groin injuhries in figure skating (1)

1Groin Injuries inFigure Skating

ByGemmie S. Devera, PA-C, MPH

Vaca Valley FSC, Childrens Specialists ofSan Diego

Epidemiology of Groin Injuries1

Hip & pelvis: 3rd mc sk8ing injury, but mostdifficult to rehabilitate

ing in frequency w/ lower back & coremuscle injuries

seen in sk8ers who do 3x jumps Injured muscle: usually adductor longus or

gracilis2 Risk factors: ?ed abductor ROM & adductor

strength3

Anatomy of the Groin Region3

2Etiology of an Adductor Muscle Strain1,4

Multi-revolution jumps Falling Running Quickly changing directions Splits: forced abduction of hip Kicking Imbalances in strength & flexibility &

inadequately strong core muscles

Types of Adductor Muscle Strains2,5-6

Acute (immediate pain) Chronic (insidious onset of pain)

normal activity for a while after good warm-up or stretching 1st degree: pain, min. loss of strength / fn. 2nd degree: tissue damage, but not complete loss of strength

& fn. 3rd degree: complete disruption of muscle tendon unit &

complete loss of fn. DDX: stress / avulsion fx, sports hernia, osteitis pubis, nerve

compression

Symptoms / Signs3

Main symptom: Pain in the groin region(medial thigh)

Signs: tenderness to palpation in groinregion on adduction against resistance

3Diagnostic Studies2

Usually a clinical diagnosis X-Rays to rule out fracture MRI to confirm m. strain / tears (if unsure)

Partial & complete tendon tears US: to diagnose muscle & tendon tears, not

strains

Other Considerations2

Biomechanical abnormalities Foot & lower leg malalignment Leg length discrepancy Gait / sport-specific motion abnormality

Location of muscle strain / tear MT junction aggressive rehab Acute partial tear at tendinous insertion of

adductors to pubic bone rest Chronicity of symptoms

Treatment1-6

Patience Initial treatment (1-2 weeks):

Rest Ice: to numb the pain Heat: to relax the muscles Elevation Refrain from activities that exacerbate pain

4Treatment (cont.) Continued treatment: gradual return to

activity Strength Flexibility Endurance

Goal: return to full activity in 8-12weeksor within 6 months

Consider surgery if unresponsive toconservative tx

Special Facts6

Groin injuries can take a LONG time to heal!!!

Adequate rest period needed Allow muscle strain to heal Prevent re-injury

Prevention2,6

Stretching Conditioning

Warm up / cool down Core strength Strengthening hip & thigh muscles Flexibility / endurance

5Groin Specific Stretches7

Butterfly stretch

Groin Specific Stretches Splits (a.k.a. straddle-sit-n-reach)

Groin Strengthening Exercises8

Squats

6 Groin Strengthening Exercises Lunges

Groin Strengthening Exercises Lunges

Skating Specific Stretches7

Spirals for hip extension

Right foot spiral

7References: 1. Lipetz J, Kruse RJ. Injuries and Special Concerns of Female Figure Skaters. Clinics in Sports

Med. [serial online]. 2000;19: 1-9. Available atdas/journal/view/0/N/1124789?ja=172676&PAGE=1.html&source=. Accessed 10/28/2007.

2. Morelli V, Smith V. Groin Injuries in Athletes. American Fam Physician. 2001;64:1405-1014. 3. Morelli V, Weaver V. Groin Injuries and Groin Pain in Athletes: Part 1. Prim Care Clin Office

Pract. 2005; 2:163-183. 4. Rupp TJ. Groin Injury. eMedicine. [serial online]. 2005. Available at

http://www.emedicine.com/sports/topic162.htm. Accessed 10/21/2007. 5. Lynch SA, Rensrom AF. Groin Injuries in Sport: Treatment Strategies. Sports Med.

1999;2:137-144. Nichoas SJ, Tyler TF. Adductor Muscle Strains in Sport. Sports Med. 2002;32(5):339-344. 7. Poe CM. Conditioning for Figure Skating. San Francisco: Contemporary Books, 2002. 8. Exercises for your legs. Available at

http://exercise.about.com/cs/butthipsthighs/l/bllegsbuttthigh.htm. Accessed 12/18/2007.

Acknowledgements Coach Ann Baharie, Ice Town-La Jolla,

Brittany Ward for demo of skatingstretches, Dr. Griselda Tiu, MD, Emma andJerome Peter, Coach Jennifer Borus,Vacaville Ice Sports, Dana Economeau,San Diego Rehab, Vaca Valley FSC, LaJolla FSC, San Diego FSC