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.
Jessica Sears presents her thoughts on this case presentation.
I know that this athlete is 21. But I kinda have a different aspect of how they get to that final point. I work with the 13, the 14 and the 15-year-olds, and what I mostly see with them is that they’re not evaluated biomechanically. We don’t really check how they move. It’s just pretty much natural talent when they start at a young age, so we don’t really check those things. So by the time we get them at the 18, 19 and the 20s, they’ve created some compensatory kind of little things to keep them going up and succeeding.
So what I usually look at is the glutes because they usually are the ones that they kinda look as if they are doing most of the work, but when you check them, they’re fairly weak. And we always kind of see the symptom of having the groin pain and the tendinopathies that appear. So I kinda work on the glutes, check the IT bands. They usually go in there. So it’s not the fun process of doing the frictions and the muscle stripping and trying to get those muscles to relax and kind of activate properly. We do try and get into the quads and the hamstrings because they haven’t been able to work properly as well as the glutes haven’t been firing properly.
So going with the effleurage, petrissage, and all the nice Swedish stuff, but they get the fun stuff as well. They get the muscle stripping, they get the frictions. And we try and get the tissues to activate and try to do the work as they should when they’re on the ice. As a lot of the other people have been saying, it’s not just the skating, it’s the shooting the puck, it’s the hitting the other players, the getting hit as well. So there’s a lot of aspects that come to play when they’re on the ice. Also, you check the SI joint, making sure that it’s moving properly because the hips are gonna get a lot of the stress because if the glutes aren’t working, the core muscles are gonna be weak as well.
The stability muscles aren’t working. So we wanna make sure that everything is functioning and talking to each other. When it comes to anything staple, we kinda wanna do the cranial staple work as well, make sure and get the movement in there because chances are, the sacrum hasn’t been in a proper functioning way to allow that to happen. So it’s kinda a group thing. Myself as the massage therapist with the muscles, I work that part and try to get them to function properly. But then, you have the athletic therapist and you have the strengthening and conditioning part of it, and you have everybody going on and also is trying to get the coaches involved to see if they see changes in the skating. So it’s kind of starting them a little bit younger, trying to get it to point one you figure all those scar tissue and everything that got into play and that you present at that age. Either way you know there’s not one injury that happened lately. There’s a lot of stuff that’s added onto it
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Jessica Sears Bsc Kin, RMT, SMT (C)
Jessica graduated with a Bachelors of Science in Kinesiology in 2003 and in 2005, she graduated from the Kiné Concept Maritimes Inc. School in Massage Therapy. Since then, she worked nine years at Champlain Physiotherapy, as a Kinesiologist and Massage Therapist and recently has moved her clinic to Protherapy. She has been selected as Team Therapist with Team Atlantic, for the National Women’s Under 18 Hockey Championship in 2011, Team Canada-Atlantic for the World Under 17 Hockey Challenge in 2013 and 2014. Currently Jessica is the Vice President for the Canadian Sport Massage Therapists Association.