Groin Pain - Physiotherapy and Focused shockwave therapy

Do you suffer from pain in your groins? Does the pain shoots to your abdomen, hips of legs? In following lines we will try to describe you the problems connected to groins and we will offer you a solution which leads to fast and long lasting relief. At the same time we will explain how to prevent the formation of recurring problems.

THE CAUSE OF THE PAIN

In adulthood the pain in the area of the hips various causes. Those are especially:

  • Injury (pulled, rupture of the soft tissues)
  • Damage of the soft tissues (muscles, joint capsules, cartilage, ligaments, tendons, etc.)
  • Wrong coordination of the deep stabilizing system (muscles cooperating on keeping the trunk against the gravitational force) with overloaded surface muscles in the area of the stomach and thighs
  • Osteoporosis (damaged cartilage and joint bone)
  • Excessive physical burden causing increased friction of the joint surfaces and increased muscle and tendon tension

The cause of pain in the area of groins is usually caused by their overload, by either wrong and often high burden (football players, ice hockey players), or by a muscle trauma (falling off of a bicycle, car accident etc.). If you leave the injury untreated, the elasticity of the muscles lowers, and during a sudden stretch the ligament fibres can get torn, the transition between the tendon and muscles, tendon alone or rarely also the attachment of the tendon on the bone.

The attachment pain, the so called enthesopathy most frequently affects adductors of the hip joint.  It is a group of muscles going from the pubis bone and attaching from the inner side of the thigh bone all the way to the knee joint. Adductors are flexing the legs against each other and at the same time they function as a outer rotators  - they rotate the leg outwardly. Following muscles which are usually disabled are front quadriceps and short muscles in the area of the hip joint.

DIAGNOSIS

In order to examine the soft tissues it is deal to use ultrasound imaging method, which can reveal the rupture of the muscle, hematoma but also overloaded soft tissues. Very optional method is also MRI (magnetic resonance), but for its financial costs is not very often used. The base is a quality clinical examination evaluating by touch the resistance of the soft tissues, the range of mobility etc.

MANIFESTATIONS OF PAIN

Subjectively one can feel strong pain in the groins in the area of the muscle attachment by the pelvis. The pain can shoot either to the abdominal area or it can go through the inner side of the leg down towards the ankle joint. Objectively there is a restriction in a range of mobility in the hip joint, especially during the outer rotation (rotating the leg outwardly) and adduction (flexing the hip joint).

These problems can be accompanied also by changes in the body posture, such as anteversion of the pelvis (tilting the pelvis forwards with a significant bend in the lumbar spine) or valgosity (X shape) of the knees and ankles, which can even result in flat feet.

But in case the front thigh muscle was disabled, the pain will be localized more in the front part of the thigh all the way to the knee and patella. Painful on touch will be the upper part of the muscles by the pelvic bone. The pain can be also accompanied by contraction in the knee and pulling the leg from behind.

In case the short muscles in the area of hip joint are disabled, the hamstring muscles, the problems can manifest by significant pain in the area of the sitting bones with a restricted and painful bow.

Traumatic injury of the groins occurs usually as a result of long-term overloading of the adductors of the thighs, during which there is a partial or complete rupture of the muscle by the attachment of the pubis bone. It is manifested by a sharp pain in the area of the groins, which can shoot to the lower abdomen and inner side of the thigh. It is very sensitive on the touch.

TREATMENT BY A DOCTOR

The doctor will ordain you to keep a peaceful regime for several weeks, you can't do any sport activity, you will be recommended to apply ice on the affected area, alternatively he will prescribe you pain killers, pills to reduce the swelling etc… In acute phase it becomes necessary to keep a peaceful regime and apply ice on the affected area as a prevention against swellings.

WHAT CAN MODERN PHYSIOTHERAPY DO?

Unfortunately, if you won't move your leg at all for several days, there is a risk of reflexive contraction of the muscle structures which leads to shortening of the muscle. Therefore it is ideal to continuously and gently stretch the thigh adductors, and use the soft tissue techniques also preventively against the formation of reflexive changes leading to higher muscle tension in the area of the pelvis, spine, knee joints and joints of the feet.

Significant role in this case has a function of the diaphragm, pelvic floor and oblique abdominal muscles. Their activity or imperfect function can be the cause of these problems.

Stretching GroinsStretching Groins slideStretching inner thighs and back

Incorrect or insufficient stabilizing function of the diaphragm and other muscles and muscle groups of the deep stabilizing system (muscle involved in the keeping the trunk in a straight position) can lead to overloading of the surrounding, but also distant  muscles, which can result in incorrect burdening, dysbalance and uneffective movement. We prevent this by exercising the dynamic neuromuscular stabilization. Correct function of the diaphragm, pelvic floor, abdominal oblique muscles and muscles around the spine can keep the trunk in a stable position, which enables the rest of muscle groups effectively use their force. Setting correctly the centered position (position without muscle dysbalance) of the big joints (shoulder and hip joints). In result, the body is able even during a bigger physical burden to work without overloading certain muscles or muscle groups, and that increases the physical performance.
Another effective method is sensomotoric stimulation, which can correctly activate the muscle groups around the big joints in the legs and muscles around the spine, that results in economic and coordinated control of the movement.

 BOSU Exercise1Rotating on the sidePlank on BOSUintraabdominal pressureKneeling on gymballscissors

Treatment with the help of focused shockwave therapy (ESWT)

In therapy of painful groin we successfully use extracorporeal shock wave therapy (ESWT), in other words focused shockwave therapy, and it can be used also in an acute stage, directly after the injury. Application of ESWT directly in the problematic area quickly stimulates the natural repairing process of the body - activating the cell metabolism and outflow of inflammatory substances. The affected area will start to heal 4 times faster, than it would without the application of the shockwave. ESWT can stimulate even formation of new capillaries, which will quickly start to support the affected area and muscle with blood circulation and accelerate the regeneration process of the tissues. In acute stage it is possible to apply the ESWT in intervals 3 - 5 days, by chronic problems the interval can be longer, 7 - 14 days.

In the area of the thigh, calf, buttock and abdominal muscles, can appear reflexive spasms or increased tension, it is ideal to apply radial shock wave therapy. Its effect is not focused directly into one spot, but it penetrates deep into the soft tissues, and the wave spreads even to the sides. For this reason it is optional to apply it into the surrounding soft structures, which have a functional relationship with the affected area, or to the areas where the reflexive changes appear. Radial shockwave therapy is possible to be applied every 3 - 5 days. We call the combination of physiotherapy and application of the radial shockwave Physiotherapy All-Inclusive.

Ideal addition to the treatment method is a mechanical lymphatic drainage, which can activate the lymphatic system. In area of the problems is then no accumulation of the lymph, which would cause pressure on the blood vessels circulating the oxygenized blood and nutrition into the tissues. Thanks to that, the legs do not swell, and the joints are more mobile.



Author:
 FYZIOklinika physiotherapy Ltd., Prague, Czech Republic

Source: Clinical experience in diagnosis and therapy with use of focused shock wave therapy; Kolář, P. et al., Rehabilitace v klinické praxi, Praha: Galén, 2012, ISBN: 978-80-7262-657-1

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