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.
Dr. Mark Wade presents his thoughts on this case presentation.
My thoughts on this case is that this is definitely an interesting case as with all tendinopathy in athletes, it’s tricky. They don’t want to rest or stay off it and we know that’s important as Jeff was just pointing out. Yeah, the lot of what they are doing is gonna be causing that continued pain. So we definitely would like to have them rest but we have to take into consideration that these athletes a lot of times wanna be back out one the ice or on the field, if you’re in Australia, as quickly as possible.
I would start as I always do with a quick posture scan to determine any major postural distortion patterns that may be causing or compensating from this. I wouldn’t have too much specific work that I could or would do with this specifically hot adductor other than may be some kinesio-taping just to provide some temporary relief. But it would be expected to find some pelvic distortions occurring most likely specifically in the pubis as well as the SI. But I would refrain from any kind of aggressive manipulations of the pubis at this time or… And focus more on the SI area. If this has been a chronic issue, he either has some problematic form or technique which we’ve all alluded to, that’s occurring from his sports activity or he has a weakness in a compensatory pattern that will be causing his adductor to be over worked. So, I’d like to see him as a… Doctor Brandon mentioned, I’d like to see him during one of his practices to evaluate his form or if he could, even just record via video and send it to me.
But as David mentioned, I’m also not an expert in hockey so I could use the advice of an hockey expert to help let me know if there is any kind of obvious form complications that could be inducing this. And if there is, we can work with him to train and re-train as Jeff was saying with some land exercises well, to get him back to where he needs to be. Now, quite honestly, that is probably the number one problem in many of these chronic problems in athletes, is incorrect posture or technique during their performances leading to chronic overuse injury of the compensatory counterpart. Now, being an adductor and knowing that with hockey you have to side to side, push and pull happening during the skating, this could make sense as well as with the actual taking of the shot, shooting the hockey puck, slapping of the stick. Now, if that was the case, he would need to get back to the basics and clean up his technique to prevent this problem from becoming a career-ending issue.
Now, additional treatments would be to line up the pelvis, find any weak stability muscles that are being compensated for and straighten them. We need to fix the technique and get the player back out there on the ice. This is how I would essentially handle that case presentation. I would use negative tension taping, though, such as superior proprioceptive rehabilitation tape, SPRT, with zero tape tension to get that.
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Dr. Mark Wade D.C, PhD, CPE,
Dr. Mark Wade is the founder of the American Posture Institute, creator of the Certified Posture Expert program, board member of the International Posture Association and President of the Council On Human Function. Dr. Mark is considered one of the most “Certified” Posture Experts on the Planet, having obtained more than 45 certifications in posture, neurology, and human function, including a PhD in Public Health. Clinically Dr. Wade has worked with professional athletes and sports teams in every major sports arena and has served as the official Posture Practitioner for the 4 Time National Champions – Parma Panthers. He has become widely known for his ability to help individual athletes and teams perform at their maximum potential having achieved a total of 7 national championships.