Cricketers suffering with Hip/Groin pain – What to do!
Here is a message we received through the website last week asking about recurrent hip/groin pain
‘I tore my groin 10 years ago, and still get twinges, as if it might go again. Can it be cleared up completely?’
Thanks for your message, we will try our best to explain the complexities of hip and groin related issues for you, and hopefully this will help out. Although, we should state early on that it is a bit of a can of worms, and in all likelihood we will probably provoke more questions than answers. There’s only one place to get answers to these questions, to come and see us, however here is some food for thought and a few idea’s of where to start.
The hip and groin region is an area with extremely complex anatomy which provides us with a very non-specific presentation of symptoms as there are many factors at play. The wide variety of potential pathologies which exist in this region also make differential diagnosis very difficult to hang your hat on, as they can often mimic one another. For example, a gluteal strain could elicit similar symptoms to an acute disc prolapse in your lower back. On top of this our ability to localise pain in this region is poor, which means that where we feel the pain, may not actually be the location of the injury.
One thing to mention at this point is that although we are physiotherapists and look at the body from a musculoskeletal frame of reference, there are also some medical issues which may present at the hip. Therefore, it is always wise to seek professional opinion and thorough examination from a trained physio or doctor. If there is something else going on, we will be able to recognise this and refer you to the relevant specialty in a timely fashion.
To give you an idea of the broad range of potential issues at the hip and groin I have compiled a large (and not exhaustive) list.
- Hip joint impingement (FAI)
- Adductor strain
- Adductor/Gluteal tendinopathy
- Sacro-iliac dysfuction
- Trochanteric bursitis
- Acute disc prolapse
- ITB/TFL syndrome
- Hip labral tear
- Stress fracture of the neck of femur
- Sacral/Lumbar stress fracture
- Inguinal hernia
- Hip joint synovitis
- Adductor enthesopathy
Now you’re all thinking, ‘What relevance does that have to me?’, and ‘What do I do with all of that information?’. In reality it isn’t that relevant to you and there isn’t much you should do with all of that information. What is relevant however, and what is the main focus of this article is how to avoid these issues and how to prevent them from happening again in future.
Cricket is a sport where upwards of 10 times your weight can travel through your body if you’re a bowler and even simply running can impose forces of 6 times your body weight at any one time. This highlights the need for adequate support and stability around the weight bearing joints, and without this, the forces will not be spread out and shared in an efficient way, leading to increased risk of injury.
Each tissue in your body, whether it be tendon, bone, ligament or muscle will have a ‘threshold’ at which the forces which act upon it become too much to handle. Once this occurs your body USUALLY lets you know by giving you symptoms such as pain or restriction and indicates some form of injury to that area. Now what we need to try and do is increase the threshold at which this occurs, making you as an athlete more robust and durable. A simple way to this is to become stronger, and when I say this I don’t necessarily mean increase the amount of tin you are lifting in the gym, I mean stronger in the sense that you can control your movement more effectively.
To do this we need to look at the body as a whole and try to select exercises which encourage ‘sling’ work. With regards to the hip and pelvis it is important to address the anterior and posterior slings. The anterior sling crosses the front of your pelvis and involves a connection between the oblique muscles and your adductors, where as the posterior sling involves your lattisimus dorsi muscle and your gluteals forming a cross across the back of your pelvis. To strengthen these slings it is important to find exercises which incorporate both of the groups of muscles discussed ie. An anterior sling exercise could be an adductor bridge.
Now referring back to the question, it is likely that your groin/pelvis/hip is reaching ‘threshold’ far too easily which is most probably being caused by some form of movement dysfunction, leaving you exposed to frequent injury.
As well as weakness being a cause of hip and groin pain, the cause could also be related to a restricted range of movement. This could be within your hip and lumbar spine intervertebral joints, or your quad, hamstring, adductor or hip flexor muscle length. There is a plenty of debate about the effectiveness of stretching but for me the use of dynamic and static stretching combined with specific eccentric exercises focussed on the muscle groups identified would be a great flexibility regime.
So to briefly summarise what I suggest your approach to this problem should be:
- Seek professional opinion in the form of a physio, to highlight your specific needs and obtain a likely diagnosis for your problem.
- Begin a hip and pelvic strengthening programme which focusses on anterior and posterior slings
- Ensure you have a good range of movement in and around your hip and pelvis to ensure that this is not limiting your movement and leaving you open to further injury. Focus on you hamstrings, gluteals, hip flexors and adductors.
- If there is no change to your symptoms then return to your physio to investigate further.
The Move4 Team
PS. Here are a few pics of dynamic exercises you can use to keep your hips mobile
Deep Squat – Dynamic Stretch
Lunge Rotation – Dynamic Stretch
Lateral Lunge – dynamic stretch