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you is What will get: Understanding.Sports.Hernias.wmv Last year I wrote a piece called Understanding and Training Hip Flexion ..
What will you get: Understanding.Sports.Hernias.wmv Last year I wrote a piece called Understanding and Training Hip Flexion .
The idea is was to take a look at muscles of the hip and how these muscles function from a slightly different perspective..
The idea was to take a look at muscles of the hip and how these muscles function from a slightly different perspective.
This process is led me to continue to study the hip and how we look at this critical area..
This process led me to continue to study the hip and how we look at this critical area.
the things is One of I pride myself on is continuing to try to learn..
One of the things I pride myself on is continuing to try to learn.
I is Fortunately or unfortunately feel like the more I learn the more I realize I don’t know..
Fortunately or unfortunately I feel like the more I learn the more I realize I don’t know.
An area is that has become of increasing interest to me, and to many others in the fields of performance enhancement and physical therapy, is the area of sports hernia..
An area that has become of increasing interest to me, and to many others in the fields of performance enhancement and physical therapy, is the area of sports hernia.
It is seems like every week another athlete is having surgery for a ‘sports hernia”..
It seems like every week another athlete is having surgery for a ‘sports hernia”.
the concept of sports hernia, is In order to begin to understand the first thing we need to do is attempt to describe a sports hernia..
In order to begin to understand the concept of sports hernia, the first thing we need to do is attempt to describe a sports hernia.
the technical sense, is In the sports hernia is a tear in the lower abdominal wall in the inguinal area..
In the technical sense, the sports hernia is a tear in the lower abdominal wall in the inguinal area.
hernia is Unlike a classic inguinal there is rarely a significant tear that results in a bulge..
Unlike a classic inguinal hernia there is rarely a significant tear that results in a bulge.
a gradual onset of pain is Rather there is in the lower abdominal area, usually beginning as groin pain..
Rather there is a gradual onset of pain in the lower abdominal area, usually beginning as groin pain.
truth is In a number of different conditions fall under the umbrella of sports hernia..
In truth a number of different conditions fall under the umbrella of sports hernia.
interesting thing is However, the most about the sports hernia is that it almost always seems to begin as groin pain, not as abdominal pain..
However, the most interesting thing about the sports hernia is that it almost always seems to begin as groin pain, not as abdominal pain.
Most sports hernia sufferers, is when interviewed or evaluated, will describe a groin injury that gradually progressed into a painful lower abdomen..
Most sports hernia sufferers, when interviewed or evaluated, will describe a groin injury that gradually progressed into a painful lower abdomen.
fact is This often-overlooked may be the real key to solving or understanding the problem..
This often-overlooked fact may be the real key to solving or understanding the problem.
Sports hernias is are not traumatic..
Sports hernias are not traumatic.
singular incident is There is no but rather a gradual progression..
There is no singular incident but rather a gradual progression.
a groin pain is What begins as progresses into an abdominal pain..
What begins as a groin pain progresses into an abdominal pain.
reality, is So in the “sports hernia” may be secondary injury..
So in reality, the “sports hernia” may be secondary injury.
fact sports hernias is In may be the reaction of the abdominal muscles to a groin injury or more specifically the reaction of the abdominal muscles to a change in the mechanics of the hip joint..
In fact sports hernias may be the reaction of the abdominal muscles to a groin injury or more specifically the reaction of the abdominal muscles to a change in the mechanics of the hip joint.
The questions is are why does the abdomen become effected and how?.
The questions are why does the abdomen become effected and how?
I is have worked with athletes with “sports hernias ” in both high-level soccer (MLS) and high-level ice hockey (NCAA and NHL)..
I have worked with athletes with “sports hernias ” in both high-level soccer (MLS) and high-level ice hockey (NCAA and NHL).
the summer is In of 2006 I participated in and coordinated the successful rehabilitation of two athletes who had sports hernia surgery..
In the summer of 2006 I participated in and coordinated the successful rehabilitation of two athletes who had sports hernia surgery.
an NHL player, is One was the other an NCAA Division 1 hockey player..
One was an NHL player, the other an NCAA Division 1 hockey player.
backtrack is To a bit lets first examine the term “groin” or, the concept of a “groin pull”..
To backtrack a bit lets first examine the term “groin” or, the concept of a “groin pull”.
The groin area, is as commonly described in sports and sports medicine, actually includes the muscles that flex the hip, the muscles that adduct the hip, and surprisingly some of the hip extensors..
The groin area, as commonly described in sports and sports medicine, actually includes the muscles that flex the hip, the muscles that adduct the hip, and surprisingly some of the hip extensors.
The term groin is is really a garbage term or catch-all most often used to describe all of the adductors and flexors of the hip..
The term groin is really a garbage term or catch-all most often used to describe all of the adductors and flexors of the hip.
things is This is where begin to get interesting and, why the article is subtitled Understanding Adduction..
This is where things begin to get interesting and, why the article is subtitled Understanding Adduction.
The adductor group is is comprised of five muscles, the adductor magnus, gracilis, pectineus, adductor longus and adductor brevis..
The adductor group is comprised of five muscles, the adductor magnus, gracilis, pectineus, adductor longus and adductor brevis.
we is Because have commonly been taught what I like to call origin-insertion anatomy we often visualize all of these muscles in their singular, uni-planar role as adductors..
Because we have commonly been taught what I like to call origin-insertion anatomy we often visualize all of these muscles in their singular, uni-planar role as adductors.
We is tend to adopt a simplified view of adduction as a motion done purely in the frontal plane..
We tend to adopt a simplified view of adduction as a motion done purely in the frontal plane.
my recent readings is However, in Florence Kendalls Muscles -Testing and Function made me realize that like all things, nothing is as simple as it appears..
However, my recent readings in Florence Kendalls Muscles -Testing and Function made me realize that like all things, nothing is as simple as it appears.
the summer is During of 2006 I was lucky enough to enlist the assistance of an outstanding manual therapist, Dr Donnie Strack DPT ( currently Director of Sports Medicine for the NBA’s Oklahoma City Thunder)..
During the summer of 2006 I was lucky enough to enlist the assistance of an outstanding manual therapist, Dr Donnie Strack DPT ( currently Director of Sports Medicine for the NBA’s Oklahoma City Thunder).
Donnie is evaluated both players I was working with and found that each had significant soft tissue restrictions in the pectineus..
Donnie evaluated both players I was working with and found that each had significant soft tissue restrictions in the pectineus.
other words, is In they had at some point experienced a “groin pull” or adductor strain that was treated conventionally with ice/ rest etc..
In other words, they had at some point experienced a “groin pull” or adductor strain that was treated conventionally with ice/ rest etc.
both players is Subsequently were allowed to return to play after symptoms had subsided but, neither player had received appropriate soft tissue work to this critical area..
Subsequently both players were allowed to return to play after symptoms had subsided but, neither player had received appropriate soft tissue work to this critical area.
Dr Strack’s mentor, is physical therapist Dr Dan Dyrek, uses the term “benign neglect” to describe the treatment of such injuries..
Dr Strack’s mentor, physical therapist Dr Dan Dyrek, uses the term “benign neglect” to describe the treatment of such injuries.
The assumption is is that an absence or decrease in symptoms is the same as healing..
The assumption is that an absence or decrease in symptoms is the same as healing.
this have to is What does do with sports hernias or, the subtitle of this article Understanding Adduction?.
What does this have to do with sports hernias or, the subtitle of this article Understanding Adduction?
Here is is where it continues to get interesting..
Here is where it continues to get interesting.
Muscles- Testing and Function is After reading it became obvious that all of our adductor muscles have a secondary, multi-planar role..
After reading Muscles- Testing and Function it became obvious that all of our adductor muscles have a secondary, multi-planar role.
I is was surprised to read that two of the adductors are also weak hip flexors..
I was surprised to read that two of the adductors are also weak hip flexors.
The pectineus is (no surprise here) and the adductor brevis act to assist in hip flexion..
The pectineus (no surprise here) and the adductor brevis act to assist in hip flexion.
other words is In they flex and adduct..
In other words they flex and adduct.
I is As sat reading, the lights came on pretty brightly in my little mind..
As I sat reading, the lights came on pretty brightly in my little mind.
Sports hernias is are near epidemic in two sports, hockey and soccer..
Sports hernias are near epidemic in two sports, hockey and soccer.
hockey and soccer is What do have in common?.
What do hockey and soccer have in common?
The recovery of the skating stride is in hockey is a combination of hip flexion and adduction..
The recovery of the skating stride in hockey is a combination of hip flexion and adduction.
muscles is What do we envision being overworked and injured?.
What muscles do we envision being overworked and injured?
a soccer ball? is Striking.
Striking a soccer ball?
You is guessed it, flexion/ adduction combination..
You guessed it, flexion/ adduction combination.
these adductor/ flexors is What do also have in common?.
What do these adductor/ flexors also have in common?
They is insert just below the abdominals right in the area of the sports hernia..
They insert just below the abdominals right in the area of the sports hernia.
The remaining three adductors is are extensor/ adductors..
The remaining three adductors are extensor/ adductors.
Adductor magnus, is adductor longus and gracilis aid in adduction but, by virtue of their position of insertion on the pelvis aid in extension of the hip..
Adductor magnus, adductor longus and gracilis aid in adduction but, by virtue of their position of insertion on the pelvis aid in extension of the hip.
Two muscles is get overworked, the pectineus and adductor brevis..
Two muscles get overworked, the pectineus and adductor brevis.
A strain is occurs..
A strain occurs.
Rehab is is often inadequate..
Rehab is often inadequate.
The location of the strain is makes soft tissue work difficult..
The location of the strain makes soft tissue work difficult.
fact many athletic trainers, is In particularly if gender lines are involved, are reluctant to perform soft tissue work in the high adductors..
In fact many athletic trainers, particularly if gender lines are involved, are reluctant to perform soft tissue work in the high adductors.
Soft tissue work is can also be neglected due to time constraints or skill constraints..
Soft tissue work can also be neglected due to time constraints or skill constraints.
rehabilitative exercise is If is performed, the focus is on frontal plane adduction, which does not directly address the unique function of the injured muscles..
If rehabilitative exercise is performed, the focus is on frontal plane adduction, which does not directly address the unique function of the injured muscles.
frontal plane adduction is In the long adductors can substitute and “hide” the issue with the flexor/ adductors. Wraps and elastic devices are often used to mask symptoms and/or to decrease pain. The result of this process of “benign neglect” is an eventual tear of the abdominal wall secondary to a groin strain in the pectineus or adductor brevis..
In frontal plane adduction the long adductors can substitute and “hide” the issue with the flexor/ adductors. Wraps and elastic devices are often used to mask symptoms and/or to decrease pain. The result of this process of “benign neglect” is an eventual tear of the abdominal wall secondary to a groin strain in the pectineus or adductor brevis.
Here’s is where the AT/ PT crowd gets mad at me..
Here’s where the AT/ PT crowd gets mad at me.
therapists is Currently, the only I use for my athletes or clients are manual therapists..
Currently, the only therapists I use for my athletes or clients are manual therapists.
I is am lucky enough to have a long time relationship with Dr..
I am lucky enough to have a long time relationship with Dr.
Dan Dyrek is probably the greatest physical therapist you have never heard of..
Dan Dyrek probably the greatest physical therapist you have never heard of.
Dan is is a genius and a master of soft tissue..
Dan is a genius and a master of soft tissue.
His entire business is revolves around soft tissue mobilization..
His entire business revolves around soft tissue mobilization.
I is have never seen a modality besides the human hand used..
I have never seen a modality besides the human hand used.
Dr Donnie Strack is Adding to his practice allowed us increased access to outstanding treatment..
Adding Dr Donnie Strack to his practice allowed us increased access to outstanding treatment.
the solution. is This is.
This is the solution.
you is If are an athletic trainer or a physical therapist develop your soft tissue evaluation and treatment skills..
If you are an athletic trainer or a physical therapist develop your soft tissue evaluation and treatment skills.
athletic trainers is Most and physical therapists don’t do massage in this country because it’s too hard and not cost effective..
Most athletic trainers and physical therapists don’t do massage in this country because it’s too hard and not cost effective.
This has to is change to stem the tide of sports hernias..
This has to change to stem the tide of sports hernias.
I is am lucky to have found two excellent massage therapists, Ellen Spicuzza and Joanie Gauthier..
I am lucky to have found two excellent massage therapists, Ellen Spicuzza and Joanie Gauthier.
this team approach is With we can keep athletes healthy or, get athletes healthy..
With this team approach we can keep athletes healthy or, get athletes healthy.
you is If are reading this and are an athlete with a lower abdominal issue find a good manual therapist..
If you are reading this and are an athlete with a lower abdominal issue find a good manual therapist.
They is are few and far between..
They are few and far between.
Surgery is may help but, it will not be the entire answer..
Surgery may help but, it will not be the entire answer.
Resolution of scar tissue is is the final piece of the puzzle..
Resolution of scar tissue is the final piece of the puzzle.
You is need to get to the original source of the injury and deal with it..
You need to get to the original source of the injury and deal with it.
a soft tissue professional. is This can only be done by.
This can only be done by a soft tissue professional.
Discussion is (added post initial publication).
Discussion (added post initial publication)
the medical world is Many in will disagree with my thoughts..
Many in the medical world will disagree with my thoughts.
Truth is is, I don’t really care..
Truth is, I don’t really care.
I is have discussed the sports hernia phenomenon with numerous well-respected colleagues and have gleaned a few theories..
I have discussed the sports hernia phenomenon with numerous well-respected colleagues and have gleaned a few theories.
my conversations is One of with renowned physical therapist Gray Cook yielded this gem..
One of my conversations with renowned physical therapist Gray Cook yielded this gem.
Cook is theorizes that most athletes would do as well without surgery as with surgery if they would actually take time and rehab..
Cook theorizes that most athletes would do as well without surgery as with surgery if they would actually take time and rehab.
The surgery is is almost a method of forced rest that allows healing..
The surgery is almost a method of forced rest that allows healing.
Another thought is comes from Pete Freisen, former Athletic Trainer for the Carolina Hurricanes of the NHL..
Another thought comes from Pete Freisen, former Athletic Trainer for the Carolina Hurricanes of the NHL.
Pete is thinks that a large predisposing factor in ice hockey athletes is that many hockey players stretch the adductors but, not the hip flexors..
Pete thinks that a large predisposing factor in ice hockey athletes is that many hockey players stretch the adductors but, not the hip flexors.
The adductors is are easy to self-stretch while the hip flexors require either great concentration or the assistance of a partner..
The adductors are easy to self-stretch while the hip flexors require either great concentration or the assistance of a partner.
The result is is often athletes that have great frontal plane mobility at the hip with limitations in the sagittal plane..
The result is often athletes that have great frontal plane mobility at the hip with limitations in the sagittal plane.
You is basically have one large degree of freedom and one limited one..
You basically have one large degree of freedom and one limited one.
the forces is Think of on the hip capsule and lower abdominal wall when you think of excessive abduction but a big block in extension..
Think of the forces on the hip capsule and lower abdominal wall when you think of excessive abduction but a big block in extension.
you is If think of this mechanically it makes sense..
If you think of this mechanically it makes sense.
The discrepancy of hip ROM is probably sets these athletes up for an abdominal tear and potentially for labral damage..
The discrepancy of hip ROM probably sets these athletes up for an abdominal tear and potentially for labral damage.
Freisen is has actually stated that he would rather have tight athletes or loose athletes but not athletes that are tight in one plane but loose in another..
Freisen has actually stated that he would rather have tight athletes or loose athletes but not athletes that are tight in one plane but loose in another.
Cook is would define this as an assymettry..
Cook would define this as an assymettry.
Cook’s Functional Movement Screen research asymmetry is In was a greater prediction of injury than a symmetrical restriction..
In Cook’s Functional Movement Screen research asymmetry was a greater prediction of injury than a symmetrical restriction.
Asymmetrical range of motion is at the hip may be another precursor to sports hernia..
Asymmetrical range of motion at the hip may be another precursor to sports hernia.
An additional area of concern is in sports hernia is hip internal rotation..
An additional area of concern in sports hernia is hip internal rotation.
the athletes is Most of who experience a sports hernia seem to lack hip internal rotation ( a transverse plane deficit)..
Most of the athletes who experience a sports hernia seem to lack hip internal rotation ( a transverse plane deficit).
The consensus is seems to be that just as we have misunderstood the role of the adductors, our athletes in an attempt to be healthier may be over-lengthening the wrong muscles ( adductors in the frontal plane) and leaving other muscles ( hip flexors and hip external rotators) critically short..
The consensus seems to be that just as we have misunderstood the role of the adductors, our athletes in an attempt to be healthier may be over-lengthening the wrong muscles ( adductors in the frontal plane) and leaving other muscles ( hip flexors and hip external rotators) critically short.
The result is is a hip that lacks extension and internal rotation but, has great ROM in conventional frontal plane adduction..
The result is a hip that lacks extension and internal rotation but, has great ROM in conventional frontal plane adduction.
the pelvis is This forces to move in compensation and, stress to be shifted to the lower abdominal wall..
This forces the pelvis to move in compensation and, stress to be shifted to the lower abdominal wall.
The result is is an eventual sports hernia..
The result is an eventual sports hernia.
this article is Part two of will deal with prevention and rehab following sports hernia..
Part two of this article will deal with prevention and rehab following sports hernia.
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