The ‘big three’ when considering ongoing chronic groin pain are:
- adductor tendinopathy (disease of the tendon, either inflammation or damage to a tendon)
- osteitis pubis (injury to the cartilaginous joint of the pubic symphysis), and
- inguinal (sportsman’s) hernia
It is not uncommon to see two or even all three of these conditions co-existing at the same time. However, there still exists a myriad of other conditions that may be affecting the groin area.
The examination needs to focus on the groin, hip & sacroiliac areas. I’ll teach you the best way to improve strength and inhibition of the adductor muscles.
You’ll need to learn proper stretches and strength training .
One of the main back stabilizers and hip flexors. If you sit all day the psoas becomes rounded like a banana; then, you stand up, the psoas pulls on your back, making you more prone to pain and lower back injury.
Most doctors neglect the psoas because it lies so deep below the surface of the skin, and therefore is hard to locate. Unlike other deep lying muscles, like the piriformis, stretching the psoas and trying to locate the psoas with your fingers is not easy. When you look at where it lies in relation to the pelvis and the role it has to play, you’ll understand that in both hip, groin and lower back injuries quality and feel of the psoas is paramount.
I have many techniques for effective self-treatment and in-office treatment of this troublesome hip flexor. I also use the DMS and laser on the psoas.
The gluteus medius is normally associated with movement. Weak glut medius muscles have ‘ruined’ more running seasons than perhaps any other single cause of running-related injury.
Appropriate assessments, exercise and rehabilitation can restore proper glut medius function.
The gluteus medius muscle originates at the top of the ilium (hip bone of the pelvis) below the iliac crest, and runs to the top outside surface of the greater trochanter (outer side of the thigh bone). It is the major abductor of the thigh (lifts it away from the body to the side). The fibres at the front rotate the hip internally and the rear fibres rotate it externally.
During walking or running when the foot is on the ground the gluteus medius is a pelvic stabiliser. It helps to keep the hips parallel to the ground. If the gluteus medius is not functioning well enough to achieve this control, compensation will occur.
Weakness in gluteus medius will have implications all the way down the kinetic chain. For example:
- the femur (thigh bone) to shift inwards and internally rotate excessively
- the knee to fall into a knock-kneed position
- the lower leg to rotate internally relative to the foot
- weight to be excessively transferred to inner side of the foot.
As a result you are at increased risk of any condition relating to excessive and/or prolonged pronation of the foot, such as medial tibial stress syndrome or Achilles tendinitis.
What contributes to gluteus medius weakness:
- Medical – hip rotator tears and congenital dislocation of the hip
- Lifestyle – standing predominantly on one leg with the pelvis swayed sideways and hip joint adducted (the classic hip-hitch slouch, often used by mothers when they stand with a child in their arms)
- Simply sleeping on your side with the top leg flexed and adducted over the other leg: maintaining an elongated position for sustained periods can weaken the glute med.
My favorite exercises for the gluteus medius are side lying hip abduction, single leg squats, and lateral band walks.
Come in and I’ll teach you how to perform these maneuvers with perfection.
Let’s talk about your butt. Why? Because the three gluteal muscles in the buttocks – the gluteus maximus, gluteus medius and gluteus minimus – are crucial for low back health, as well as strength and power in athletic movement. The butt is part of your core!
Weak glutes not only cause low back pain but are related to other conditions like patellofemoral pain, knee injuries (anterior cruciate ligament injuries), iliotibial band syndrome, ankle injuries and Achilles tendinopathy.
Regarding the glutes, it is less about the maximum weight they can lift, and more about the ability to recruit the glute muscles to perform proper hip extension and gait movements.
I use the squat to assess the glutes, and I use other tests to check stabilty of the hip in an extended position with the pelvis held in neutral.
Depending on position you are moving around in, the gluteals need to be able to act as either a prime mover or a stabiliser, depending on the task.
It is common in athletes for the gluteal muscles to become lengthened (chronically stretched), thus reducing the tension in the range around hip extension. This undermines athletic performance – and makes them more prone to injury as well.
Some of my favorite glute exercises are:
Theraband side walk
Side lying hip abduction
There are two major problems with hip pain that I have to look for:
The first type of problem – and the easier to treat – is when the hip joint has restricted motion. This can produce local hip pain or cause dysfunction in the lumbar spine/sacroiliac joint or the knee, as a result of these structures attempting to compensate for the lack of movement at the hip joint.
The second type of problem is where the hip joint has an increased amount of movement arising from a lack of control of the femoral head (top of the thigh bone) in the hip socket; you will often feel or hear clicking or clunking, or a feeling of weakness in the region. A failure to correct this lack of control can lead to joint damage and subsequent long-term restriction of movement.
If only it were so simple that we could split the problem into one or other type of dysfunction. However in reality it will often be a combination of the two.
Muscle imbalance is related to two changes in muscle function: (1) a tightening of a “mobiliser” muscle and (2) the weakening of a “stabiliser” muscle.
- So-called mobiliser muscles are those that produce movement; they are often big muscle groups with more fast-twitch fibres. Although they produce high power, these muscles have a tendency to shorten. The hamstrings and rectus femoris (one of the quadracep muscles) are the two main mobiliser muscles around the hip joint.
- By contrast, stabiliser muscles control movement or joint position, often working against gravity. They are smaller, deeper muscles which often have more slow-twitch fibres. They should be well coordinated and have good endurance capacity, though they have a tendency to be under-active and weak. The gluteals are the key stabiliser muscles around the hip joint.
If your hip, scaroiliac joint area, or low back is bothering you, come in and I’ll check to see if this is your cause of the pain. Call 310-473-2911
Sciatica is a symptom more than a condition, as it refers to pain which refers down the back of the legs, rather than to the cause of the pain. The cause of Sciatica can be from the lumbar spine, where a disc is irritated and is compressing the sciatic nerve, or this compression can occur at the point where the sciatic nerve passes under (or through in some cases) the piriformis muscles in the buttocks. In this case, the muscle is often overworked and in spasm, resulting in compression on the nerve. The causes of piriformis syndrome include leg length differences and muscle imbalances including tight groin muscles and weak hip abductors.
I am getting really impressive results with the warm laser, the Deep Muscle Stimulator, and neuromobilization techniques for sciatic complains. I usually know within a few sessions if I can help your condition.
Posted by DrTucker in Ankle, Arthritis, Hip Pain, Inflammation, Knee pain, Laser Therapy, Low Back Pain, Neck, Shoulder, TMJ (Temporomandibular Joint), Treatment on 11 16th, 2010 | no responses
You can feel the warm deep tissue penetration. This deep heat significantly increases the body’s cellular production of ATP (Adenosine-triphosphate) to reduce inflammation and heal the inflamed area.
Here are some of the benefits of using the deep tissue penetration that laser provides safely and effectively:
Healing and pain relief with no side effects, drug interaction effects, or invasive surgery.
Treats acute and chronic conditions as well as post surgical pain.
Pain relief is often felt immediately.
Most laser treatments take only 10-20 minutes.
Are you a potential candidate?
- If you have pain that is of musculo-skeletal origin, laser therapy may be for you:
This includes sports injuries, back and neck pain, any joint pain (knee, shoulder, ankle, etc), bursitis, tendonitis, tennis elbow, contusions, strains and sprains, carpal tunnel syndrome, chondromalacia patellae, arthritis, fibromyalgia, heel spurs, plantar fascitis, migraine headaches, neck pain/whiplash, nerve root pain, postoperative pain, repetitive stress injuries, TM joint pain and more.
- If you have the wound that is slow to heal and has been resistant to treatment, you may be a candidate for laser therapy. This includes slow healing fractures, as well as soft tissue injuries and ulcers.
- If you have multiple trigger points (sore spots in the muscles) that do not go away, you may be a candidate for laser therapy. This includes areas associated with fibromyalgia.
- If you have had Prolotherapy or PRP, and wish to accelerate the response of healing, you may be a candidate for laser therapy. This includes any area that has been treated with Prolotherapy/PRP injections.
- If you need Prolotherapy or PRP therapy but are afraid of needles, you may be a candidate for laser therapy.
- Laser therapy stimulates the same areas that Prolotherapy targets. It does it without needles, but requires a lot more time and repeated treatments to gain the result that can be gotten from Prolotherapy and laser together.
Feel free to call me directly at 310-473-2911 or call my cell phone at 310-339-0442
Patients undergoing total hip replacement often have weak hip abductor muscles before and after surgery. One of the most common hip exercises is sidelying hip abduction using an ankle weight. While this may be an effective exercise to activate the gluteus medius muscle, open-chain, non-weight bearing hip abduction is not specific to the function of the gluteus medius as a pelvic stabilizer in single-leg stance. Resisted lateral walking with a Thera-Band® Band Loop or Tubing with Cuffs is an example of such a closed-chain exercise as the patient steps away from the involved leg.
Researchers at the University of Kentucky evaluated electromyographic (EMG) levels of 4 exercises in total hip patients between 7 and 32 weeks post-operative. Dr. Cale Jacobs and colleagues were interested to see if there was a progression of muscle activation to guide clinical decisions about hip abduction exercise prescription. They published their findings in the Journal of Arthroplasty. The 4 exercises included 2 non-weight bearing and 2 weight-bearing exercises:
- Standing hip abduction with cuff weight at 1% of bodyweight, lifted to 30 degrees
- Sidelying hip abduction with cuff weight at 0.5% of bodyweight, lifted to 50% of leg length
- Standing hip abduction with uninvolved leg to 30 degrees
- Lateral walk with Thera-Band resistance band attached with extremity straps around ankle
Researchers used a level of Thera-Band resistance that created the same torque as the standing hip abduction exercise (1% body weight) with stretch on the band at 50% elongation. The researchers used this chart of Thera-Band elastic resistance pull forces to prescribe the appropriate color of band.
Both the sidelying abduction and weight-bearing standing abduction with the other leg produced an average of 67% maximum voluntary isometric contraction (MVIC). The Thera-Band resisted lateral walk exercise produced an average of 63% MVIC and the non-weight bearing standing abduction produced 58%. There was no significant difference in activation between exercises, indicating no clear order of exercise progression. The researchers suggested these exercises can be used interchangeably, particularly when balance impairment or postural position may be an issue.
In conclusion, non-weight bearing exercises involving open-chain hip abduction provide no additional benefit of gluteus medius activation compared to more functional closed-chain exercises. Thera-Band loop resisted walking provides moderate (>60% MVIC) of gluteus medius activation in post-operative total hip replacement patients.
REFERENCE: Jacobs CA, et al. Electromyographic analysis of hip abductor exercises performed by a sample of total hip arthroplasty patients. J Arthroplasty. 2009 Oct;24(7):1130-6. Epub 2008 Aug 30.
Posted by DrTucker in Core training, Hip Pain, Low Back Pain, Rehab Exercises on 07 19th, 2010 | no responses
•Side lying against wall hip abduction
•Tube walk or ‘Monster walk’
•Squats with adduction
Posted by DrTucker in Fitness & Exercise, Hip Pain, Low Back Pain, Rehab Exercises on 07 19th, 2010 | no responses
•2 leg bridge
•Cook hip lift bridge
•Foot elevated hip lift (aerobic step, foam roller, med ball)
•Single leg Romanian deadlift – develops posterior chain, improves balance, & decreases load & stress on the back.
•One-leg straight-leg Good Morning
•Slide board leg curls (start with toes up)
•Stability Ball Leg Curl – develops torso stability while strengthening the hamstrings. Heels on ball + curl.