Well, you might imagine the look of surprise and relief on the face of a client I saw this week when I told him what was finally causing his hip/leg pain. This particular client trains with one of my staff members. He has a longstanding history of pain in the upper posterior thigh and groin area. It flared up recently and he finally went to see a physician.
He was diagnosed with an adductor strain and given a prescription for physical therapy. My trainer wanted asked for guidance in working with him as not to aggravate the situation yet continue his fitness program. As I spoke with him, he mentioned his worst pain occurred with sitting. In fact, he can’t tolerate more than 5 minutes of sitting due to pain. This struck me as very odd and not typical with adductor strains.
I began to probe further. Next, I had him do some specific movements and I took a closer look. My brief exam yielded limited hamstring flexibility and pain/weakness with hamstring resistance. It was clear that his groin pain was more likely related to a medial proximal hamstring strain and not an adductor strain. Because the medial hamstring controls hip rotation, his symptoms would easily be provoked in certain movements and positions much like an adductor strain.
The take away message here is simply to listen carefully and closely examine the affected tissue to determine the true source of pain/dysfunction. Treating the adductor will NOT cure his hamstring problem. I am sure his physician is very competent, but often MD’s do not listen closely enough or perform inadequate testing, which leads to an incomplete or inaccurate diagnosis. Any intervention I offer to clients should yield positive results or improvement within 4 weeks.
If you have an injury or physical goal and are not seeing forward progress in this time period, it is time to take a closer second look at the plan of attack. It may take a different set of eyes and ears to get you back on track. The little things really do matter!
In my last post, I spoke of lunging and the stress on the knee joint. Today, I thought I would speak about muscle strains. Keep in mind you strain muscles and sprain ligaments. The most common muscle strains I see are hamstring, quadriceps and groin injuries.
They typically occur with a deceleration movement in sport or recreational activity. In my experience, I notice that some athletes tend to be more prone to these than others. This particular group of athletes seems to be those with a predominance of fast twitch fibers (more of your sprinters) and those lacking good flexibility and mobility (no surprise there).
Proper warm-up, strengthening, plyometrics and acceleration/deceleration training all play a role in preventing these injuries. Recovering from such an injury is often a tricky thing. Athletes often are fearful of pushing the injured tissue 100% (they fear re-injury) and coaches may not sufficiently gauge how long to hold the athlete out of full participation. More importantly, the athlete often under reports the pain associated with the injury. I have included a great recovery article HERE that gives you 3 R’s to go by.
I also included a picture of one of my favorite rehab exercises for rehabbing high hamstring strains below. It is the single leg Romanian dead lift and provides n excellent way to elongate the hamstrings functionally. Pain or the absence thereof during full range of motion will indicate the relative healing of the injured tissue to date. One should be able to do this equal to the non involved side without pain.
RDL - Descent
Ever have knee pain in the gym with lunges? I work with so many clients who find their strength program limited by knee pain. It is very common for women to suffer from Patello-femoral Pain Syndrome (PFPS) as they get older. It commonly begins affecting them around age 30.
Essentially, the cartilage behind the kneecap may soften (often referred to as chondromalacia) or break down exposing the subchondral bone (below the cartilage) to excessive stress. There are many pain receptors in the subchondral bone region that let you know quickly when the knee is unhappy.
Activities like stair climbing, kneeling, squatting and impact exercise often bring this pain on. Therapists and trainers have long debated whether one should lunge or squat with the foot beyond the toes. To date, little research has been done to support the notion that allowing the knee to extend beyond the toes dramatically increases PF joint stress.
That is until now. In a recent study in the Journal of Orthopaedic & Sports Physical Therapy (JOSPT November 2008), researchers compared a short and long step lunge both with and without a stride (stepping out and back). The results in a nutshell confirmed that indeed a short lunge (allowing the knee to extend beyond the toes) produced more force and stress on the PF joint than a long step lunge (knee remains over the foot). The stride with a short step and long step also produced more force than it did with a stationary lunge indicating a stationary lunge is less stressful, especially at lower knee flexion (bending) angles.
The angles where the forces really increased on descent were from 60-90 degrees. This research would suggest that people with anterior knee pain would be better served to lunge less than 50 degrees with a longer step length in a stationary position while rehabbing or until they build enough strength to move safely into a deeper lunge without pain. The big takeaway here is to find the range of motion that works for you, but ultimately lengthen the step length to avoid increasing PF joint stress with lunges.
With all that said, I still believe we were designed to move in ways that the knee does extend beyond the toes. It happens with step-over-step stair descension and sprinting/acclerating for sure. Yet, doing 2-3 sets of weighted lunges 1-2x/week on a regular basis for strengthening in this fashion may lead to problems long term. For those with documented PF problems, the safer route is to side with the research and listen to the body. I hope this info serves you well in the gym moving forward!
Ever wonder why your fitness program does not work, or why that nagging pain in your back, shoulder or knee never goes away? I will tell you WHY. It’s because most people fail to listen to their body. Stay with me here.
If your fitness program is not yielding results, I bet you are not working hard enough and likely doing the same old routine. Your body knows this and tells you this as it is not ever sore, nor does it change. Likewise, the body sends signals of injury or mechanical failure in the form of pain, swelling, stiffness and weakness. If you blow it off, bad things are likely to follow in time.
Consider the stubborn client who has a small shoulder pain related to a new kettle bell class he has been taking. The pain starts out as a minor irritation, but as time goes by it grows. Now bench press and shoulder press is hard to even do. Even getting dressed is uncomfortable. You guessed it. The rotator cuff is flat out mad and inflamed. Continuing to ignore it may lead to a tear, chronic inflammation and certain activity restrictions.
Can this be avoided? In many cases the answer is yes. Recognizing changes or the lack thereof, should give all of us a call to action. It is much easier to solve pain and inflammation with early detection. Telling yourself you can work through it and it will get better in time is foolish. Not true 9 times out of 10. Look at my neck problem. I tried to work through it for a week and then realized it was not going away. In fact it got worse. Then I started an anti-inflammatory medication (mostly beneficial early on) and cervical traction. The result is my symtpoms are resolving within 5 days of beginning treatment. Whew! The surgeron can keep waiting for me because I have no plans to visit anytime soon.
Am I fortunate? Absolutely. No one likes a pinched nerve. But, do NOT discount the value of early recognition and intervention. It has and will continue to keep me healthy long term. So, listen to your body. It provides all the clues necessary for people like me to help you stay fit and healthy while overcoming the plateaus and physical injuries. Check back as my next post will give you some guidelines to determine if and when you can safely ramp activities back up after injury.
I hope you had a wonderful Thanksgiving with your family. I enjoyed my time away from the office and my PC as well. With one more day remaining on my Holiday pre-launch book sale, Healthy Golf Shoulders is selling well. I have received lots of positive feedback from many customers already and sold well over a hundred copies in the past 3 days. If you were unable to see a sample file you can view one here.
The sale will end tomorrow at Midnight EST so take advantage before the price goes up to $39.95. I also wanted to share a challenging sample exercise from the book that I featured in a recent online post for my “Functionally Fit” Column in PFP Magazine. Check out the tripod push-up plus here.
By the way, if you have questions related to injuries, rehab or sports performance, I want to read them. I am always looking to provide solid info on my blog and if you have a question many others may have the same question and benefit from reading my answers to them. I may even write an article about your particular issue. Send all questions to [email protected] or post a comment to the blog as well.
I look forward to hearing from you. Enjoy the rest of the weekend!!
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