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 email@example.com
Health and happiness!
As an outsider looking in, I have noticed an inordinate number of Achilles tendon injuries at NFL camps (nine the last time I looked) this year. As many try to explain them away as not related to the lockout, I would contend it is precisely due to the lockout that these injuries are occurring.
The Achilles tendon is the longest and thickest tendon in your body. It is made up of two muscles, the gastrocnemius (which is more easily seen and referred to some as the “calf muscle” with its two heads) and the soleus muscle (which is deeper in the body and makes up most of the tendon). They join together to form the Achilles tendon and occupies the bottom quarter of the leg. It inserts at the back of the heel bone (calcaneus). This anatomy makes the tendon a powerful force during accelerations, sudden stops and sprinting activity.
Even though the Achilles tendon is not a muscle, studies have shown that it has contractile properties, so it should be treated as such. Sensible, progressive training principles should be done to help strengthen the Achilles tendon and give it adequate viscoelasticity. Typical training methods, such as resistance exercises, plyometric training and sprint training all provide strength to the tendon, and recovery activities, such as stretching and massage therapy, provide pliability to the tendon (so it will be useful for the next training session). These methods such be put into place for months before full game day activity is attempted.
Struggling to get into game shape with limited training time is certainly a dilemma. If someone asked me (and no one will!) how I would solve this, I would tell them to do less volume daily, but increase the restorative activities. This will do two things, allow the athletes to do more intense work on a more regular basis, because they are recovered fully and also give the athletes a fitness base with the restorative activities such as circuit training or stationary biking. Then, like any fitness program, slowly increase the volume of intense work as the weeks progress. As a podiatrist, I would add two measures in regards to the Achilles tendon: add in some eccentric heel drops, made famous by Alfredson; and of course, to wear some shoes with no heel lift, i.e., Altra, during the day (not during exercise) to provide increased Achilles tendon activity.
Hopefully all the players get into game shape and are able to play the beloved sport of football! Please contact me if you have any questions.
Health and happiness!
I am planning to do several talks to local shoe stores to inform the staff about certain common foot and ankle injuries and how to approach them. Here is a handout of what I talk about:
• Arguably the most common foot complaint
• When first seeing a podiatrist, it has progressed from fasciitis to fasciosis
• Fasciitis is an inflammatory condition of the fascia on the bottom of the foot
• Fasciosis is collagen degeneration with no inflammatory cells present
• Seen in all types of people, but common thread is usually a sudden increase in activity; pain after a period of rest that goes away after 5-10minutes and at the end of the day
• Treatment involves: rest, supportive shoegear in conjunction with therapy that causes an inflammatory response, i.e., aggressive stretching, self-massage, injection (cortisone/anesthesia mixture or just anesthesia)
• Orthotic therapy maintains the healed/healing plantar fascia, along with prevention of any biomechanical abnormalities that caused the condition
• Has become common, especially for individuals who have worn high-heeled shoegear for a long period of time and want to start wearing flatter shoes
• When first seeing a podiatrist, it has progressed from tendonitis to tendonosis
• Tendonitis is an inflammatory condition of the tendon about ¾ inch from the back of the heel bone
• Tendonosis is collagen degeneration with no inflammatory cells present
• Pain is present after a period of rest that goes away after 5-10 minutes and with increased activity
• Treatment involves: rest, supportive shoegear in conjunction with therapy that causes an inflammatory response, i.e., Alfredsson stretching protocol, aggressive cross friction massage
• Orthotic therapy maintains the healed/healing Achilles tendon and may incorporate a heel lift to decrease stress upon it
• A condition mostly due to biomechanical abnormalities
• It is an inflammatory condition of the capsule (sheath surrounding the joint with nerve and artery supply)
• Pain usually in the ball of the foot, is mild in the morning, but increases as the day continues and is usually sharp in nature with no radiation.
• Mostly like to compensatory overload of the second metatarsalphalangeal joint, due to inadequate functioning of the first ray (i.e., too short, too long, too stiff, etc.)
• Treatment, involves rest, supportive shoegear and use of adequate orthotic therapy that restore normalcy to the first ray joint.
Happiness and good health!
- About Armstrong Podiatry
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