I had an opportunity to contribute to a friend’s webmagazine (hurdlesfirstbeta.com) the other day in regards to “groin” strains. There are many ways that people look at it, but it is a reminder of how each body part works in unison with each other.
The “groin” is a catch-all term, referring to five muscles in the inside of the thigh. Their major function is to bring the leg towards the midline of the body (adduction). Injuries to these muscles are usually due to these muscles doing more than they can handle, as a large component of their activity is postural in nature (keep the body upright). This excessive activity is due to muscular imbalances and faulty body positioning elsewhere in the body.
Tight hip flexor musculature (lifting the leg and thigh up at the hip) is something I find all too common with patients, specifically the iliopsoas muscle group). This can be created by prolonged sitting, bad postural (forward lean) when walking and of course, the dreaded high heel shoegear. These can all make for an overworked iliopsoas group, which causes it to become tight.
Two muscles that make up the “groin” have a lesser function in hip flexion also. If the iliopsoas is not able to perform its usual function, these muscles become the primary hip flexors. This increases its muscular activity, making it more prone to strain/injury.
Another result of an overworked/tight iliopsoas muscle group would be its effect on the pelvic bone. Because of their attachment to the pelvis, its tightness causes the pelvis to tilt, lengthening some other muscles attached to the bone, i.e., the hamstrings (muscles at the back of your thigh). The hamstrings changes from a primarily postural muscle to a hip extender (bringing your hip and thigh down), as the gluteal muscles (“butt” muscles) loses this role and its resultant strength via pelvic positioning. In addition to the hamstrings, three other muscles of the “groin” become hip extenders. These muscles are prone to become overworked, due to their increased activity.
Treatment of “groin” injuries involve the usual rest, compression and elevation. But the emphasis should be on not forcing these muscles to be overworked. Hip flexor stretching, along with soft tissue release can help with the tight iliopsoas muscles, in addition to flatter shoes, more erect posture when walking and lesser sitting. Abdominal exercises will help tilt the pelvis properly; variety is the key (the regular crunches do not work the right muscles and are not recommended). Lastly, exercises that focus on the gluteal muscles will help it regain some of its strength, i.e., Deadlifts, Romanian Deadlifts, Hip thrusts.
Please feel free to contact me if any questions at firstname.lastname@example.org
Health and happiness!
Recently, I have been seeing lots of blog articles about shin splints, which I believe have been rather generic in nature. I would like to submit my thoughts about the subject, which are a little more unique in nature.
“Shin splints” is a common problem, affecting athletes of all ages. The pain in the shins can be gradual in intensity and debilitating in nature. It can be an injury that gets worse and could lead to a stress fracture.
“Shin splints” is really a “catch-all” terms that refers to pain on the inside of the shin bone (tibia). It really seems to be caused by tension of three muscles on the fascia of the bone. This friction between the muscles and the fascia causes an inflammatory state (fasciitis), which can occur during walking or running. If this inflammation continues, the bone could get involved, and you can get periositis (inflammation of the covering of the bone) and then potentially a stress reaction/fracture of the bone itself.
Like any overuse injury, the adage, “Doing too much, too soon”, certainly applies to “shin splints”. The body that is unaccustomed to increased stress will breakdown. It is usually seen in overweight individuals who are beginning to run as exercise, especially on hard surfaces, i.e., sidewalks. The pain appears when starting out for a run and gradually disappears, only to reappear after the run is complete. The pain can usually be replicated by hopping on the affected side.
Individuals prone to this injury may have either a “flat foot” or “high arch foot”. A “flat foot” already has increased tension of two of the muscles involved in “shin splints”, in addition to increased internal (turning in) rotation of the legs. Running or walking places increased force on the feet, exacerbating the “flat foot” position, i.e., increasing the muscular tension and internal leg rotation. A “high arch foot” places tension on the other muscle involved in “shin splints”, in addition to the commonly restricted ankle joint motion. This type of foot is rigid and running/walking activity creates more forces, leading to more pressure on the foot and more muscular tension.
Treatment and prevention of this injury involves a multifaceted approach. The key is that the inflammation must be reduced and controlled. One way to do this is the usual ice, rest, compression and elevation; the other way is by reducing the tension of the affected muscles causing the inflammation. I usually do both of these and tailor the treatment plan according to the individual. To reduce the muscular tension, an insole or even an orthotic can be used to allow the affected muscles to “rest” for up to six to eight weeks. Activity modification is also emphasized, i.e., limited exercise-related weightbearing activity.
Individuals with “flat feet” can benefit from hip strengthening exercises, specifically hip abductor strengthening (http://runninginjuryclinic.com/resources/exercise-videos/), short foot protocol (http://vimeo.com/43187129) and intrinsic foot exercises (http://www.youtube.com/watch?v=2OOJ9AQ1AEg). Individuals with “high arch feet” benefit from hip strengthening exercises, specifically hip adductor strengthening and calf muscle stretching. These exercises work to reduce tension on the affected muscles, by mobilizing and utilizing other ones. Once inflammation control is achieved, a slow gradual return to activity from low stress, i.e., short job to high stress, i.e., hopping, jumping.
Of course, prevention is the key for “shin splints”. It is important for beginner runners to follow a structured workout plan, conceived by a knowledgeable running coach. Running on softer surfaces is also recommended, in addition to flatter surfaces.
As always, if you have any questions, please contact me.
Health and happiness!
Injuries have always played a part in any physical fitness activity. That sore shoulder after playing softball during the summer or that painful heel after running twelve miles during the weekend are prime examples of injuries. These injuries can be due to a number of factors: training mistakes (“doing too much too soon”), muscle-tendon imbalances, improper shoegear, abnormal biomechanics (the functional motion of the body), anatomic malalignment and nutritional factors, to name a few. With the continuous presentation of any or all of these factors upon the body in explosive (throwing a ball) or repetitive (running long distance) activities, anyone can and will get injured
How does this happen? All these factors lead to a wear and tear of the body’s tendons (fibers which connect muscle to bone), ligaments (fibers which connect bone to bone at a joint), muscle, skin, bones, fascia and joints from the explosive and repetitive nature of the body’s motion. By applying these forces upon the body, the body reacts by breaking down. Let’s take the classic model of an unfolded paper clip.
By bending the paper clip back and forth upon itself, you are applying a loading and unloading force upon it. This can be seen in individuals that has “soreness” in the shoulder, foot, etc., after an activity. If you continue to apply the same force ad infinitum, eventually the paper clip will break apart. This is when the injuries are called, “overuse injuries”.
The breakdown of the body is seen by the process of inflammation, a complex response defined by pain, redness, swelling, heat and lack of function. Initially, the inflammation is acute with increasing signs of these characteristics, but with overuse injuries, the inflammation is chronic or longstanding. Why? Acute inflammation usually takes about two to three weeks before the pain, swelling, etc., disappears, but in overuse injuries, the inflammation is still present, but not as obvious as the acute variety. Chronic inflammation leads to a weakening and/or destruction of tendons, ligaments or bones. This is mostly seen as scarring in the soft tissue, making it more prone to reinjury. That is why it is so important to rest any injury in the acute phase, before it becomes detrimental to overall health and fitness. And furthermore, it can avoid THAT visit to the doctor! It is the chronic inflammatory injuries that I specialize in, and will discuss treatment plans and modalities, along with preventative measures in future entries. that may be of benefit to any injured individual, primarily in the foot and ankle. Of course, the best way to get treatment for your condition is to see a medical professional! Feel free to contact me if you have any questions at email@example.com
Happiness and good health!
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