Iliopsoas Related Groin Pain

Previously I have written about hip adductor related groin pain (ARGP), which is the most common area for groin pain. There is also iliopsoas related groin pain (IRGP). Patients who have IRGP usually have iliopsoas tenderness/ pain while stretching the area  and have pain with resisted hip flexion (or bending). 

There is not enough evidence to suggest which exercise protocol or treatment technique is superior for treating IRGP. However, there is evidence to suggest a quicker return to sports (and to running) using a multi-modal program (manual therapy, stretching, heat and exercise therapy) compared to exercise therapy alone (Weir et al, 2010).

Strengthening the iliopsoas via isometric, concentric and eccentric contractions using elastic bands for 6 weeks have been found to substantially improve iliopsoas (hip flexor) strength (Thorborg et al, 2016). King et al (2018) found that athletes had high rates of pain free return to sports participation and had improved cutting performance when rehabilitation focused on inter-segmental (lateral hip, legs and abdominals) control.

Neutral spine, anterior or posterior tilt

There you have it, no magic stretches, protocol, nor any therapeutic machine to really treat groin pain on its own. Some physios teach core or stabilization exercises with a neutral spine (pictured above).

3 planes of motion

Like I wrote before, we do see many patients with groin pain in our clinics. Our approach to treatment is very different. It depends on what our assessments show. The patients do not do any strengthening exercises when they are in the clinic. We prefer to treat them using mostly our hands instead. Since the pelvis (or hip) has 3 planes of motion, we treat them with our hands with respect to he 3 planes of motion (pictured above).

For example, for a patient with groin pain, they may also have a hip rotated to the right side (pictured below). 

Hip rotated to right side

We can treat the hip with respect to the shorter side. Short in terms of length. So the right side is shorter in front (pectineus) in the picture above, while the left hip is shorter behind. 

The patients can then do the strengthening exercises they need on their own. We treat what they cannot do themselves in the time they have with us. Come see us in our clinics if you have groin pain.

References

King E, Franklyn-Miller A, Richter C et al (2018). Clinical And Biomechanical Outcomes Of Rehabilitation Targeting Intersegmental Control In The Athletic Groin Pain: Prospective Cohort Of 205 Patients. BJSM. 52(16):1054-1062. DOI: 10.1136/bjsports-2016-097089

Thorborg K, Holmich P, Christensen R et al (2011). The Copenhaen Hip And Groin Outcome Score (HAGOS): Development And Validation According To The COSMIN Checklist. BJSM. 45(6): 478-491. DOI: 10.1136/bjsm.2010.080937

Weir A, Jansen JA, vande Port IG et al (2011). Manual Or Exercise Therapy For Long-Standing Adductor-Related Groin Pain: A Randomised Controlled Clinical Trial. Manual Therapy. 16(2): 148-54. DOI: 10.1016/j.math.2010.09.001

Core Work On Stable Or Unstable Surfaces?

Taken by my wife for a talk she did way back in 2005!

Many of my patients engage personal trainers to help them with their workouts regularly. Out of curiosity, I always ask them to tell me what sort of exercise routine they go through with their trainers. Turns out that "core strength workouts" are a very popular choice amongst personal trainers.

Well, here's a post on whether your "core strength" workout is giving you the workout you want.

A group of researchers studied a group of subjects doing core strength workouts. At the start of the study, the subjects performed fitness tests including tests for core muscular endurance, flexibility, balance and a 20 metre sprint.

The subjects trained twice a week for six weeks. Each session was a 30 minute circuit session rotating among three exercises : cross curl-ups, side bridging and bird dogs. One group did the session on a stable surface while group did the same exercises on unstable surfaces.

For example while doing bird dogs (starting on hands and knees and reaching alternate limbs horizontally), a basketball was placed under the supporting hand. As the study progressed, this group added additional elements of instability to each exercise. Example : putting a squishy ball/ balance cushion under the supporting knee and lifting the foot of supporting knee off the floor.

After six weeks, both groups improved significantly.Despite what the researchers thought would be the case, the group who did their exercises on unstable surfaces did not outperform the stable group.

The researchers reported that core strength training is feasible and safe and it produces marked increases in strength, flexibility and skill related components such as balance, coordination and speed.

They concluded that if the goal is to enhance physical fitness, core strength workouts on unstable surfaces has no advantage over the same exercises on stable surfaces.

Reference

Granacher U, Schellbach J et al (2014). Effects Of Core Strength Training Using Stable Versus Unstable Surfaces On Physical Fitness In Adolescents: A Randomized Controlled Trial. BMC Sports Sci Med Rehab. 6(1): 40. doi: 10.1186/2052-1847-6-40. eCollection 2014.

Another look - 10 years ago....