Can’t break the cycle of groin strain and adductor overuse injury.

[Nightwalker]

Hi, I am looking for some advice on what to do, I have been suffering from a recurring series of groin strain and adductor over use injuries for 12 months now. I am a mid distance runner, up to half marathon and used to cover about 25 miles a week at 8 minute miles or there abouts. I picked a groin strain on a half marathon and went through a process of rest and rehab but every time I tried to get back into exercise I would end up with a similar relapse injury really easily, like all the muscle endurance had been lost form my adductors. After about 6 months of this cycle of getting better, getting a relapse, I got a referral to see the physiotherapist at the local hospital. He was really good, I followed all the exercises and was back to training after a couple of months of taking it easy. I got my mileage back up to 5 miles over about 3 months and did weekly strength training and cross training in the gym (3 runs, 1 gym a week). I thought I was back to normal but 4 weeks ago I got another groin strain in my right pectineus and have been suffering overuse in my adductors on both sides. I wait a week or so for the pain to go away, then go out for a gentleish 3 mile run and am back to the start with more overuse problems in my adductors. Swimming front crawl seems to be ok but I can’t run, row, do much strength training and have lost all the muscle endurance in my adductors again. How do I break this cycle, how long do I need to rest etc? Any advice appreciated.

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[marj]

If you liked the physio, I would try to follow up with him again. You may need him to look at your spine and pelvis as well as your running pattern to fully resolve the issue.

[Nightwalker]

I made a note of all the exercises that were prescribed last time when I had the physiotherapy at my local hospital. I have been in touch with them but I would need to get a referral from my GP which would then be a 4-5 week wait to get back in to see the physiotherapist. After the last 4 weeks of trying to get back into running and re-injuring myself I have decided I need more rest time, and have started the same course of exercises that I was given by the hospital. I am planning to take a 4 week break from running and to swim and cross train (building up the time and intensity) over those 4 weeks to try and preserve my fitness as much as I can and to also keep off the running while the muscles/tendons heal.

What I don't understand though is why this problem comes back again and again; the last 4 weeks I think I tried to run again too soon hence taking more time out. Before that though I was training normally for 3-4 months before coming down with the same injury. I don't think its my running style that is the problem though as in all the times I have had this injury it has nearly always been as a result of resistance training in the gym or climbing or some activity other than running.

As a general rule, what is the best way for me to build strength and endurance in my adductors? How often should I train, how long should I rest etc. I wonder if the start of this current injury period was due to a cumulative effect of too much exercise not enough rest time. There seems to be no warning though; it seems to be very easy to overdo it and then its too late. Would it still be worth getting my running pattern analysed?

[marj]

I made a note of all the exercises that were prescribed last time when I had the physiotherapy at my local hospital. I have been in touch with them but I would need to get a referral from my GP which would then be a 4-5 week wait to get back in to see the physiotherapist. After the last 4 weeks of trying to get back into running and re-injuring myself I have decided I need more rest time, and have started the same course of exercises that I was given by the hospital. I am planning to take a 4 week break from running and to swim and cross train (building up the time and intensity) over those 4 weeks to try and preserve my fitness as much as I can and to also keep off the running while the muscles/tendons heal.

What I don't understand though is why this problem comes back again and again; the last 4 weeks I think I tried to run again too soon hence taking more time out. Before that though I was training normally for 3-4 months before coming down with the same injury. I don't think its my running style that is the problem though as in all the times I have had this injury it has nearly always been as a result of resistance training in the gym or climbing or some activity other than running.

As a general rule, what is the best way for me to build strength and endurance in my adductors? How often should I train, how long should I rest etc. I wonder if the start of this current injury period was due to a cumulative effect of too much exercise not enough rest time. There seems to be no warning though; it seems to be very easy to overdo it and then its too late. Would it still be worth getting my running pattern analysed?

Since you say that it is not running that triggers the problem, then you're probably right that analyzing your running biomechanics may not be the most useful way to go. Often recurrent adductor problems are associated with facilitation of the muscles from dysfunction in the jupper lumbar spine or pelvic malalignment associated with inadequate dynamic pelvic stabilization. It is doubtful you will be able to solve this without having another thorough physiotherapy examination and participating in treatments (exercise, advice +- manual therapy).

It will help the physio to know which exercises, activities seem to trigger the problem and then, hopefully, together you will be able to figure out why the problem has been recurring.

If the hospital is too long a wait, then perhaps a private physio could help you.

Keep us posted. Good luck.

[Nightwalker]

Hi,

After taking your advice I have been seeing a private physiotherapist which has helped me get back to a level of normality. The dull pain in my right groin has all but gone and I have just started to return to running very slowly. I also finally got an appointment for the ultrasound scan I was waiting for at my local hospital to get a scan of my my groin/adductor to try and identify any underlying issues. The chap that did the scan said I had chronic inflammation of the tendon at the insertion point with the pubic bone, he said he could see the calcification. Hopefully that makes sense?

I should get a letter with his written notes at some point (or I can ring up and get them to confirm exactly what he said). Obviously I am a bit worried as I don't really know much about the problem and how likely I am to make a full recovery. I thought I was on the road to recovery but now I feel a bit unsure. I want to get back to running properly and get on with the marathon I have been planning for so long! I will speak to my physiotherapist but my next appointment is not for a week or so. What is the prognosis, am I ever going to be back to full strength and able to run high mileage like I used to?

[Flowers88]

I have had an on-off groin injury for ten years now, at first the pain wasn't too bad, but after a year I took part in a half marathon and I couldn't walk for a few days after so I got it checked out.
After numerous scans and tests, they advised that due to it being left so long mine was chronic as well.
I was put under aesthetic and given a cortisone injection, and after the recovery period it did feel a lot better, but it was never back to normal. They advised this would only last a few years (and that you are only allowed 2-3 maximum in one area in your lifetime).
I was told I could never run on pavement again, as the impact is too harsh, and to continually do the exercises given to me by my physiotherapist.

I gave it a year, focused on weights and soft running (on grass or the treadmill) and decided to start running on pavement again.
I ran for only about 10 minutes, and the next day the pain was back. Luckily with a few days rest it was ok again, but shows that it really isn't practical to run on pavement.
The pain has now started again, and I haven’t even run recently, so looks like I will be having another injection (last one was 4 years ago).

I hope yours isn’t as bad as mine, as for a keen runner, its pretty dampening news.
Things that do help are continuingly doing the exercises given to you, doing yoga regularly and running in water.

Hope the info helps

[KelcieLe]

I think you should not ignore this problem and rather seek profesional advice. Get it checked from a doctor and see what he has to say about it.