REHABILITATION ADDUCTOR STRAIN INJURIES PART 3 - REHABILITATION OF By Stephen Mutch, BSc, MCSP and Seonaid Airth, MSc, MCSP, SRP

The literature provides no controlled studies of the management of groin pain or adductor related injury.

The management and treatment protocols discussed in this paper are based on the clinical experiences of the authors to date. Over the past five years a working group has been established in cen- tres in Stirling and Edinburgh to modify existing practice and identify strategies for prehabilitation and rehabilitation of region- al groin pain.

The patient would progress through a selection of the following techniques according to their individual needs. These strategies have been identified by the working group as being valuable in the rehabilitation of the patient with chronic non-specific region- al groin pain where serious pathologies such as stress fractures and tumours have been ruled out.

As with any injury, time is spent explaining to the athlete the anatomical structures which are affected. It is of benefit to explain the mechanics of the hip and pelvis and functional anato- my of the adductor muscles group. It is also useful to try where possible to explain how the problem has occurred. The programme is kept sports specific to the individual athlete and timescales are discussed with expected outcomes at regular intervals.

REHABILITATION STRATEGIES 1. Increasing hip range of movement It is our experience that patients with chronic groin pain are often reluctant to participate in activities which require the hips to move beyond midrange. This can also be the case for the ath- lete who has recently injured their groin. Time has been spent developing various techniques to overcome the pain and stiffness associated with this and to regain the confidence of the patient to re-establish normal movement patterns.

■ Sling suspension techniques are valuable to increase hip exten- sion and abduction in a gravity neutral position

■ Myofascial and soft tissue release of the adductor muscles ■ Trigger point therapy of the adductor muscles, hamstrings, quadriceps, psoas, gluteals, sarto- rius, piriformis and gemelli

■ Hydrotherapy to increase hip range of movement and core stability

■ Manual hip traction ■ Anterior hip capsule mobilisation

Figure 1: Modified lunge 20

■ Hold/relax techniques ■ Modified lunge – over step, upper body weight supported through arms (Figure 1).

At this stage manual techniques and muscle energy techniques are used to address any stiffness in the lumbar spine or altered bio- mechanics of the pelvis/SIJ.

2. Core stability Patients with chronic groin pain are often deficient in this area particularly after lengthy time out of sport. As most athletic activ- ities are multidirectional in nature the adductors will become overloaded in these cases. A sound base in core stability and pos- tural control is crucial for the athlete to make the transition from rehabilitation to functional integration in sport.

Stability training comprises: ■ Swiss ball training ■ Deep water stability exercises ■ Slide board exercises ■ Pilates

3. Conditioning Any conditioning programme must work the adductor group into all directions of hip movement. As discussed the adductor group is a dynamic multidirectional group and any conditioning must relate to this. Therefore resistance exercises in pure adduction, and in isolation, are of minimal value functionally. Consequently the conditioning exercises which have been selected for inclusion require the muscles to interchangeably contract concentrically and eccentrically in all ranges of hip movement. Tendons and muscles adapt favourably to physical stresses including concentric and eccentric loading.

One of the main activities introduced to the programme in 1999 is the slide board because it was identified that this activity demands the muscles work in this manner. The slide board also allows core stability to be challenged as well as cardiovascular fit- ness. Additionally this was included as it allows for deceleration and acceleration forces in a semi-controlled environment.

The demands of the slide board mimic the unexpected and occa- sionally unstable surfaces that athletes encounter in sport. Thus the proprioceptive input of the slide board demands that the ath- lete must adapt.

An advanced training regime on the slide board incorporates a slide move followed by a ‘freeze’ command which is included to assist hip stabilisation as well as core stability. Eccentric loading of the adductor group is achieved in upright postures with thera- band or with loaded lunge and split squat exercises. Plyometrics can be useful for conditioning in late stage rehab when postural control has been established.

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