KINE 203: Techniques in Athletic Training Group Members: Your Names HereGroup Presentation Topic: Acute Groin Strain

MOI: An unconditioned soccer athlete with a history of tightness in his groin is trying out for the men’s soccer team. A half an hour into practice on the third day of consecutive tryout sessions, he suddenly rotates his trunk while stretching to the right side to reach for the ball. The athlete experienced a sudden, sharp pain and a sense of “giving way” in the left side of the groin that caused him to stop immediately and limp to the athletic training room. (Drez, Bach, & Nofsinger, 2008)

S/S: As the athlete described it to the athletic trainer, there was severe pain when rotating his trunk to the right and flexing his left hip. Inspection revealed the following:

1. Significant point tenderness in the groin, especially at the tendinous insertion of the adductor muscles into the pubic bone.

2. No pain during passive movement of the hip, but severe pain during both active and resistive hip motion (primarily hip flexion and hip adduction).

3. Rule out (R/O) injury to illiopsoas and rectus femoris muscles; however, extreme discomfort noted when adducting the left hip from a stretched position.

Additional observation for biomechanical abnormalities that may predispose injury: foot and lower leg malalignment, muscular imbalances, leg length discrepancy, gait or sport specific motion abnormalities that could theoretically place abnormal loads on the adductors (Prentice, 2011).

Assessment: Grade 2 adductor/groin strain.

Rehabilitation Plan

Phase 1: Acute Inflammatory Response Phase GOALS: To stop hemorrhage, reduce pain, and stop muscle spasms. ESTIMATED LENGTH OF TIME (ELT): 2 to 3 days (Prentice, 2011). TREATMENT: Careful physical examination plus MRI to R/O conditions other than a strain PRN (Morelli & Smith,

2001). o IMMEDIATE CARE: RICE (ice pack – 20 min) intermittently, 6 to 8 times daily. When weight bearing, the

athlete should wear a groin wrap (Prentice, 2011).o EXERCISE REHABILITATION: No exercise to groin – as much complete rest to adductor muscles as

possible (Morelli & Smith, 2001). o GENERAL BODY CONDITIONING: Upper body ergometer to maintain cardiovascular fitness 30 min/day.

Phase 2: Fibroblastic Repair Phase GOALS: To reduce pain, control spasm. And restore full ability to contract and stretch the adductor muscles. To

maintain cardiovascular fitness. ELT: 2 to 3 weeks (Prentice, 2011). TREATMENT:

o MODALITIES – Pre-exercise: Ice massage (10 minutes) 3 to 4 times daily followed by hip ROM movements, all directions as tolerated. Soft-tissue massage or foam roll is helpful in reducing scar-tissue adhesions and stimulating blood flow to encourage healing after day 2 – 5 depending on the extent of tissue damage (Houglum, 2010). Post-exercise: Muscle electrical stimulation combined with an ice pack (20 minutes).

KINE 203: Techniques in Athletic Training Group Members: Your Names HereGroup Presentation Topic: Acute Groin Strain

o EXERCISE REHABILITATION: After ice massage, all exercise performed within pain limitations (Toy & Healy, 2008). –

Athlete begins isometric contraction exercises on day 2 or 3 for all hip muscle actions as tolerated with proprioceptive neuromuscular facilitation hip patterns/PNF (10 repetitions, 2 sets) 2 or 3 times daily (Houglum, 2010).

When able to move in an antigravity position, the athlete will progress to using 2 pound leg ankle weight or resistance band (10 repetitions, 3 sets) once daily (with gradual increase in resistance as tolerated).

Once able to transfer weight from one extremity to the other pain free, begin stork standing (3 sets of 30 second intervals) with progression to BOSU increasing in duration to develop balance and, later, agility (Houglum, 2010).

Advanced exercises towards the end of phase of recovery include: Ball squats, lunges, leg press, side walking, step ups, bridging at high reps, low

resistance; progress PRN weight as tolerated (Houglum, 2010). All exercises other then bridges: begin with 10 repetitions, 2 sets progressing as

follows: 12 repetitions, 2 sets → 15 repetitions, 2 sets → 10 repetitions, 3 sets with gradual increase in resistance.

Jogging in chest level water (10 to 20 minutes) 1 to 2 times daily for first exercise rehabilitation week followed by flutter kick swimming (pain free) once daily during subsequent weeks (Prentice, 2011).

Treadmill activities can also begin when the athlete walks normally without crutches; the treadmill progression starts first with walking, then jogging, and finally running. General body maintenance exercises 3 times/week as long as they do not aggravate the injury.

Phase 3: Maturation and Remodeling Phase GOALS: To restore full power, endurance, and muscle extensibility. The athlete gradually returns to practice and

finally performs, wearing a groan restraint. ELT: 3 to 8 weeks (Prentice, 2011).

o MODALITIES—If symptom free, precede exercise with ice massage (10 min). Post-exercise: Ice pack (20 minutes).

o EXERCISE REHABILITATION: While maintaining adductor specific strengthening and flexibility program described in Phase 2, progressively increase practice time and concentrate on active, pain-free range stretching and strengthening.

Additional exercise progression includes: adding rotational motions to agility; move to combined or more complex rotational and jumping exercises; plyometric exercises after agility such as box jumps and bounding; functional and sport-specific exercises (dribble, strike, sprint, cut, karaoke running drills, etc.) (Houglum, 2010).

Criteria for Return to Soccer Participation1. Minimum of 70% strength to that of the uninjured hip (Morelli & Smith, 2001).2. Hip has full ROM.3. Soccer athlete is able to perform sport specific exercises, such as:

Able to run a full sprint the length of the soccer field.

KINE 203: Techniques in Athletic Training Group Members: Your Names HereGroup Presentation Topic: Acute Groin Strain

Able to strike the ball repetitively. Able to run figure eights at full speed around obstacles set 5 feet apart.

References

Drez, D., Bach, B. R., & Nofsinger, C. (2008). Sports Medicine Cambridge Pocket Clinicians. Retrieved from:

http://www.netlibrary.com

Houglum, P. A. (2010). Therapeutic exercise for musculoskeletal injuries (3rd ed.). Champaign, IL: Human Kinetics.

Morelli, V. & Smith, V. (2001). Groin injuries in athletes. American Family Physician, 64(8), 1405-14. doi: 88770025

Prentice, W. E. (2011). Principles of athletic training a competency-based approach (14th ed.). New York, NY: McGraw-Hill

Companies, Inc.

Toy, B. J. & Healy, P. F. (2008). Primary care for sports and fitness: A lifespan approach. Retrieved from:

http://www.netlibrary.com.