Resolving Groin Injuries Part - 2

Diagnosing a Musculoskeletal Groin Injury

The Hip Joint

When discussing a groin injury, the hip is a logical place to start. Your hip joint is the largest weight bearing joint in your body. It is designed to absorb shock, generate force, while maintaining an impressive range of motion when functioning correctly. Unfortunately this has also made the hip joint very susceptible to injury due to the amount of repetitive motion and force this joint is subject to.

Understanding Motion Patterns of the Hip

The successful resolution of a groin injury often involves a complex understanding of kinetic chain relationships, and a functional understanding of how motion of the hip is related to specific anatomical structures. When you observe a deviation from normal hip motion after a groin injury, it is often a direct indication of which anatomical structures are involved in creating and perpetuating a groin injury.

A mechanical groin injury that involves the hip will be a combination of four functional muscle groups:

· Agonists (Prime mover) – Muscles that contract to produce a specific movement. Example: The quadricep is a prime knee extensor.

· Antagonists – Muscles on the opposite side of the joint of the agonist. Example: Hamstrings are antagonists to the quadriceps.

· Synergist – Muscles that limit motion as the prime movers contract and also assist motion. Example: The Iliopsoas, and tensor fascia lata are synergists to the quadriceps.

· Stabilizers – Muscles that fix or stabilize the bones of the origin of the prime movers.

An understanding of these structures, combined with a whole body examination of kinetic chain relationships, provides a practitioner insight into all the structures that may be involved.

This next section gives you a basic overview of structures involved in hip actions. Optimal hip function is about maintaining a balance of these structures in order to achieve stability in the hip while performing all actions.

Specific Structures.

Notice that only certain sections of muscles are involved in some specific actions and that the same muscles help to perform multiple actions depending on hip joint position. Once a practitioner has an understanding of these structures, they can often obtain a considerable amount of information just by observing patient motion. If the patient is having a problem performing a specific action, and it’s just a mechanical problem, it is most likely due to a combination of the following structures:

Muscles involved in hip flexion:

• Psoas and Iliacus.
• Medial Quadricep (Rectus Femoris).
• Adductor longus, brevis and magnus (The superior portion of the adductor magnus is involved in hip flexion).
• Sartorius.
• TFL (Tensor fasciae latae)
• Gluteus medius (Anterior portion of the muscle).

Muscles involved in hip extension:

• Gluteus Maximus – This is a prime hip extensor. If it is weak, an increased load will be passed onto the hamstrings. In addition, if the psoas muscle is tight, the gluteus maximus muscles will be turned off.
• Gluteus medius (Posterior portion of the muscle).
• Hamstrings (Semimembranosus, semitendinosus, biceps femoris – long head).
• Adductor magnus (Inferior portion of the muscle).

Muscles involved in hip adduction:

• Adductor Magus, Longus and Brevis. – Adductor longus is the most common muscle injured in a groin strain.
• Pectineus.
• Gracilis.
• Obturator externus.
• Gluteus Maximus (The lower section of the muscle).

Muscles involved in hip abduction:

• Gluteus medius and minimus.
• Gluteus maximus (upper section of the muscle).
• TFL (Tensor Fascia latae).
• Sartorius.
• Piriformis muscle, gemellus superior, gemellus inferior, obturator internus (These muscles are involved in abduction when the hip is flexed)

Muscles involved in medial rotation of the hip (Internal rotation)

• Gluteus Medius (Anterior section of the muscle).
• Gluteus minimus.
• TFL (Tensor Fascia latae).
• Medial hamstrings (Semimembranosus and Semitendinosus).
• Adductor Magnus and longus.

Muscles involved in lateral rotation of the hip (external rotation)

• Gluteus Maximus and medius (posterior section of the medius).
• The deep six (Obturator externus, quadratus femoris, gemellus superior, gemellus inferior, obturator internus, piriformis) – In cases of sciatica it is often assumed that the entrapment involves the pirformis muscle, when, in reality, entrapment of the sciatic nerve can involve any of these muscles.
• Sartorius.
• Lateral hamstring (biceps femoris – long head).
• Popliteus (This muscle is behind the knee – and is primarily involved in lateral rotation of the hip when the leg is in a fixed position

In part three of Resolving Groin Injuries we will cover treatment. 

If you would like to more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Resolving Groin Injuries – Part 1

Groin injuries are a common athletic injury in both contact and non-contact sports. Injuries to the groin can occur from direct trauma in sports such ice hockey, basketball, football, rugby, and in non-contact sports such as gymnastics. In hockey, 10% of the injuries that occur each year are groin injuries. These injuries should be taken seriously because, once an athlete injures their groin, they are twice as likely as other players to incur the same injury again.

Anatomically your groin is the area where your upper thigh meets your pelvis (lower abdomen), essentially the crease or fold between these two areas. In reality, groin injuries involve a much larger area than just this. A groin injury can encompass an area that extends from your lower abdomen, to your pelvis, to your hip and inner thigh, and right down to your knee.

Since a groin injury can cover such a large anatomical region it can involve muscles, tendons, ligaments, joints, connective tissue (fascia), neurological, circulatory structures and even internal organs in the lower abdomen. In this blog we will limit our focus to musculoskeletal causes, except for a quick review on some conditions that must be ruled out (See differential diagnosis).

Differential Diagnosis

A differential diagnosis refers to the process of determining the probability of one condition over another. It is the process of making sure we are actually dealing with a musculoskeletal condition and not something more serious (pathological).

Fortunately most groin injuries are musculoskeletal injuries (mechanical problems) that will respond well to manual therapy and exercise. However, it is still important to evaluate other causes of groin pain (pathological causes) rather than assuming the problem is just a simple muscle strain. Some of the other problems that must be considered are:

Hernias

· A hernia is a condition that must be ruled out whenever a groin injury presents itself. Minor hernias do respond to rest, ice, and range of motion exercises. More severe hernias require surgery (mesh reinforcement).

Bursitis

· The hip contains approximately eighteen superficial and deep bursae. Bursae are small pouches with slippery surfaces that reduce friction between two moving surfaces (increase gliding). The bursae are usually located in areas where muscles and tendons glide over bones. When the bursa becomes inflamed it loses the ability to decrease the friction between the moving surfaces. As inflammation increases, instead of providing ease of movement, they become a source of friction and pain. Chronic bursitis can be due to an underlying inflammatory condition. Examples of common sites of hip pain due to a bursa are the:

Superficial bursa

· Directly over the greater trochanter

Deep bursa

§ Between gluteus maximus tendon and the greater trochanter (posterolateral prominence).

Fractures (Frank or Stress fractures)

· If the initial groin injury has been caused by trauma (in a contact sport) then possible fractures must be considered. The two most common sites for stress fractures are in the upper leg (femoral neck) and in the pelvis (pubic ramis). A simple X-ray is often all that is needed.

Avulsions

· An avulsion often refers to a bone injury where the tendon (which attaches muscle to bone) is torn away from its insertion point. Some of the possible sites of avulsions in a groin injury are:

§ ASIS (anterior superior iliac spine) – The site of the sartorius muscle attachment.

§ AIIS (anterior inferior iliac spine) – This is the site where the middle quadriceps (rectus femoris) attaches.

§ Ischial tuberosity – This is the site of attachment for your hamstrings.

Osteitis Pubis

· This condition is also known as gracilis syndrome. It is a repetitive stress injury that affects the pubic symphysis. This is an injury that can occur in runners, or sports that involve jumping or kicking. Osteitis Pubis can be increased after childbirth due to ligamentous laxity.

Nerve Compression

· Nerve compression can be a common problem associated with a groin injury. An example would be compression of a nerve called the femoral cutaneous nerve. When this nerve is compressed it creates a condition called Meralgia Paresthetica. This condition creates alter sensations on the outside of the hip.

In part two of Resolving Groin Injuries we will cover diagnosing a musculoskeletal groin Injury, including specific structures involved.

If you would like to more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)