Case Presentation: Adductor Tendinopathy in a hockey player with persistent groin pain
So a 21 year-old male, previously competitive hockey player with persistent groin pain was referred for an MRI. This athlete was competing recreationally and had some symptoms of chronic pain in the region of the groin. The patient described his pain as localized to one specific region in the proximal portion of the left groin. Palpatory pin point tenderness was elicited at the proximal portion of the left groin at the tendinous insertion.
Dave Fleming quickly presents his thoughts on this case presentation.
As a trainer and a therapist, I’m not able obviously to diagnose anything so I’d have to kind of assume that the diagnosis the person arrived with was accurate. Then I’d still have to go ahead and just assess the body and really see what the body is showing me and telling me about the presentation at the time.
The pain, assuming that the diagnosis is correct, in this case is also mediated by the local tendinopathy. At the end of the day, we need that tendon to heal for the pain to subside, so the first protocol really is to encourage as much pain-free movement as possible. I wouldn’t be able to provide any kind of site injections or similar restorative medicine, but I would certainly look into working alongside someone who could in this particular instance.
Also I don’t know what caused the problem as such. We know it arose while the individual was playing recreationally or kind of peaked when the person was playing recreationally. I would definitely want to dig into any other injury and medical history that maybe gives some relevant clues as to what could have inhibited the system to end up with this problem, and obviously get a really good understanding of what’s involved in the sport. What is involved in the movement.
That’s such a key part of the process when dealing with athletes especially if it’s something that you have no experience of yourself or you haven’t really looked into. I would definitely spend time doing that. Primarily I would want to be utilizing movements to improve stability around the hip, the pelvis and the spine.
Ideally I’d want to find angulations where I could. Load the tendon to promote some blood flow there, but are obviously pain free, and that initially would be working with some isometric work. Working above and below the problem site with this kind of thing. Well obviously there’s a healing time involved and once that healing has occurred the problem’s going to be largely resolved, we can assume.
Working above and below the site in the meantime, promoting active pelvic mobility drills, spine mobility drills. Drills at the knee, ankle and foot ipso-laterally, all under reduced loads and obviously in pain-free ranges of motion. Then enhance motor control strength and try and maintain some kind of reflexive muscular balance, because at the end of the day with this kind of level of [23:16] ____ firing off while the person heals, there’s going to be unavoidable inhibition that occurs in the system. Something I would do, or I could do as a trainer, would be to try and provide flexibility, mobility and stability and strength. Prescriptions that can basically keep that person as functional as possible while they heal.
Nutritionally, I would definitely want to recommend them avoid any inflammatory foods or anything generally speaking that’s gonna inflame the system further. In terms of the muscular system and the mechanics of the problem I would definitely want to coach good pelvic floor control, psoas range of motion, strength control, looking at the opposite shoulder, the opposing glute complex, paraspinals and the ipsilateral QL, and as has been mentioned, the abdominal musculature. I think a sport that’s as violent as that… I used to do a bit of mixed martial arts, I know you get lots of bangs to the head and things like that, you can definitely get a repetitive inhibition of the abdominal wall. And even if you’re not going into it as deeply as looking at TBI and things like that, you can certainly promote good abdominal facilitation and contraction by making sure that the cranium and the craniofacial joints and sutures are as mobile as possible.
So that’s kinda how I would go about this one. I try and work in conjunction with other therapists who can revive things that are gonna promote the healing, and I’m gonna try and give the person as easy a ride as possible while they’re going through that healing process, and ultimately when we’re trying to take them past the initial phases of rehabilitation, taking them into a good, you know, moving them from isometric work into eccentric work and finally building up into a dynamic work, and just making sure that the athlete is ready for each stage when we get there.
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David Fleming is creator and co founder of the Institute of Applied Movement Neurology or AMN Academy. With a BSc in Holistic Health Sciences and David is currently pursuing MSc and PhD in Integrative medicine with Quantum Physics, as well has completed numerous certifications ranging from Strength and Conditioning, Functional Biomechanics to Functional neurology. Teaching the Applied Movement Neurology system internationally he presents concepts of functional neurology, quantum physics, systems biology and much more to doctors, therapists, trainers and movement specialists alike.