Epidemiology of Groin Injuries1
Groin Injuries in Figure Skating By Gemmie S. Devera, PA-C, MPH Vaca Valley FSC, Children’s Specialists of San Diego
Anatomy of the Groin Region3
Hip & pelvis: 3rd mc sk8ing injury, but most
difficult to rehabilitate ↑ing in frequency w/ lower back & core muscle injuries seen in sk8ers who do 3x jumps Injured muscle: usually adductor longus or gracilis2 Risk factors: ?ed abductor ROM & adductor strength3
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Types of Adductor Muscle Strains2,5-6 Etiology of an Adductor Muscle
Multi-revolution jumps Falling Running Quickly changing directions Splits: forced abduction of hip Kicking Imbalances in strength & flexibility & inadequately strong core muscles
Symptoms / Signs3
Strain1,4
Acute (immediate pain) Chronic (insidious onset of pain)
normal activity for a while after good warm-up or stretching
1st degree: pain, min. loss of strength / fn. 2nd degree: tissue damage, but not complete loss of strength & fn. 3rd degree: complete disruption of muscle tendon unit & complete loss of fn. DDX: stress / avulsion fx, sports hernia, osteitis pubis, nerve compression
Main symptom: Pain in the groin region (medial thigh) Signs: tenderness to palpation in groin region on adduction against resistance
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Diagnostic Studies2
Usually a clinical diagnosis X-Rays to rule out fracture MRI to confirm m. strain / tears (if unsure)
Partial & complete tendon tears
US: to diagnose muscle & tendon tears, not strains
Other Considerations2
Biomechanical abnormalities
Location of muscle strain / tear
Foot & lower leg malalignment Leg length discrepancy Gait / sport-specific motion abnormality MT junction aggressive rehab Acute partial tear at tendinous insertion of adductors to pubic bone rest
Treatment1-6
Patience Initial treatment (1-2 weeks):
Rest Ice: to numb the pain Heat: to relax the muscles Elevation Refrain from activities that exacerbate pain
Chronicity of symptoms
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Treatment (cont.)
Continued treatment: gradual return to activity
Strength Flexibility Endurance
Goal: return to full activity in 8-12 weeks…or within 6 months Consider surgery if unresponsive to conservative tx
Special Facts6
Groin injuries can take a LONG time to heal !!! Adequate rest period needed
Allow muscle strain to heal Prevent re-injury
Prevention2,6
Stretching Conditioning
Warm up / cool down Core strength Strengthening hip & thigh muscles Flexibility / endurance
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Groin Specific Stretches7
Butterfly stretch
Groin Specific Stretches
Splits (a.k.a. straddle-sit-n’-reach)
Groin Strengthening Exercises8
Squats
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Groin Strengthening Exercises
Lunges
Groin Strengthening Exercises
Lunges
Skating Specific Stretches7
Spirals for hip extension Right foot spiral
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References:
1. Lipetz J, Kruse RJ. Injuries and Special Concerns of Female Figure Skaters. Clinics in Sports Med. [serial online]. 2000;19: 1-9. Available at das/journal/view/0/N/1124789?ja=172676&PAGE=1.html&source=. Accessed 10/28/2007. 2. Morelli V, Smith V. Groin Injuries in Athletes. American Fam Physician. 2001;64:1405-1014. 3. Morelli V, Weaver V. Groin Injuries and Groin Pain in Athletes: Part 1. Prim Care Clin Office Pract. 2005; 2:163-183. 4. Rupp TJ. Groin Injury. eMedicine. [serial online]. 2005. Available at http://www.emedicine.com/sports/topic162.htm. Accessed 10/21/2007. 5. Lynch SA, Rensrom AF. Groin Injuries in Sport: Treatment Strategies. Sports Med. 1999;2:137-144. Nichoas SJ, Tyler TF. Adductor Muscle Strains in Sport. Sports Med. 2002;32(5):339-344. 7. Poe CM. Conditioning for Figure Skating. San Francisco: Contemporary Books, 2002. 8. Exercises for your legs. Available at http://exercise.about.com/cs/butthipsthighs/l/bllegsbuttthigh.htm. Accessed 12/18/2007.
Acknowledgements
Coach Ann Baharie, Ice Town-La Jolla, Brittany Ward for demo of skating stretches, Dr. Griselda Tiu, MD, Emma and Jerome Peter, Coach Jennifer Borus, Vacaville Ice Sports, Dana Economeau, San Diego Rehab, Vaca Valley FSC, La Jolla FSC, San Diego FSC
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