ADDUCTOR INJURIES TIP

Squatting exercises are an excellent exercise for adductor magnus as it is an important hip extensor and is capable of generating large forces. Split squat is particularly bene- ficial in the patient with pain and weakness at the adduc- tor origin on the pubic symphysis (figure 2a and 2b).

4. Neural mobilisation There is considerable benefit to including activities to improve the mobility of the neural system in relation to the obturator nerve as discussed previously. Specific neural mobilisation exercises would be implemented initially as pain allowed. Activities such as slide board, sling suspension with cervical spine flexion and extention, and modified swiss ball exercises are excellent progressions. Where the nerve is restricted by muscle and fascial tightness in the groin region it is essential to facilitate mobilisation of the nerve with soft tissue techniques, myofascial release and trigger point ther- apy. It is often found that the fascia overlying adductor brevis is tight as described by Bradshaw and McRory (29). Myofascial release of this fascia has produced excel- lent results.

5. Lifestyle/work assessment "Musculoskeletal pain syndromes are seldom caused by precipitating events but are the consequences of habitual imbalances in the movement system" Sahrmann 2002.

fessional rugby clubs in Scotland. This structured, ath- lete led programme involves many of the rehabilitation activities discussed and groin injury has been dramatically reduced in the last four years. Incidence of groin and adductor surgery has been minimised to one isolated case.

Figure 3: Side lying - useful position for soft tissue work

There is no recipe for the pre- vention and treatment of regional groin pain. Every case is individual and sports specific.

The principals of treatment and rehabilitation should reflect the functional anatomy of this area.

TIP

As with palpation, a useful position for these soft tissue techniques to be implemented is in side lying (figure 3)

THE AUTHORS Seonaid Airth MSc, MCSP, SRP – Seonaid qualified as a physiother- apist in 1991 from Queen Margaret College, Edinburgh and worked in Edinburgh until 1994. During this time she developed an interest in the area of hip and groin pain. Over the next five years Seonaid worked in Australia and NZ in private practices and with sports teams at the Australian Institute of Sport in Canberra, 1996. In 1999 she com- pleted a MSc in Sports Physiotherapy at the

It is essential to have ascertained exactly what the athlete’s work or social life involves, eliminating any habits or movements con- tributing to the problem. A good example of this is an office- based person who always gets up from their desk to one side. Ask about their work station setup. You need to know if they rotate off a computer chair to the right within a small space 15 times an hour to get to the printer! Similarly full time athletes may spend time studying, surfing the net or playing with games consoles for five hours at a time. Repetitive activities no matter how small, may be the factor which is preventing symptoms from settling.

6. Prehabilitation Clearly prevention of adductor injury (prehabilitation) is better than cure. A preventative strategy was developed and established by the working group in 2001 and implemented with one of the pro-

AIS in Canberra, researching the neural component of chronic groin pain in rugby players. Seonaid returned to Scotland in 1999 and established a private practice, Physiofocus. She was on the medical team at the 2002 Commonwealth Games and over the past 6 years she has continued to work and lecture in the area of chronic groin pain.

Stephen Mutch BSc MCSP SRP – in addition to being full-time phys- iotherapist at Scottish Rugby Union since 1998, Stephen works with the Scotland Sevens international team and the Scottish Institute of Sport. He is partner of the multidisciplinary 'Spaceclinics' in Edinburgh city centre. He was also physiotherapist to Scotland’s Commonwealth Games team in 2002, and will repeat this role in 2006. He is currently a part-time MSc sports physiotherapy student at UCL.

Figure 2a: Split squat exercise (foot flat)

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Figure 2b: Split squat exercise (heel up)

REFERENCES 1 Taylor DC. Abdominal musculature as a cause of groin pain in athletes. American Journal of Sports Medicine 1991;19(3):239–253 2 Ekberg O, Persson NH, Abrahamsson PA, Westin NE, Lilja B. Long-stand- ing groin pain in athletes. A multi-disciplinary approach. Sports Medicine 1998;(14):30–36 3 Smodlaka VN. Groin pain in soccer players. American Journal of Sports Medicine 1980;12:302–306 4 Cabot JR. Osteopatia dinamica del pubic. Proceedings of the XVI World Congress of Sports Medicine 1966;359–364 5 Hume RS. Injuries in rugby union in one season. Australia and New Zealand Journal of Science 1995;2(3):231-236 6 Briggs C. Functional Anatomy of the Pelvis and Groin. General Files, University of Melbourne 1996:1–8 7 Orchard JW, Read JW, Neophyton J, Garlick D. Groin pain associated with ultrasound finds of inguinal canal posterior wall deficiency in Australian Rules footballers. British Journal of Sports Medicine 1998;32:134-139 8 Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189

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