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Groin pain

The patient may complain of a mild ache in the sacroiliac joint, which may worsen when performing particular movements, therefore limiting sporting activity. Sometimes the patient may also complain of a “click”or “cluck” noise coming from the hip.

Usually there is evidence of an acute trauma or microtraumas over time, responsible for a painful contracture that simulates an articular problem on the hip or a visceral pain, that which leads the patient to undergo a series of internistiche consultations. Pain can irradiate up to the groin.

In sportsmen the iliopsoas muscle and tendon are commonly responsible for many cases of groin pain. The ileopsoas is an internal muscle of the hip that flexes, abducts and externally rotates the head of femur. It originates from the lateral facets of the first four lumbar vertebrae and from the iliac joint, and inserts on the lesser trochanter of the femur. This is a bilater postural muscle which is typically under greater tension amongst individuals with accentuated lumbar lordosis.

The diagnosis is usually clinical, and is based on muscular tests to determine resistance and palpation. Sometimes, additional examinations are required to exclude a possible muscular injury (MRI scan) or the involvement of the coxo-femural articulation (X-ray).

Treatment is universally conservative and it is based on specific myofascial massage in addition to relaxing muscle massage on the other muscular districts that are usually involved, postural and stretching exercises, selective tonification of the psoas and synergistic muscles.

It is also very important to integrate therapies in the gym with a vertebral manipulation that can address possible failures in the articulation of the pelvis.

Groin pain rehabilitation

In the scientific literature there are at least 72 cases of pubic pain, but the majority of these can be identified as a syndrome of functional imbalance of the muscles underlying the basin.

The patient with groin pain is often demoralized due to inactivity, the pain and the lack of decisive action; the solution is almost never surgical. It is important, therefore, in this disease more than in others to perform a careful medical examination and a precise diagnosis which goes to investigate the real cause of the functional imbalance.

Rehabilitation treatment for this kind of pubic pain aims normalization of joint and miotensive structure and the global functional recovery of the basin.

The first phase of rehabilitation focuses on the elimination of compensation and the treatment of any contracture, trigger points and muscle contractures through relaxant massage therapy, depending on the clinical picture, the knee flexor muscles, medium and large buttock, lumbar paravertebral, quadratus lumborum, adductors, quadriceps, iliopsoas myofascial, reflex piriformis and through postures and prolonged stretching of the above muscles. It is appropriate at this stage to start aerobic activity as early as possible (stationary bike, elliptical, treadmill roullant) because groin pain exacerbates with inactivity.

Once the muscle retractions caused by the compensations are solved and the mobility is recovered you can start the middle phase of the rehabilitation protocol, that of muscle rebalancing through strengthening exercises predominantly eccentric abdominals (rectus and oblique), the adductors (including manual), flexors, gluteus, iliopsoas, quadriceps and very important your core muscles with progression from bodyweight exercises until the use of unstable surfaces and Bobath balls. The goal is to stabilize the pelvis by stretching and strengthening the muscles and tendons that underlie the movement of the same.

After you rebalanced the muscles  and started the run on the tapis roullant you can move to the third and final phase of the rehabilitation protocol: that of the recovery on sports field. It is the most delicate phase of treatment because you can witness a steady improvement in muscle strength, but when performing the sport specific gesture you may experience discomfort in the affected muscles. Conceptually, the athlete should get to do more physical activity on the field with the same annoyance and then, thanks to the right mix of unload (through massage) and reconditioning (with exercise targeted), the pain should decrease gradually.

It is fundamental to follow the feelings of our patient and be based on the modular work in the gym and on the field. Only through teamwork between the patient, trainer and therapist you can get to progress with loads, regain movement and the specific athletic movement.

At discharge it is essential to run the home program of specific exercises for the management of the return team and prevention from re-injury.

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