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796 Views 1 Reply Latest reply: Oct 16, 2012 6:35 AM by JamesJohnsonLMT RSS
ThisGuy11 Rookie 1 posts since
Oct 11, 2012
Currently Being Moderated

Oct 11, 2012 6:12 PM

Sports hernia surgery/groin strain recovery

Hi,

So I've read through a couple of threads already about other runners recovering from sports hernia surgeries, etc., and there seems to be a lot of mixed results/their case is different than mine - thus, I am starting my own. While my main sport is not running, I do run XC in the fall, play ultimate frisbee, swim, and bike. Plus, I would kill to be pain-free and able to run however and when ever I want to - overall very active. Basically, around 10 months ago I injured my adductor/groin with an explosive movement- it gave me a weird feeling on my inner thigh at the time, but wasn't exactly painful. That night I could hardly walk, and any movement using the adductor muscles (pinching my thighs together, hip flexion) was unbearable. The next day it seemed to have improved dramatically, and my normal course with injuries (although none this serious) was that they healed relatively quickly and I never had to take dramatic time off. Essentially the pain never went away, and physical therapy didn't work. I self-diagnosed it as an adductor/groin strain, but I was in the middle of my seasons so I just stuck it out until the summer. By then the pain had spread to my lower ab (all of this on the left side) and going 100% was out of the question. This summer I finally went in, it was diagnosed as a sports hernia, and I found out I've got retroverted hips (also very inflexible, inherited, in case this changes anything)- one orthopedic surgeon recommended 6 weeks of rest, it didn't work, so I just got the sports hernia repaired 2 weeks ago. The surgeon said 6 weeks until I can start doing ab-work (includes swimming) but maybe a bit before then I can start low-distance low-intensity running. What do you think is the likelihood that my adductor pain will return (after rest of course)? And if the sports hernia is related to a groin strain, is it possible for the injury to return if we haven't fully fixed the groin strain? At this point I just want to be back at 100% and am not willing to risk re-injuring it... I've improved dramatically since the surgery, not doing anything on it/avoid using my abs/adductor, came off pain meds 3 days after the surgery. When I begin to re-introduce to activity, how will I be able to gauge if I'm going too hard ? I tend to go at my max if I'm being active and don't want to lose all my progress. Sorry for the post length, and thank you! Any details are MUCH appreciated!

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. Oct 16, 2012 6:35 AM (in response to ThisGuy11)
    Re: Sports hernia surgery/groin strain recovery

    I am hoping yours is not one of the cases when apparently successful surgery, rest, and rehab are followed by the same pain that led to those interventions. This obviously interferes with normal athletic life, but If it turns out that way, do not worry. There is always the hope that the problem is not as severe as it seems, or the original professionally rendered diagnosis was wrong or incomplete. Going forward, I would not proceed with surgery without at least a second opinion, because of the possibility of setting up permanent patterns of pain in the area where the incision is made. Hernias can be mimicked by muscle strain, and muscle pain can be perpetuated by physical trauma like surgery.

     

    If there actually was a sports hernia, It would not necessarily be directly related to a groin strain. It is more likely these injuries could both have been caused at the same time by the explosive movement you mentioned earlier. I would expect each problem to resolve independently, but pain felt in one part of the body tends to invite protective reflexes that lead to pains elsewhere. Rest cannot by itself guarantee resolution. The trick is to find just the right activity level to cause the healing tissue to properly model itself and minimize chaotic scarring, while avoiding any further provocation to "splint" and guard against excess movement. Abs are crucial to hip-flexion. Some of the adductors are involved in hip flexion, and some with hip extension, as well as adduction. There is an ideal level of exercise that usually helps them recover, but in some cases, this is not enough, as I will discuss below.

     

    Regarding the retroverted hips, I'll assume they are telling you there is a pelvic abnormality, not that the hips are simply adopting this posture, which they could, due to muscular tension. Since you said the hip inflexibility runs in your family, it's probably the angle of the acetabulum they are talking about, which could potentially be a source of impingement but no doubt, engenders some muscular compensation.

     

    It's this last part that concerns me, because it is possible that some or all of the pain you have been feeling is due to the overworked and/or pulled muscles, as you originally suspected. The hernia and retroversion may be a visual distraction from the actual cause of pain. Structural anomalies don't necessarily hurt in and of themselves, but misalignment almost always leads to muscular dysfunction and pain of muscular origin in an athlete. If you've read my other stuff, you know that muscular pain is not always felt where it is produced, a fact which can and does throw off many a professional diagnosis.

     

    Though exercise may hurt now, and rest has not reversed the problem, it's not the end of the story. This is often true of recalcitrant muscle tissue. Fortunately, there is more than one way to deal with muscle strain.

     

    In extreme cases, rest and exercise do not alleviate the pain that strained muscles may produce. Healing may be complete, the muscles may be well-conditioned, but that does not mean they will work properly on demand. Dysfunctional muscle may remain in a state of partial contraction, or fail to contract with full force, even after a strain has healed. Manual therapy is almost always indicated when rest and exercise alone do not reverse muscular dysfunction. Usually this involves targeted pressure combined with passive or active movement, such as a pin-and-stretch technique like ART. The point is to eliminate contracture or mini-spasms in the muscle tissue, often with patient but persistent therapy. Before buying into any expensive protocol however, you should assess everything you can and can't do with your equipment as it is now.

     

    You mentioned not being able to use the adductors for common adduction movements, without pain. From your account, this appears to be ongoing. Let's suppose you have a strained Adductor Magnus, portions of which can produce as a primary symptom, deep pelvic and/or groin pain. There is no law that says this muscle must recover from strain without special attention beyond retraining. We treat hernias, fractures, inflammation, but usually expect strained muscles to heal and behave normally after that. Often, they do not go back to business as usual, even after targeted exercise. They may hold patterns of contraction that produce predictable results.

     

    The upper portion of A. Magnus, just under the pubic bone, can be accessed from the rear or between the legs. The pain in a damaged Magnus can be excruciatingly sharp, or dull and vague, and you may feel it when pressing spasms in the muscle, or when performing certain movements involving hip flexion/extension, as well as adduction. The pain may feel like it's coming from your nads or your joints, but  the actual source of pain is often confined to spasms in the muscle. You can often work these spasms out over time with consistent but properly modulated applications of pressure from your own fingers.

     

    While many people are aware of the above, there is still a pervasive but unreasonable expectation that remedial work has a set end point, or can be measured by steady progress. In actual practice, a simple accident often sets up pain syndromes that must be attended to daily, if not several times a day, until they eventually resolve. Sometimes treatment is not aggressive enough to promote progress, and other times it actually perpetuates the syndrome. There is often a combination of the two extremes, leading to mixed results, temporary progress, and setbacks. It is tempting to interpret these results as failure, when it may simply be a failure to get it right one time. This is often the case in many modes of treatment when effects cannot be directly observed and results are delayed.

     

    Some strains and their pain syndromes can be easily rested away. Some can be exercised away. Some respond well to manual therapy, and some persist for years, even a lifetime. This is not to say it has to be so, but often is because of the desire for a quick fix, and too little patience for anything else. There is always a way out, but the uncertainty about outcome is sometimes worse than the problem itself.

     

    As a runner, I know the frustration of being sidelined by injuries for longer than I would like. I realize it is more than just a waiting game, and that each phase of healing and recovery requires careful execution and patience. This highlights one of the most important factors, which is the patient's compliance with rehab protocols. We all can't wait to get out there, and are sometimes mystified when things don't work according to our timetable, but there is always a reason for delays, and an exit strategy when we regress. Never push too far too fast.

     

    The important thing to keep in mind is that after a long layoff, you still possess the same power to train into shape that you had before. It may be like starting over again, but that is the test that separates athletics from mere recreation.

     

    I like your well-rounded athletic resume', and I think you demonstrate the right attitude by pondering the relationships between your experiences so far. I'm sure you will be back out there, and the pain will become a distant memory. If your hip structure is an inherited anatomical feature, there is probably a set of exercises that will expedite muscular compensation, and perhaps some orthotic intervention available. The ideal order for all of this is probably healing, elimination of the pain syndrome, therapeutic exercises, any necessary equipment changes, remedial exercises, and a return to training. I wish you the best combination of patience, targeted therapy, and luck.

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