Groin strain A groin strain or groin pull occurs when the medial thigh muscles, the adductors, tear near their origin at the pubic symphysis. The tear is normally due to a dramatic change in force on the adductors or a sudden change in hip direction. This injury is characterized by pain on the inner thigh near the groin and a loss of strength, particularly when bringing both legs together. Pain may also occur at the knee when raising the knee of the affected side. Groin strains are diagnosed according to degree: First degree strains involve pain but only a small loss of strength. Second degree strains involve pain, inflammation and swelling, and a greater loss of strength. Third degree strains are a complete tear of the adductors at the pubic symphysis, involve severe pain, bruising, muscle spasms, and a dramatic loss of strength and ROM. Due to the delicate region this injury occurs in, therapists not attempt massage therapy during the acute phase. For diagnosed second and third degree strains, therapists may want to withhold massage therapy until the injury has healed some on its own. Massaging the thigh’s adductors may be uncomfortable for the athlete as some work is required near the genitals. Massage therapists should keep a clear line of communication open and use proper draping that is cinched around the upper thigh to prevent exposure. This helps to ensure an athlete’s privacy. (Therapists may wish to ask the athlete to hold the top half and the bottom half of the draping together at the hip for further protection.) Once draped, with the athlete in the supine position, the therapist rotates the athlete’s leg outward and pushes the knee towards the shoulder so that the affected leg forms a V-shape. The thigh’s adductors are now fully accessible. Lower back pain Injuries to the lower back do not discriminate. While lower back injuries come in many forms – strains, spondylolysis, spondylolisthesis, and herniated discs – this course will focus on strains, the muscular dysfunction massage can most effectively treat. Muscle strains of the quadratus lumborum (QL) and erector spinae group (spinalis, longissimus, and iliocostalis) are exceedingly common: The Journal of Sports Medicine estimates that lower back strains account for as much as 20 percent of injuries among football players alone. If not treated soon enough, lower back strains can lead to a myriad of problems such as altering a runner’s gait which may lead to runner’s knee or shin splints (see below). Note : Therapists may work with cases of mild to moderate lower back strain, but if an athlete presents with severe pain, it is contraindicated for massage and the athlete should be referred to a physician. With the exception of counter torque twisting and petrissage, any of the remaining techniques – cross fiber friction, deep tissue, directional massage, hot stones, myofascial release, stretches, and trigger point therapy – can be used to ease the pain of lower back strains and restore function. Naturally, where therapists apply each technique will depend upon which muscle is injured, but massaging the surrounding muscles (the erector spinae group if the QL is injured and vice versa) can only help and certainly should be done after treating the strained muscle. To treat the QL, therapists should begin with cross fiber friction at its origin at the posterior superior iliac crest and work towards the spine. They should then treat the QL insertion along the lumbar vertebrae and at the inferior border of the athlete’s lowest rib. Next, therapists should try myofascial release as lower back pain sometimes results from superficial restrictions between skin and muscle tissue and not a strain at all. If the athlete experiences no relief after attempting myofascial release, therapists should engage the QL with directional massage. After one passage of directional massage, therapists should move slowly into the QL with a forearm or elbow, as the QL is fairly
The two most effective techniques used to treat this injury are myofascial release and petrissage. At this point, the client should be properly draped and positioned. To use myofascial release, therapists will work from the insertion of the gracilis muscle on the medial, proximal tibia towards the origin of the adductor magnus just below the pubic symphysis or as close to the pubic symphysis as an athlete is comfortable with. Massage therapists will also use petrissage liberally, starting just above the inside of the knee, moving up as close to the pubic symphysis as the athlete is comfortable with. Although using petrissage liberally is useful for groin strains, therapists should not use petrissage for more than five minutes on a muscle group, as doing so may tighten rather than loosen muscles. Very gentle passive stretches that do not bring the athlete into any amount of pain are permissible, although therapists should avoid AC and CRAC stretches for this injury until the athlete no longer experiences pain during adducting movements. Additional treatment and prevention Besides R.I.C.E. before and after a massage, the best prevention for a groin pull is to focus on stretching the adductor muscles before activity and gradually build up to the level of activity that is required of the athlete’s sport. After recovery, the athlete should focus on exercises that strengthen the inner thigh. This injury is common among athletes who participate in sports that require a great deal of inner thigh strength such as football, ice hockey, soccer, and volleyball. Among ice hockey players, groin strains affect one out of every 10 players. broad and will take a while to work if using directional massage alone. Deep tissue is also a good technique for this injury because therapists can approach the QL from several angles: With athletes in the prone position, massage therapists can approach the QL from the side, pushing their forearm into the soft tissue between the iliac crest and the last rib, even using the elbow to give the iliac crest cross fiber friction. Or massage therapists can lean over the client and lay their forearm or elbow into the thoracolumbar fascia near the spine and work their way between the iliac crest and the last rib towards the outside of the body. (Therapists should be mindful of their body mechanics here to ensure they don’t slip and fall on the athlete’s injured back!) Therapists can also have the athlete lay in a side-lying position with the affected side up and a pillow between the uninjured side and the table; this position gives massage therapists full access to the QL and makes deep tissue and trigger point work much easier. Trigger points in the QL are common and are usually found just below the QL’s insertion at the last rib. (Massage therapists should be careful to stay on the QL and not stray into the area of the kidneys, which are only partially protected by the lower ribs.) Trigger points in the QL will refer pain to the gluteal muscles, the greater trochanter of the femur, and the region just above the anterior iliac crest. If trigger point work is too painful for an athlete, hot stones are highly effective for relieving pain and reducing tension. Massage therapists should be sure to work the stones into the QL and not simply left on the spine, as this will only help the erector spinae muscles. Stretches are highly effective for mild to moderate back strains, too. Massage therapists should use AC and CRAC stretches by resisting the athlete’s movements with their hands on the iliac crest when they hike their hip (hiking the unaffected side for AC stretches, alternating hiking each side for CRAC stretches). Massage therapists can treat the erector spinae muscles with all the same techniques, although they may have to cover more territory, since the erectors as a group run the length of the spine from the thoracolumbar fascia to the vertebrae of T1 and T2.
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Book Code: MLA1224
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