Unresolved Groin/Hip Pain

[L_Master]

Been dealing with groin pain now for the last 7 months. Was running about 70mpw beforehand but have since been sidelined.

Initial Injury Details: Started having groin pain during a workout of fast 300s. Didn't seem to really get worse with each repeat so I decided to continue on with the workout. That didn't end well, as on the cool-down it become very uncomfortable and by the time I got back home I was basically limping. Was painful to walk, get in and out of cars, etc. for the next 2-3 days. After about a week it felt better doing daily activities so I did a 1k race on campus, which of course brought back the symptoms, though not as severely as initial injury. Over the next month a half I tried twice to run on it again (easy pace) at various points when it started to feel better, but to no avail, and each run brought the symptoms back to where it was noticeable, though not super painful, for daily activities/walking. At that point decided whatever, I'll just let it heal and wait till I have no symptoms.

I took about 3 weeks off of any physical activity, then started doing some biking to maintain fitness as this did not illicit any pain/discomfort/etc. Gradually improved over the next few months to where there was really no discomfort with any daily activities, except for a very, very minor discomfort if I tried to put on my left shoe with the leg crossed over the right thigh, and perhaps a tiny bit if I were to aggressively pull open a door.

Since then it hasn't really improved. I can run a tiny but on it (.5-1 mile) without problems, but the "feel" is that if I continue this it will come back.

Symptoms/Tests: No real stretching or palpitation seems to cause problems. External and internal rotation by themselves are not a problem, nor is adduction.


I can induce mild discomfort lying in bed if I lay supine and abduct + light downward pressure into the bed to create resistance, but this results in sensation on outside and top of the thigh/anterior/lateral hip, and some light, possibly referred pain can be felt near adductors right as the tension is released. Doing the same thing, but with adduction causes minimal to no pain. Straight adduction or abduction, like on a machine in the gym does not seem to cause pain. Tests like FABER and FADIR don't seem to produce symptoms; nor do most physical exercises like ellipitcal, cycling, squatting, lunges, hiking, etc.


The only things I can seem to find that reproduce the pain/discomfort are what I described earlier (supine abduction + downward force/hamstring contraction/hip extension against resistance) running (especially higher velocity), and some discomfort if I were to grab the handles on the stairs or grab a pole and try to swing aggressively around in a clockwise direction, or cut very sharply to the right. All of these are quite mild though, barely a 1 if I had to rate it. One other oddity is that adduction against resistance is fine, with one exception, and that is if I were to lay supine with feet flat and knees up, put both my knees directly together and forcefully adduct there is a sharp pain, almost a pinch, around common insertion of the adductor tendons. If I put a soccer ball or something between the legs I would get much less of a reaction, if any. Adducting the legs in a totally supine position does not seem to cause this sharp pinch.






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[physiobob]

This sounds like a pevlic alignment issue. Go see a good physio with training in Muscle Energy Technique (Nordic Therapy) who can assess that alignment and realign if required. The tell tail sign is that pain on squeesing the legs together in supine. Sounds like you need a manip to sort that out. This is why rest is doing nothing for you.

[SportRehab]

I agree with Bob

Another possible condition might be anterior glide syndrome as described by Sahrmann. It might be that your posterior hip capsule is tight which does not allow the femur to glide inferiorly while flexing the hip. It is also possible that you have lack of hip Internal rotation on the involved side (capsular or muscular restriction) which additionally contributes to the structural alignment. Obviously the adductors over-activity is present in your case which might be coupled with anterior pelvic tilt, tight fip flexors and inhibited lumbo-pelvis stabilizers.

And just one "out of the box" suggestion.... the application of "wishbone manoeuvre" technique might work for you (described by Lucy Whyte Ferguson in a paper "Knee pain: Addressing the interrelationships between muscle and joint dysfunction in the hip and pelvis and the lower extremity") published at Journal of Bodywork and Movement Therapies. I really recommend this article, it clearly reasons the applicability of the technique.

I personally have a quite good experience with this technique.

Any other thoughts welcomed