Friday, May 21, 2010

Groin Strains in Track & Field

Coach Martin asked me for some comments on this topic. First of all we need to define it, since it's sort of non-specific. I take it to mean the area including, but not exclusive to the adductors, sartorius, pectineus, iliopsoas, origin of the rectus, and the lower abs.

Before we even get started, keep a close eye if the pain is right up on the pubic ramus (bottom/front pelvic bone), or in the AIIS (anterior inferior iliac spine). They are frequent sights of stress fractures, especially in females and all athletes in the 14yr. old range. Way more common then you think.

Not too much GOOD research on the groin area. The best functional study of the adductors I have seen is from way back in Partridge Family era 1970! Get out your platform shoes and polyester shirts cause we're goin' retro (Am.J. Phys. Med. 49(4): 223-240, 1970). Researchers Greene & Morris found subjects with enough guts to walk around with fine wire electrodes in their legs. Here's what they found about how the adductors functioned in walking/running:

The left adductor magnus and the right adductor longus exhibited equal activity at left heel strike. The reverse occurred at right heel strike. This would be consistent with the magnus functioning as a hip extensor and the longus functioning as a hip flexor. As subjects walked with their trunks intentionally held in a forward flexed position, the activity of the adductor magnus increased dramatically, while the adductor longus activity appeared to change very little. Walking with an extended trunk increased longus activity and decreased magnus activity. Apparently, the adductor magnus plays a major role in decelerating hip flexion and accelerating hip extension. The opposite would be true for the longus.

The authors then had the subjects walk with a very wide and a very narrow base. Although this appears to be a change in the frontal plane, the authors intended to change the amount of transverse plane motion of the pelvis. Their measurements of pelvic rotation showed that the wide base decreased pelvic rotation and the narrow base accentuated it. With both “tweaks” the pattern of activity (opposite magnus and longus contracting together) remained the same. With the wide base of support there was still significant activation of both muscles. Of great interest is the substantial increase in the “amplitude and duration” of both muscles produced by the increased pelvic rotation caused by the narrow gait. (Thanks for D. Tiberio of GIFT for the commentary).

-What's to be learned from this?
1. The adductors obviously don't adduct the legs in walking or running; gravity gives that to us for free.
2. The adductors don't dig (using 70's terminology) the pelvis wiggling around during running (Jack- here is where the cramping could come in). Strength training is important here.
3. If #2 is true, then it is conceivable that the adductors, rather than being week, may be taking on the butts role is decelerating leg adduction and internal rotation. Again, dormant butt= strength training (functional that is).
4. Getting back to numero dos- remember the pelvis is an interdependent ring. What goes on one side has a direct influence on the other. Remember runners who run in straight lines are subject to what Vlad Janda called "pattern overload". Their bodies may have become adapted to running and movement patterns rigidly grooved.

Now- what the hell to do about it.
-in the short term, reduction in activity and E-stim/sound combo treatments, ice, massage stick, light IASTM if it's available, and MET (muscle energy technique) about the pelvis is valuable to reduce spasm and make the athlete more comfortable.
-The long term muscle spasm can create adaptations in the pelvis like rotations and upslips in the innominate bones of the pelvis. That's fancy wording meaning you can wind up with more groin strains. The MET's work great on this stuff.
-for long term- I believe 3D running should be an integral part of the recovery/restoration process. Backpedaling and backward running, slide steps, carioca; with a variety of arm swings should be included in the cool down process, or included on what Bowerman would call "the easy days".
-for long term- Plenty of 3D lunges, squats, and step ups. Combine them with an overhead reach if you want to do some "integrated isolation" on the groin.

Phew! Talked too much! Good luck this weekend Coach Martin and all coaches! Would love to be there but I've got baseball/softball at Williams Field.


KP said...

Great post Joe.

At times I feel like a broken record having the majority of the athletes I see with a leg injury doing multidirectional lunges, stepups and the miniband routine. But it seems like everything comes back to the glutes not doing their job they way they should, chalk it up to the hours sitting or whatever, but seeing this post (and I'm going to get the article) tells me I'm probably not crazy.

Jack Martin said...

Thanks. Our runner in question is somewhat rigid for the speed he has. We'll get him on some of the short term and long term rehab you suggest as soon as things quiet down a bit. Martin

Kev said...

Great post. This is the type of post that has me coming back every week. You never know what great pearls of wisdom you might learn.

Thanks Joe!

sal m said...

I love Sam Malone's take on the groin injury...

Garrett said...

Hi Joe,

Great post on this. We have just finished some research here on the adductor squeeze test in 0, 45 and 90 degrees of hip flexion where we measured squeeze values and EMG activity of adductor longus in healthy players. We found that the greatest squeeze and EMG values were at 45 degrees of hip flexion which would tie in nicely with the previous 70's work - we concluded that this position of hip flexion is akin to that at heel strike when it would be important for adductor longus to decelerate IR of the hip, perhaps compensating for weak glutes. Our testing was conducted in lying so a further study could be to measure something similar in standing whilst concurrently measuring activity in the glutes to get the real picture. The majority of the groin injuries I see I believe are glute related dysfunction problems so this is of great interest to me. The 3-D running idea for rehab is great - I think it helps athletes who may have some ongoing pathology feel like they are back out training again and not just stuck in the gym with rehab - sound body, sound mind and all that!!

Jack Martin said...

KP brings up an issue that I have been trying to address for a couple of years now-GLUTES. I have been unable to really find some very specific exercises to attack the problem of weak glutes-especially the medius. Sean Fife writes about it but I have not seen specific exercises. I read in Franz Bosch's Running of how the glutes are engaged in all parts of the running cycle. Do you think when things quiet down for you, you might be able to address this in a blog or two over the summer-especially if you get to see Franz Bosch at GAIN?
I think, from my recent experience, that this might address a lot of running problems that I have seen. Thanks. Martin