Feature Story
The Hockey Doc on early-season groin injuries
Over the
years, one of the most commonly asked questions that I get asked is “What are
some of the most common early-season hockey injuries and what can I do to
prevent them?”
I can say without a doubt that the most
common early-season injury that we see at the
Groin strains are caused by an irritation
of one of the hip adductor muscles at the insertion of the pubic part of the
pelvic bone. In addition, the point at which the muscle joins the tendon (the musculotendonous junction) can also become strained,
irritated and swollen.
Groin strains are almost always due to a
sudden change in training habits. In the majority of cases that we have seen,
this occurs at the start of the season, with the initiation of a hard, on-ice
training regimen.
The pain from a groin strain is almost
always localized to the pubic part of the pelvic bone or at the muscle-tendon
interface of the adductor muscles in the groin region. This pain is almost
always increased with any maneuver in which the thigh crosses the midline of
the body, especially with power skating and crossovers.
The treatment of groin strains is usually
based upon the symptoms that are present with activities. Luckily, in the majority
of cases, groin strains are a self-limited condition that will resolve with
time. However, we recognize that a few days off during the early part of the
season, especially during try-outs, can seem like an eternity to some players
and coaches and can make the difference in making the team or not.
For minor injuries, a good stretching and
warm-up program, followed by avoiding on-ice activities which cause symptoms,
will usually result in the resolution of pain over the course of a few days.
This would include avoiding any significant power skating or crossovers until
the symptoms have completely resolved.
Over-the-counter anti-inflammatory
medications, such as ibuprofen, can also serve a useful purpose to decrease
some of the pain caused by the inflammation process. However, these
anti-inflammatory medications will not cause this tissue to heal. They need to
be used with a stretching, and appropriate warm-up program, to maximize the
chance that you will get back on the ice sooner.
In the case where an athlete cannot skate
because of pain, a program of rest, ice, and ultrasound is recommended until
the athlete can resume skating. Cross training by cycling or pool therapy can
help to keep up one’s cardiovascular status until the symptoms improve.
In those cases where symptoms do not
resolve over a week or two, further investigation should be performed to
determine if that pain is from another source. These other sources include
stress fractures (especially in female skaters), sports hernias, or an
irritation of the pubic symphysis (where the two
pelvic bones meet).
Overall, the best way to treat groin
strains is to work on prevention. We attempt to have our players work with our
strength coach and athletic trainer on a program of stretching, prior to the
initiation of any on-ice activities, so that they do not develop groin
injuries.
It is also equally important to know that
a stretching program should not be initiated prior to warming-up appropriately.
Studies have shown that the incidence of muscle strains is actually higher in
athletes who stretch before warming-up than those who stretch after warming-up.
Therefore, a short ¼ mile jog or 4-5 laps around the ice may be necessary to
get the blood circulation going to the muscles, so that you will be able to
stretch appropriately.
If the symptoms from a groin stain do not improve using this program,
then follow-up with a physician may be advised to see if there are other causes
of the source of the
pain. It is not uncommon for the symptoms of sports hernias, which are due to
tears of the abdominal wall muscles, to present similar to groin strains.
Therefore, any groin strain which lasts more than a couple of weeks should be
considered to be a possible sports hernia until it is ruled out of the
diagnosis.
Dr. Rob LaPrade, MD, PhD,
is the team physician for the