Help...I've strained my groin, Again.

I am very fortunate to be able to spend day after day working with Mike Potenza and throwing around ideas on how to improve performance, recovery and regeneration qualities for elite level hockey athletes, especially for the groin injury.

For years, the tradition at many sports practices has been to "circle up" at the beginning of the session, and perform a series of static (holding one position) stretches anywhere from 30 to 90 seconds.  As a former athlete and now coach who works with athletes, I have an appreciation for this tradition and understanding that participation in a group warm-up can be very beneficial to a team, with each player knowing that it is time to focus on the practice time ahead. However, the inclusion of static stretches in these warm-ups can not only decrease performance, but also can lead to serious injury.  The vast majority of hockey skills require some type of explosive movement. Whether it is maximal effort slap shots, checking, or sprinting, the stress on an athlete's muscles and connective tissues (tendons and ligaments) is greatest during these very high speed movements. The force an athlete can produce during these movements is not only dependent on the strength of the muscles that are being used, but the elastic nature of these muscles and the connective tissues involved.  Because the "groin" is often a very common muscle group to experience injury, many coaches recommend that athletes spend extra time stretching that group BUT, we've all seen rubber bands that have lost their elasticity, static stretching can turn your muscles and connective tissues into loose rubber bands, permanently deforming your tendons and ligaments. It is important for high speed, explosive movements to keep a certain amount of stiffness in your muscles and connective tissues.

When I talk to our athletes and check for tissue quality and strain in the adductors, I am thinking of the basic mechanisms for cumulative injury. To combat the problem of adductor strains you must first identify and understand the mechanisms involved.  The term trauma may not be accurate but is widely recognized.  Actual trauma to the affected area is not required for this disorder to be present so injury would serve better as a descriptive term.  Cumulative injury disorder is a group of injuries to the muscles, tendons, bones, blood vessels, fascia and/or nerves.  CID results from acute injury, repetitive injury, or a constant pressure/tension injury. 

As I check for these mechanisms I know that the stretching often performed on their own is decreasing the sensitivity of the pain receptors in the muscle and coupled with the constant tension in the the "hips" results in the perfect storm of regular groin strains.  Now that we have decided that stretching is one part of the problem, we have to identify which parts of the hip are the other half of the problem. The culprit is, the major muscles at the posterior hip which are the gluteals, piriformis, gemelli, obturator internus and quadratus femoris. They function together and in similar directions. These muscles are deep and strong.  They change function based on how much the hip is flexed. These muscles are usually involved whenever there is a lower extremity problem that requires compensation of motion, ie:  (the adductors).  The piriformis and gluteus medius become very tight and fibrotic due to the position most common to hockey players.  Reduction of this tension can resolve most of the pain and overuse which ultimately results in adductor strains. Manual treatments of the tight and fibrotic hip has alleviated most of the strain seen in our groin strain athletes.  When looking for manual therapies, the piriformis and gluteus medius should be treated first.  Treatment of each individual muscle should involve isolation of the angle at which the muscle lengthening is maximized over the surrounding muscles.  These muscles change function based on how much the hip is flexed. In the anatomical position they externally rotate the hip and as the hip is flexed past 90 degrees their function changes to internal rotation and abduction.

So, we seem to have finally found the solution to maintaining tissue quality and groin health after all the discussions and analysis of our athletes. Our athletes complete a three-part warm-up before each intense training session. The first is a general warm up to increase circulation and the temperature of acting muscles. The second part is a series of dynamic body-weight movements, done in a full range of motion, including several lunge variations. The third part is myofascial release component using rollers and lacrosse balls especially focused on the deep rotators of the posterior hip. A good rule of thumb is to start at the feet and work your way up the body. This progression will allow you to focus on areas closer to the ground first. For example, if you're tight in your calves, you should stay there longer before moving onto your thighs.

We recommend releasing on a roller or PVC pipe for 10-20 passes over these tighter areas. After all, we now know that your muscles are not the only tissue contracting and may require manual treatments utilizing ART and trigger point reduction for those experiencing "major" issues.