Posted by Daniel Miller (BAppSc (Physiotherapy))
With the pre-season kicking off for many sports, ‘groin pain’ is a common complaint that is reported to me by the athletes I work with. It often appears as either a gradual overuse injury (for example groin tendinopathy) or as a sudden acute injury (for example a groin muscle strain).
The actual term ‘groin’ is a label used to describe an area that includes the junction between your abdomen and the upper thigh on either side of the pubic bones. Even though we tend to commonly describe discomfort in this region as groin pain, the specific source of pain could be related to numerous different structures including muscle, tendon, ligament, joint, bone and nerves. Symptoms can be quite variable and are often vague and diffuse, which can make it difficult to pin point the underlying cause of the pain. Also to further complicate the issue there are often multiple pathologies co-existing in the athlete.
Below is a summary of the local pathologies that we frequently associate with groin pain:
ADDUCTOR MUSCLE STRAIN/TEAR:
The most common source of groin pain that people are familiar with is an adductor muscle strain. This occurs when the muscle has a sudden pull or stretch that leads to a breakdown of the muscle fibres. It is often involved with sports/activities that include a lot sprinting, sudden changes of direction and kicking. Signs and symptoms include acute pain over the muscle belly, swelling and occasionally bruising.
Can occur through overuse or as a result of a previous injury, such as a groin strain; can come in the form of a reactive tendinopathy, which is an acute inflammation of the tendon, or tendinosis – a chronic tendon injury with degeneration of the tissue with no inflammation present. Signs and symptoms include pain at the point just below where the upper adductor muscles attach to the pubic bone. It is often described by patients as gradual onset of groin symptoms characterised by ache or stiffness in the area post activity.
HIP FLEXOR MUSCLE STRAIN/TEAR
Similar mechanism of injury to the adductor strain when the hip flexor (iliacus + psoas major) muscle has a sudden pull or stretch that leads to a break down in the muscle fibre tissue. Occurs more commonly in activities that involve sprinting or sudden high knee/leg lift, such as kicking. Although the signs and symptoms may be closely associated with an adductor strain, the treatment and rehabilitation plan involve many different components and types of exercises.
Overuse injury characterised by tissue damage and inflammation to the pelvis at the site where the two pubic bones join (pubic symphysis) resulting in groin pain. Common again in activities that involve repetitive running, kicking or change of direction, especially when there is an imbalance of muscles that attached to the pubic area which results in uneven and excessive load on the pubic symphysis. Signs and symptoms include pain over the pubic bone and adductors and usually require imaging to provide a definitive diagnosis.
Tends to be a less frequent cause of groin pain. It is created by a defect of the abdominal wall in the inguinal region. This can cause abdominal contents to protrude through the hole in the wall causing a bulge and pain on side of your pubic bone. Pain in the groin may be increased by bending over, coughing or lifting.
Sports Herina is a term that people are becoming more familiar these days, but this not a true hernia. Involved in activities with sprinting, twisting, and quick change of directions, the injury occurs in the form of tears and weakening in the deep layers of the abdominal wall, but there is no herniation of abdominal contents. The signs and symptoms include pain in the groin with accelerating, twisting, turning, lifting, coughing or sneezing. Over time, if left untreated, it could develop into a true (inguinal) hernia.
A number of acute or chronic hip pathologies can lead you to experiencing groin pain, but 2 of the most common causes are:
- Tear to the labrum – the labrum is ring of cartilage sitting around the edge of the hip joint. Its role is to help stabilise the hip joint. It most commonly is damaged by repetitive impingement at the hip joint, but can occasionally occur from a single injury such as high velocity movement at extreme ranges of the hip (kicking, twisting, slipping). Pain is in the front of the hip (most often in the groin area) and may be accompanied by clicking, locking or catching.
- Hip osteoarthritis (OA) – more common in the elderly population, hip OA is the wear and tear and eventual breakdown of the articular cartilage inside the hip joint. It results in swelling, stiffness and pain in the hip and groin area.
From the information we have just discussed you can now appreciate that not all groin pain is the same. It is an area of complex anatomy with the symptoms you are experiencing often being a combination of one or more of these structures. The underlying cause could be wide ranging including inappropriate training or techniques, poor biomechanics, poor pelvic and core stability and muscle weakness/tightness just to name a few. All these aspects and factors need to be addressed appropriately in order for a full recovery from groin pain. There are many ways RHP physiotherapists assess groin pain in athletes to determine which structure(s) are the source of pain and what the causes are. This then enables the best course of treatment and rehabilitation to take place.
To make sure you get the most out of your season leading into the 2018, come in for some specific advice and rehabilitation of your groin pain from one of our experienced physiotherapists at RHP physiotherapy.
Post by Will Thwaite (BPhty(Hons), BSc, Physiotherapist APAM)
Firstly, a big congratulations from RHP Physiotherapy to all Red Dog athletes who competed (and supported) at the Noosa Triathlon Festival over the weekend! It was a great day filled with great results. Peter and I had good day doing post race recovery work on a lot of tired bodies – fortunately this year there were no traumatic injuries on the day. It is normal to feel a few niggles and aches after a race, so I wanted to share a few strategies that you can use to enhance your physical recovery.
This week it is important to follow up on your recovery as arduous exercise can leave the muscles of your legs feeling heavy, stiff, fatigued or tight – or a combination of these things. A good recovery will allow you to get back training hard for the next event and reduce the risk of developing injury.
Here are a few recovery ideas for this week to get your body going again –
1. Get a massage – Deep and firm soft tissue work can help delayed onset muscle soreness (DOMS) from high intensity exercise. It can also restore some flexibility in the legs. Regular soft tissue work is also a good idea if you are in consistent training.
2. Active recovery session – a light session of cross training or on the bike/pool/road will increase blood flow and help with soreness. Increasing blood flow can also speed up the muscle-rebuilding process. Aim for a 20-30 minute session of 40-60% of your maximum heart rate.
(image taken from www.alterg.com)
3. Alter G Treadmill – as mentioned above, a light recovery run is a good way to facilitate muscle recovery. The Alter G treadmill allows you to run at a reduced body weight, thus reducing your metabolic demands and the impact of running on joints and muscles. A 20 minute run at 50% bodyweight could be a great active recovery session. For pricing and bookings call RHP Physiotherapy Kelvin Grove – 3856 5566.
4. Foam roller – a foam roller is a quick and easy way to get some additional soft tissue work done at home. Evidence shows that foam rolling before training increases flexibility without affecting muscle strength, and foam rolling after training reduces muscle soreness. Foam rolling for 2-3 mins per muscle group will have you feeling fresh for your next training. Here are some key muscle groups to get stuck into with the foam roller:
Quads (front of thigh)
ITB (lateral thigh)
(images taken from )
5. Get checked by a physiotherapist – While all of these suggestions are great for recovery sometimes niggles can persist after a Triathlon. If you feel any pain that is different to normal post race soreness – no matter how small or large get in to see a physiotherapist. An early diagnosis and management plan is always better than dealing with an injury weeks down the track.
RHP Physiotherapy has discounted rates for Red Dog athletes, so get in to make sure your body is ready for the summer season. To make an appointment at RHP Physiotherapy contact us at 3856 5566.
Good luck with your recovery and congratulations again on a fantastic weekend! All the best for your ongoing training and any upcoming events!
For Alter G session pricing, please visit: http://www.rhpphysiotherapy.com.au/about-us/special-offers/
Post by Will Thwaite (BPhty(Hons), BSc, Physiotherapist APAM)
Recently I went away as the head physiotherapist for the Queensland Volleyball teams at Australian Junior Volleyball Championships. In total there were 13 Queensland teams (130 athletes) the under 15/17/19 age groups consisting of both mens and womens teams. After a tough week, Queensland finished as overwhelming champions across all all divisions and were repeat winners of the Presidents Cup – awarded to the best performing state. Overall, Queensland teams walked away with 10 gold medals, 2 silver medals.
It was a busy week looking after 130 athletes, as volleyball is a highly dynamic sport that involves a lot of explosive movement and jumping. This can really take its toll on the body. A volleyball player can very quickly amass a large number of jumps in a training session or game. This high amount of jumping and spiking can lead to several overuse conditions. Below is a list of common volleyball injuries – both acute and overuse injuries.
1. Ankle sprain – with players jumping in close proximity at the net there is a risk of landing on another players foot and rolling your ankle. An acute ankle injury can range from mildly disabling and painful when walking to severe with a lot of swelling, bruising and pain. Sometimes, fractures can occur in the foot and shin bones due to the high levels of force as you land. Ankle injuries require a comprehensive assessment to direct best treatment to reduce your pain and aid in the prevention of repeated injury. It is important to restore range of motion, strength, balance and co-ordination after this injury otherwise you may be prone to recurrent injuries and chronic instability.
2. Jumpers Knee (Patella tendinopathy) – this is a typical overuse injury from a high amount of jumping. The patella tendon is put under a lot of load when jumping and landing and can become painful over time. This type of injury will typically “warm up” when playing but will become stiff and sore afterwards. Rehabilitation of this injury may mean temporarily reducing your number of jumps, strengthening muscles of the hips, thigh and calf, or using supportive braces during play.
3. Osgood Schlatters – another overuse condition affecting the knees of growing athletes who run or jump alot. This condition affects the bone on the front of the top part of your shin where the patella tendon joins the bone. There is commonly a very painful boney bump at the top of the shin. Management of this condition may require activity modification and strengthening/stretching of muscles in the legs to relieve some stress into this area. It is important to address this issue early as damage to the growth plate can lead to long term disability and/or pain.
4. Shoulder Pain – shoulder pain is very common in the spiking arm of a volleyball athlete. Acute shoulder injuries can be a tear or impingement of different structures around the shoulder. Most commonly, overuse of the shoulder through serving and spiking leads to tendinopathy or irritation of the tendons. As the shoulder is a highly mobile joint, muscle control and strength around your scapula (shoulder blade) and rotator cuff is extremely important. Poor movement and control of your upper and lower back can also contribute to overload the shoulder. Good rehabilitation should focus on strength and mobility of both your shoulder and trunk.
5. Low back pain – low back pain can come from many different sources in your back. As you can see in the picture (left) a large range of motion of the hips, lower back and upper back is required to spike.
Without good range of motion and control throughout this movement, the low back can become overloaded and irritated. Muscle spasm is very common. It is important to see a physiotherapist if you regularly develop back pain when playing volleyball. A thorough assessment will determine if you have mobility limitations or require strength improvements.
In summary, Volleyball can put alot of stress on the body. An RHP Physiotherapy screening can be performed to identify any areas of concern and optimise your movement to reduce the risk of these injuries. If you are experiencing pain in any area of your body or have any injury concerns from playing volleyball, call to make an appointment and start your rehabilitation.
Post by Sam Donaldson (M.PhtySt, BAppSci(HMS), Physiotherapist APAM SMAM)
Justifying the physical approach to therapy in rehabilitation and performance.
Every fortnight at RHP Physiotherapy, we are fortunate to have implemented an in-service program, through which our therapists are afforded the opportunity to learn as a team and collaborate in the care of our patients.
This fortnight we took on the science behind Mechanotherapy.
Mechanotherapy is a term used to describe the therapeutic use of any modality that provides a mechanical stimulus to the tissue, which is directed towards rehabilitating or developing the body to return to, or improve activity. My personal favourite definition (from Huang et al 2013) is the “Therapeutic interventions that reduce and reverse injury to damaged tissues or promote the homeostasis of healthy tissues by mechanical means at the molecular, cellular or tissue level.”
What this whittles down to is that when a force is applied to any bodily tissue, that force stimulates a change. When jumping up and down, the muscles must stretch and contract; tension pulls and recoils in the tendons, the bones absorb vertical compression which also bends and twists them (ever so slightly). The cells in these tissues must deform under that force, which will stimulate a cascade of events within the cell, as well as between the cells. Ultimately, the cells of those muscles, tendons and bone, will stimulate DNA transcription (the building blocks of our bodies) and create new muscle, tendon and bone.
What is most interesting to us, is that each tissue type will respond to different types of forces. Not only that, but the cells of these tissues will respond at various amounts depending on how much force, the rate of repetition of that force and the recovery period between those forces that are applied. This means that we can potentially find an optimum amount of that mechanical force, that will stimulate change: with far too much being detrimental, a little too much being no better than the optimum, and too little not being effective enough to make the necessary adaptations.
Without going too much further into the dry science of it all, it is these cellular mechanisms that underpins every aspect of our physical approach to therapy; be it massage therapy, stretches, exercise therapy or even something like shock-wave therapy or low intensity pulsed ultrasound.
So, if you have ever wondered why you have been asked to do certain exercises or walking or running with explicit repetitions, sets and recovery times, this cellular response to that exercise is one justification for the specificity of that prescription.
Without a doubt, there is more at play than just the biological responses at a cellular level when we are considering how we might rehabilitate an injury. Pain and the nervous system is a whole other kettle of fish! However, the way the body can physically adapt to whatever it is we ask it to do, it seems we can achieve the most when we do just the right amount at just the right intensity, and allow certain rest times. Sometimes less is more, and more is less!
The human body is an amazing organism and one we are continually amazed by. Treat yours well and it will reward you!
If you would like to learn more or have any physical barriers to doing what you would like to be doing (injury, pain or other), then get in touch with our physiotherapists on 07 3856 5566.
- Warden, S. J., & Thompson, W. R. (2017). Become one with the force: optimising mechanotherapy through an understanding of mechanobiology.
- Khan, K. M., & Scott, A. (2009). Mechanotherapy: how physical therapists’ prescription of exercise promotes tissue repair. British journal of sports medicine, 43(4), 247-252.
- Huang, C., Holfeld, J., Schaden, W., Orgill, D., & Ogawa, R. (2013). Mechanotherapy: revisiting physical therapy and recruiting mechanobiology for a new era in medicine. Trends in molecular medicine, 19(9), 555-564.
Sit – Stand Workplace Tips
Workstations that allow computer workers to vary their position between sitting and standing are becoming more common, and the costs involved in setting up a sit – stand workstation are becoming more affordable for all.
Our guidelines for how best to incorporate sit-stand technology into your day include
- Prepare your body for sitting
- Prepare our lumbar intervertebral discs for sitting by going for a walk in the morning. Our discs compress at the start of the day after lying/sleeping. A walk will help the disc start the day in an ideal state. Perhaps > 20 minutes.
- To enable our bodies to be able to sit with the ideal posture outlined in various ergonomic guidelines, we need to be
- flexible in the hamstrings and back of the hips to help maintain a neutral lower back curve (lordosis)
- flexible in our chest muscles to help maintain upright trunk posture
- Prepare your body for standing
- After sitting for a while the muscles at the front of your hips will have tightened a bit. Thus, stretch them out before your standing stint so the lower back position will be optimised. Tight muscles at the front of your hips can drag the arch in the small of your back into a shape that is too deep, and this can compress the joints in your lower spine.
- Maintain strength of your abdominal, pelvic floor, gluteal, and spinal muscles. These need to be gently active and supporting your skeleton whilst standing.
- Prepare your workstation
- For standing ensure a cushioned surface and shoes that provide stability and some shock absorption.
- Invest in a sit-stand workstation that meets all your requirements e.g adequate space for monitor(s), keyboard, documents, phone, drinks etc.
- The sit-stand workstation needs to be easily moved from the sitting position to standing and vice versa. Supported lifting hydraulics and durable mechanisms are recommended, as well as non-pinching hinges.
- Sit-Stand workstation guidelines
- Stand with your breast bone positioned over the front of your pelvis. A common mistake is to allow your pelvis/hips to slide forwards during standing.
- Don’t cock your hips to one side whilst standing.
- Only stand for 20-40 minutes. If you are uncomfortable or can no longer maintain good posture, then it is time to sit again.
- Change position whilst standing. For short periods, it may be useful to place one foot up on a small stool.
Sit – stand work stations can be a helpful addition to the workplace if utilised correctly, and if your body and workstation are appropriately organised.
If you are experiencing pain associated with your computer work, RHP Physio’s are able to help identify the physical contributors, and provide remedies specifically for your body or work environment.