why won't my groin adductor injury heal??

Hi all,

July 2011 i injured my groin, it was my fault i had rapidly increased my running but boy do i regret it now.

at the time went to local well renowned sports physio- he was light hearted about it, gave me electric laser treatment and used metal scraper implements to promote healing and said i would be back running in 2 weeks.

Same low dull ache any time i tried a small light run. Could walk ok, and minimal aggravation if i use an exercise bike to keep fitness up.

As it wasnt getting better he referred me for ultrasound-didnt show up anything abnormal, and then i saw a consultant specialist who sent me for MRI scan - waiting weeks/months for each appointment all the while all  i am doing is exercise bike.

I have the MRI which the specialist says shows 'stress changes at the adductor insertions', he thinks this is good news and recommends further conservative treatment.

Back to physio - he now gets me doing resistance band drill for a month which i stick to. No improvement.

Physio then refers me to a podiatrist who i saw 3 weeks ago. He gets me doing rotational luges, balancing on each leg and a hip flexor stretch. On advice from a poster on here i also started doing core stability work - planks,sideplanks, bridges etc.

I notice a difference to my abs but the same low vague dull ache continues at my right groin!!!Aaaargh. To be fair to the podiatrist i thought that doing his exercises had initially helped but the pain seems to have just come back - possibly due to upping resistance levels on exercise bike on 1 gym session. Next time i see him in 2 weeks he says he hopes to analyse my gait and fit me with orthodics as he thinks i may have slight functional diference in leg length as i throw my right leg out a bit when i run.

Now 9 months since i last ran and really going up the walls. Why have i been to all these professionals and no improvement has occurred (not say a drain on my finely balanced finances). Am i likely to ever run again?? Is it not true that the longer the injury remains the harder it is to repair?? Im male, eary 30's btw.

Any advice appreciated

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Comments

  • RicFRicF ✭✭✭
    Ok, the dull ache you feel is the mechanism of muscle recruitment at work. The way muscles work is that for any given load only a few of their fibres are working. The more work you do, the more of the fibres are brought into play which is the principle of endurance training. The dull ache is the feeling you get when new muscle fibres are brought into play. Essentially they are lazy gits and are complaining about doing some work. Its the really sharp pain that is to be avoided. As you do more work the dull ache takes a little time to appear during your workout, so at first you feel nothing and then it gradually appears. Its just a balancing act really. Just jog along through the dullness and one day it won't appear at all.
  • Thanks RMcF i appreciate your answer,

    I have the low dull ache all the time though, virtually 24/7, and i havent ran in months. Any time i tried a run the pain/discomfort/soreness levels increased fairly quickly, and next day the dull ache would be substantially higher a take a few days to settle down to previous levels. Although i havent tried a run in ages i suspect it would be hard to carry out through the soreness thresholds.

    Its also a vague pain - it moves about, sometimes its the top of front of my thigh that has it worse, other times its right inside the leg??

    Does any of this mean any thing ?

    Thanks again 

  • RicFRicF ✭✭✭
    Damn! a move about job. I have the impression that either such things are caused directly, i.e by a fragment of some sort floating about, or by some kind of nerve problem. The nerve itself isn't damaged but the structures around it may be. Movement inflames the structures which puts pressure on the nerve. I'd be doing my best to ice this area at every opportunity. Good luck, this injury sounds like a right sod.
  • Parklife, I totally sympathise with you.  I'm 9 months in with AT, no running and no sign of it going away after various treatments.  To make matters worse, I have also been diagnosed with a laberal tear in my right hip (had the same thing repaired several years ago) and am booked in for an op in a couple of weeks.  Are you sure your injury is a groin adductor strain?  By the way you describe it, partic the dull ache most of the time, does sound quite like a laberal tear?????  Is the pain worse when you sit or drive, like a pinching pain deep in the groin?  I'm not sure how my AT is going to stand up to several weeks on crutches as the bad achilles will be the weight bearing one image, suppose it can't get any worse!!!!
  • Thanks again for the response lads and or lasses

    RicF - Im icing the area right now as i type to try out your advice to see how this goes! Can you think of anything else that might help like any particular ttype of exercise?? Sorry to go on but i will try anything.

    Hi Bumble - after the mri scan the specialist doctor consultant said it was 'stress changes at the adductor insertions' so i have to go by what he says i guess. It is a little more noticeable when i drive or sit down, but cant really say its a pinching pain, just a vague dull soreness that gets worse when i try to run. Sorry to hear of your problems, being injured is completely crap isnt it, it is tormenting me! Especially as no light at the end of the tunnel.

  • Parklife

    Does it respond to anti-inflammatory medication?
    Have you and the consultant considered a steroid injection to aid the healing?
    As RicF said it may be that with the best of intentions your exercises are making you worse. Unfortunately some of these groin/adductor injuries can be very resistant.
    Also have to consider other diagnoses - sometimes MRI is not always that good. Things can be missed or just not picked up.
    Have a look at a condition called Femero-acetabular impingment (FAI).

    I would have a chat with the consultant about a steroid jab to see if that helps - this will also help with diagnosis. Other option is to consider injecting the hip with an anaesthetic to see if that takes the groin pain away. Need to determine where the pain is originating - hip, adductor, back?

    Hope that all makes sense

    Greg
  • Thanks Greg i will have a good look at that condition you mentioned.

    Anti Inflamatories dont seem to touch it. The consultant has said that should conservative treatment not work then he will consider other options like cortisone jab or even surgery. Am very reluctant to go down either of these 2 routes as i understand that cortisone may take the pain away but not actually solve the problem.

    I thought my physio was pretty unfocused to be honest, the more i research the more i realise that at know time did he try to establish the actual movements or muscles that are causeing pain and treat specifically for that.

    I think the podiatrist has been much more on the ball to be fair, and i think his hip flexor lunges may have been working initially but then i got carried away and did too much. Have to setle it all back down and stick to his programme.

    Thanks again for your interest i will post any updates!

  • Gutted, I had been to the podiatrist i felt his exercises were helping - rotational lunges etc - and he suggested a phased return to running.

    All the while i felt my right injured groin had improved, though it didnt feel the same as my good left groin.

    Anyway, when i got to 20 mins gentle running - I bloody well broke down again, physically and emotionally.

    Now 10 months injured and no sign of an end to this. Now got to the point where i am thinking of this effing injury every hour of every day and seriiously affecting my outlook on life.

    Same symptoms over 10 months. Seems to me that conservative treatment has failed. That said, im still not convinced that the physio ever did an indepth asssessment of me, and he was a bit gung ho with treatmet exercises, me being the one having to tease out how many sets of each exercises on how many days etc.

    Seeing the consultant specialist next week. I wonder whatll he'll suggest - possibly cortisone jab.

    I cannot believe that such a seemingly innoculous injury at the time has left me in this state for this length of time with no end in sight. Will i ever run again?? will i ever be able to do a marathon again?/ will i ever get rid of this dull ache in my groin??

    Any suggestions/hints/advice or stories about all ot this, and/or from anyone who have had a cortisone jab gratefully received.

    Thanks!

  • RicFRicF ✭✭✭
    I'm wondering if the breakdown isn't actually scar tissue giving way under loading. Minor by comparison, I've been bothered by some injury problem for around 10 or 12 weeks. I'm finding that apart from the initial trauma, as I build up the training from a position of apparent recovery, there's stages where 'something lets go' and then its a case of adjustment until I can start the process over again. I have the feeling that the set backs are becoming smaller and in time will disappear completely. The big difference between my injury and yours is that those groin type injuries can take ages to sort. If its any consolation I'm convinced that the 'breakdowns' are just part of the healing process rather than the injury being repeated. Feels the same mind.
  • Thanks lads -

    I kind of have been a combination of biking and if not pilates then core work over the past several months. The exercise bike is good but i wonder sometimes if that is aggravating my groin just a tiny bit.

    R McF when i get one of those breakdowns should i rest it at that point or carry on with a gentle running programme??

    Thanks for your interest

  • RicFRicF ✭✭✭
    Sometimes its a case of backing off the loading until whatever exercise you are doing doesn't aggravate the injury. Bearing in mind that at times I've run over 100 miles a week and cycled 3 times that also, I've also had to back off training to absolute zero in order to determine that the injury is getting better rather than just sitting there. An extreme example of this were two international runners who after battling against injuries for years decided to retire. About six months later, both of these guys realised that they didn't hurt any more. Tried a bit of training and found that they had a new lease of life.
    I'm fortunate in having alternative pastimes that don't require physical effort.
  • Hi Parklife!

    Reading this is kinda like looking in a mirror! As you, i also pulled my groin in July 2011 and since then the pain has not gone away.

    Im getting that dull ache pain you mentioned (more so when sitting) and when i actually press down on the area it hurts like hell!! The main area it hurts is on the left side of my groin and the pain sometimes goes across the pubic bone and down the right.

    I went to my GP who told me to rest for a few weeks, so i did, but after 6 weeks nothing was happening so he then sent me to physiotherapy. The physio pulled my leg about and cracked my back a bit and used an ultrasound stick thing. After 6 sessions of that the physio said he could do no more and said i should go to see a specialist. After a cock up with the paperwork it wasn't until 4 months later I actually saw him and he sent me away to get an ultrasound scan done. I'm due to see him next week for the results of that, but he mentioned to me that he may do a cortisone injection, which to be honest i'm not really looking forward to!

    In the meantime all this is happening, im actually meant to be joining the Navy in a few months time!! So speaking to the GP he said its OK for me to run. So back in January i started running again (slow at first) but the big thing is that im OK when i run! Iv started doing sprints now, so i shall see how i get on with those.


    Hopefully we'll get there in the end mate image
  • Hi Parklife,

    Where do you live? It might be worth finding a local, reputable massage therapist to have a look at the injury (I'm not a big fan of electric laser treatments etc - how does the therapist feel what he's doing?). 

    Maybe get the massage therapist to take a step back & look at your hips and legs as a whole, as I often see the pain is the symptom of an overall problem.  Working towards the overall problem can address why this symptom is not shifting despite your efforts. 

    Amit
    SKA Remedial

  • Interesting postings.   Recently begun having pain in my hip, been to the physio and that has helped but now i have pain n my left groin.  not sure how to get rid of it but sitting down and then walking makes me limp kind of.  

    Tried to see what exercises are on the web especially for hip/groin strain etc, not a lot out there.

    I have rested but it seems not to go away as it were.

  • Bad Luck Parklife

     The body is great at getting itself better, as long as its given the opportunity too. If you destroy more cells in a day than you produce you wont get better....obviously.

    From reading the ins and outs I think Id be keen on seeing what you haven't had done, rather than what you have had done - you can only wiggle a piece of tissue around and call it lots of different things, but it's still a wiggle.

    Your consultant will reasonably think that you've failed at conservative intervention; whether you had the right stuff done for the right reason is the unanswered bit. The MRI tells you where, but not why.

    Lots of other things (apart from steroid) can be squirted around. Make sure you ask the right questions....why steroid, not PRP, autologous blood, large volume, dry needling....

    image

  • Have you considered a 2nd opinion on your initial adductor diagnosis?
  • Hello All,

    I am also suffering from this injury, for the last 15 months with very little relief. I am at the point where I can't even walk more that 5 blocks without it flaring up. I have had a labral tear ruled out and have been told I have a severe adductor strain. After 9 weeks of physical therapy, I am now being referred to a different therapist and an orthopedic surgeon. I have not been able to run, hike, or bike for the past 6 months. It has gotten much worse since I started a new job in October where I sit in a cubicle all day long. Sitting is the worst. My physical and emotional health has never been so poor in my life. I am only 28 and I feel like I should be enjoying my life, not feeling so sad and frustrated every day. I sympathize with everyone going through this issue. I hope to see some light at the end of the tunnel soon! 

  • PhilPubPhilPub ✭✭✭
    Physio in Blackheath wrote (see)
     Have a look at a condition called Femero-acetabular impingment (FAI).


    +1.

    From scanning through this thread I'm not sure whether a correct diagnosis has actually been made?  At the very least my recommendation would be to get a referral to an orthopaedic surgeon.  I was diagnosed with FAI after a series of physio appointments and scans including x-ray and MRI which didn't show anything.  No amount of resting or exercises is going to change an underlying condition which essentially involves lumpy bone rubbing against and inflaming cartilage; not that this is necessarily what is going on, but unless it's ruled out you may not make much progress.

  • bionic-hipbionic-hip ✭✭✭

    Might also want to get a scan of your lower spine - there is a possibility that all of the pain you experience is in fact referred pain and that you may have a compressed disc which is causing a squeeze on the nerves - something I suffered with just after I fractured the neck of my right femur in 2009 (which was misdiagnosed by two physios, my GP and a specialist who only took an x-ray image) that presented very similar symptoms. MRi scan showed both injuries. Hip fixed with a dynamic hip screw and compressed disc managed by means of mega back and piriformus type stretches has allowed me to get back on the road and since then completed 9 half-marathons and 5 marathons/ultras. Really good stretch for the back highlighted on this site at the moment.

  • http://www.sportshernia.com/

    Read this, Many groin strains are misdiagnosed by underskilled people. You may have a sports hernia, sometimes undetectable by MRI and doesnt show a bulge but remains unhealed because of specific tears in a specific muscle area and cannot heal properly remianing weak and painful..

    http://www.sportshernia.com/gallery/?album=3&gallery=2

  • Thanks for posting Neas

    To all following this thread I was eventually diagnosed with femoroacetabular impingement with labral tear and had an operation at xmas 2012 to fix it. There is a specific thread for this condition on this website and I have been posting regularly on there.

    Currently rehabbing, but it seems I have similar condition on my other hip too which will require an op at some point.

    Neas - your are not wrong I certainly felt I was treated initially by underskilled professionals - especially my first physio who was pathetic really. My 2nd physio is excellent.

    I fail to see how anyone with a groin injury can be immediately assumed to have some sort of slight groin strain. Groin pain can be from a number of causes, and if it lingers then hip issues have to be considered. Here I am nearly 2 years after first getting symptoms still quite some way from activity, with probably a further op to look forward to!!!

     

  • Good to see your getting sorted Parklife. I've put up with many mis diagnosed injuries over the years beggars belief how some of these people get employed.I know you can't take a sledgehammer to crack but I find the best people are those who have been in sport at some time and not just reading books.

    Mine has existed for over 7 months and its not getting better or worse for that fact. More like a pendicitis dull ache that just makes the whole area feel weak. Strong core is so important and the surrounding muscles that hold the hip flexors need to be strong not just abs and back. Great advice from an ex Briitsh cycling physio. No ultrasound, no massage, just biomechanics and regular strength work.

    Keep us updated with progress mate

  • Hi all,I got injured during a rugby match in early October 2012. No snapping or sudden pain, I just finished the game and it started to tighten up. I continued to try playing through it for a few weeks, which was a bad idea. I have adductor longus pain, and also pain when i lift my knee: I'm told tight hip flexors are not helping this. It seems to rear its ugly head when I run/jog/sprint, or for example burpees (rapid knee raising in the lower part of the exercise).

    I've been to 3 physios now, giving me a variety of stretches and exercises to do, as well as recommending ibuprofen, and massage roller. I've continued with swimming and biking as these seem to give little in the way of aggravation. The doctor pretty much refuses to give me a scan, or injections or anything, and has referred me to a 'sports doctor' - why he didn't do that some time ago i'm not sure.

    I also have a sportsmans hernia (I had it about 5 years ago, it eventually went away but the symptoms are recognisable.) But this is the least of my worries.

    I'm putting on bad weight because I don't enjoy swimming and cycling as much as running, and thus am less positive about doing them. Also, I can't lift heavily at the gym or do any real leg work, which is frustrating. The rugby season begins again in september 2013 (9 weeks), and I'm seriously doubting if i'll make it. I'm 27, and I just want to play again...

    Could anyone recommend a course of action? Even if i rest it and it feels better, it's back to square one after one jog at 30% speed. Banging my head on the wall here image

     

  • Hi All,

    i have also been suffering with the symptoms described. After a frustrating 9 months, including rest (didn't help) MRI (didn't show anything obvious) Cortisone injection (didn't help at all) I was just going to reside to the fact that it's unrepairable. Even my consultant said you may just have to deal with it as there is not much he can do for me. My X-ray did show up issues with my hips but he advised me not to go down that route. I have played football all my life and only took up running 9 months ago as my groin pulled every time I changed direction on the pitch. I try to mange my runs but it really aches for 2 to 3 days after but I can't just sit around and rest doesn't help. I'm 40 this year and without the release of running I will be doing no exercise which will drive me crazy. It's been a while since the last post so I wondered how you were all getting on as I'm desperate for a way forward. Thanks Justin 

  • Anyone looked at osteitis pubis ?

  • Justin C,

    If your consultant is noticing hip problems but saying just ignore then he is burying the head in the sand.

    He may be thinking you have Femoroacetabular impingement which an Xray ultimately diagnoses as it is a bony protusion which rubs against the hip socket cartilage/labrum.

    There is a wealth of knowledge and experience on the Femoroacetabular impingement thread...if this is what your consultant suspects but you need to confirm it from him first.

  • In 3 days time on Tuesday I will undergo my second direct inguinal operation as a result of running 4 marathons within 18 months. The first time I felt a sharp pain that slowed me down to stagger through the last stages of a HM in 2012. A year later I felt a sharp burning pain during a gut busting long run that slowed me down. I went on to run two marathon last year with hernia.

    I have no idea when I will return back to gut busting marathon training. I hope this operation puts an end to my guts literally busting and resulting in painful hernias.

  • Hi all,

    Getting an accurate diagnosis is really important, but only the start. Once you know what the 'condition' is, in order to resolve it, you need to ask what is the root cause of that condition. Remember the body doesn't 'break down' for no reason.

    The hip is an incredibly powerful and resilent joint when it is working correctly. Powerful supporting ligaments, strong cartilage, a deep ball and socket joint, tough labral tissue and a strong joint capsule. Added to that are incredibly powerful surrounding muscles which help stabilise the joint.

    So what is going on? Why hip degeneration, arithitis, femoroacetabular impingement, muscle pain etc.? 

    Basically the joint, and surrounding structures are not working properly, which means the head of the femur (thigh) bone is not smoothly moving in the ball socket of the pelvis. There are so many reasons why...perhaps one side of your pelvis is not moving correctly, so the thigh bones keeps grinding into it. Perhaps the muscles around the hip joint are unbalanced and so are not giving it the correct stabilisation it needs, so over the years it literally takes a beating. Perhaps the surrounding musculature is unbalanced, so other nearby muscles have to work overtime to help them out and eventually they show signs of pain. The list could go on.

    The root cause often is something biomechanically is not working as it should, and the root cause of this is that the muscular system is out of balance. Remember, muscles position your joints. And the root cause of this is we don't use our bodies the way they were designed too. We sit for long periods and move less than anytime in history. If you correct the imbalances in your body the pain should go away.

    So whoever you go see, its great if they give you a diagnosis but make sure to ask them why the condition showed up in the first place. Normal wear and tear, or old age is NOT a good enough answer as there are 90 year olds running marathons, so don't accept that answer from anyone. And always look for a permanent solution. Don't settle for temporary 'fixes' like straps, supports and stretching.

    Take care and feel free to ask me any questions.

    Ameet Bhakta

    Postural Alignment Specialist

    www.healththroughposture.com

     

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