The Osteopath's Groin Injury!

I became a hobbling cliche in June after partially tearing/rupturing my adductor muscle (a groin tear) during the dads’ sprint race.

I’d had a niggle all week but could run at 70% without a problem. I even played tennis on the morning of the 'big race' so wasn't completely cold. I couldn't refuse my son asking me to run, so lined up with the other dads in our non-sports wear and summer shoes.

The groin injury happened halfway into the race - three or four discernible pops from the front of my groin and I had to pull up, dreams of glory in tatters.

My initial response was of course to rest, helped by paracetamol for the considerable pain. I was fairly sure that the injury was muscular in nature, but did have my doubts the next morning when the inside of my leg had swollen up like a small melon.

But it did at least give me experience of a new injury! And the ability to do my own osteopathy rehab.

It's maybe not a surprise that osteopaths and physios report an upsurge in business at this time of year!!

A lovely photo (!) showing the pretty extensive bruising from the result of a muscle tear.

I'd mainly rested the groin injury, but also did some gentle walking each day around Wimbledon Common.

So what about the usual advice of rest, ice, compress, elevate?

The RICE protocol has been staple advice for sports type injuries since the late 1970's (Dr Gabe Mirkin). However, recent studies have questioned the benefit of trying to reduce the inflammatory response in these early stages. After all, it is a natural response and surely has a purpose?

Dr Mirkin has since updated his position, stating 'it now appears that both ice and complete rest may delay healing, instead of helping'.

Inflammatory cells rush to the site of an injury (or infection) to start the healing process, releasing a hormone called Insulin like growth Factor (IGF-1) into the damaged tissues, which signals recovery can begin. Applying ice (or ibuprofen) to reduce swelling constricts blood vessels, reducing the blood flow which carries the inflammatory cells, thus delaying or preventing the release of IGF-1.

However, ice can also offer pain relief, so if you are going to ice an injury, do so for 5-10 minutes. Of course, prolonged swelling and inflammation can reduce our ability to move a joint/area, and movement itself may be beneficial. So, after an initial period of reduced activity, brief icing may be appropriate (this differs depending on the individual and injury type/location).

I tried to rest the area, but kept a low level of activity...

• walking once or twice a day (for 30mins)
• performing gentle mobility and stretching exercises
• very light isometric exercises (as an attempt to reassure myself that it wasn't a complete tear of the muscle or avulsion of the tendon).
  

Strength and mobility were steadily returning.

Much of the bruising had now reduced and moved down the leg, with thankfully no new bruising.  The area at the top of the adductor (groin) muscles was still tender, but relieved with gentle pressure, massage, or stretch. I was optimistic!

I was pleased to find fairly rapid improvements in mobility and strength between days 6 and 10.

I continued with daily mobility and light strengthening exercises, but found prolonged sitting on a hard surface resulted in pain and a great amount of stiffness.  This was relieved with gentle stretching and massage to the area.  

I found there was no pain using either the stepper machine or a static cycle in the gym (plus upper body weights). I intended to leave running as long as possible, especially whilst there are other options available to build strength and maintain fitness.  

Lunges were fine, but squatting activates the adductors more, so I left those out at this point. I completed two sessions on the adductor machine in the gym, starting on just one plate, moving up to 4 by the second day (around 25 reps ranges for 4 sets). This is still very light, but it’s all about increasing blood flow to the area to aid repair in the direction of forces the muscles will incur in the future, rather than ‘building muscle’ per se. 

Steady as she goes. 

My improvement continued without any set-backs. I was very pleased by the progress...frequent and focused Osteo and physio/exercise treatment really seems to work...who knew?!

I combined strengthening on the groin with stretches and mobility work, plus I added jogging then running.

I could not sprint or push harder than a 70% run, but everything else was fine. Deep lunges felt very tight on the groin, as did prolonged sitting (as it causes compression of the area).

BUT I was far ahead of expectations! I'll continue to progressively load the area, but gradual steps have worked so far so theres no need to try and leap forward now.

Rehab Routine:

• 4 sets of 25 reps of adductor machine or at home isometric resistance (pushing against a fixed object/another limb) for 25 seconds.
• Massage/pressure to the inside of the leg.
• Stretching - gentle lunges & groin stretches (sat down, feet together, knees falling to the side).