A common misconception is that coaches and personal trainers live their lives without any musculoskeletal issues. Free from niggles or injuries and blissful in their pain-free existence! Watching a coach demonstrate a deep squat or a perfectly executed scapula push up gives the impression that they move so well that injuries must be uncommon for them. This, however, is not the case and coaches, given the nature of their active work, can present with frequent issues that require attention.
Following Eric Cullinane’s monthly blogs on bulletproofing coaches the next coach I would like to discuss will be Daragh.
Assessing Daragh's Groin Issue
Daragh is a Personal Trainer, S&C coach for The High School, and is a formidable back-rower with Terenure 1st XV. Like all other coaches his week is filled with physical activity through coaching classes, individual strength work, and preseason rugby training. Additionally, Daragh has been exposed to a number of injuries and niggles across his rugby career.
He presented to me with :
Pain along the front and side of his hip.
Discomfort felt through the groin and lower back whilst running.
Felt gluteus muscles were constantly tight.
Assessing Hip ROM (IR/ER/Abduction/Adduction)
Assessing Hip Adduction strength (BL groin squeeze/ SL bent knee/ SL extended knee)
Assessing Hip Abduction strength (BL extended knee)
Palpation of the Adductors
The main findings were the following:
Tenderness palpating the proximal groin, adductor brevis muscle (the area Daragh felt was causing him the most pain).
Weakness and “cramping sensation” upon resisted adduction of the left leg compared to the right.
Tenderness and reduced muscle length in the left hip flexors and internal rotators. Recent research by Igor Tak et al. 2017 found that athletes with lower than 85 degrees total rotational hip range of movement have a high risk for developing groin pain. Daragh’s total rotational hip range was 70 degrees, therefore a target area for improvement.
No difference in groin flexibility
The adductors, hamstrings, hip flexors, glutes, and lower abdominals must all work in unison to provide stability to the groin complex, a concept known as force closure. Therefore the aim of the exercise program is to build tissue resiliency of all the muscles in that region to develop a strong and bullet-proof groin complex. Recent research has found that athletes with weak adductor muscles are 4 times as likely to sustain an injury.
This groin pain rehab program commenced with light isometric loading of the adductors to minimise pain and decrease the sensitivity of the tissues in Daragh's groin. He then progressed to exercises that subject the groin to higher levels of load, faster speeds, and multi-planar movements.
1. Seated hip Internal Rotation stretch
Place opposite leg over to enhance the stretch. Hold this for 10-15 seconds, repeat 5 times each leg.
2. Side lying adductions
The goal is to ramp up as strong as a contraction as you can, but keeping it just below the threshold when you begin to feel pain in your groin.
3x6-8 reps each side (5 second hold at the top)
3. Foam roller squeezes
Keep a strong contraction just below the point where you begin to feel pain in your groin.
Glute bridge 2x5 with 5 second holds.
Supine straight leg 2x5 with 5 second holds.
4. Copenhagen plank- Bent knee
A study by Harøy et al, 2019 found that adding Copenhagen planks to a warm-up decreased the risk of groin injury by 41% in a group of semi-professional soccer players. This exercise allows for high activation of the adductor longus muscle, as well as considerable eccentric adduction strength gains of the groin complex.
Daragh's Rehab Plan
It was important to discuss Daragh’s high training volume and see if there were areas to add active recovery/mobility sessions into his week. I asked him to avoid stretching the groin, top-end sprinting, and any rugby training for one week – and then grade it back into his program depending on overall symptoms. As the symptoms started to improve and groin strength matched that of the opposite leg, we added in the Copenhagen plank. I assured him the pain in the adductor brevis muscle would dissipate with compliance to his rehabilitation program and avoidance of all known aggravating factors.
Please note: The above exercises were prescribed following a detailed assessment of Daragh's groin issue but can provide benefits to those as part of an active warm-up or training session. However, they are not the solution to all problems. If you think you have a problem with your groin, we advise you to see a Chartered Physiotherapist to get it checked out and given a tailored rehab programme for your specific issue.
Find Out More:
If you need advice, a physiotherapy assessment or feel your team/business could learn more about workplace ergonomics, contact Kathryn at email@example.com or visit www.ffs.ie/physiotherapy.
About the Author:
Kathryn Dane is a Chartered Physiotherapist working with FFS Physiotherapy, a practice based on Leeson St Lower. Chartered Physiotherapists have specialist knowledge in the field of work-related injury management.
She also plays for the Ulster Senior Women’s Rugby team and Irish Senior Women’s rugby team.
If you need advice or a physiotherapy assessment, contact Kathryn at firstname.lastname@example.org or visit www.ffs.ie/physiotherapy.