopedic surgeon to discuss the options with him. i dont really feel discomfort in the area until i bring my knee to my chest, but this is something that i have always had as long as i can remember. however after running/ball work the other day, my hip flexors are quite sore. i am not sure if it is just delayed onset muscles soreness or if it is related to the injury.

what are your thoughts?

Gary Moller said...

I would be inclined to take a cautious approach and use surgery as the last option if all else fails.

Surgery does not always work and can never be undone.

The best thing right now is to concentrate on steady, progressive physical conditioning. Ensure you have a first class diet. Ensure you have a little protein every 3-4 waking hours.

Ensure there is balance between exercise and recovery sessions and never break this rule.

If, after 6 months of genuinely sticking to the rules of good athletic conditioning, there is still significant disability, then consider exercising the surgical option.

Anonymous said...

While I played soccer professionally I was fortunate enough to have a family friend that was actually in the hall of fame for personal trainers/athletes. I had no idea there was such a thing but he would tell you this because he worked on similar injuries with me. Time is the best thing you need to remember is time and relaxation but to speed up the process, don't put heat on an injury before 24 hours. After that you need to do hot/cold compressing. So hot bath/icing/icey hot (and be careful where that injury is located) this pumps new clean bloodcells to start rebuilding your injury. Hope that helps. For other tips you can go here to my blog and site for soccer training