These injuries are very common in athletes , about 60% of football players will suffer this type of injury at some point in career.
Athletes can begin to lose range of motion in their hips, and is an early sign for this type of injury.
Because there are several factors at play , you should be able to trace a Kinetic Chain of events in the case history.
1. they place more force on their hips
2. if they are growing rapidly eg 12 to 16 years old, they may suffer a mild slipped capital epiphysis or similar 'growth injury'. These can gradually grow into a hip 'deformity', further restricting range of motion and potentially Aggravating the labrum.
3. All the above could be the factor that causes the labral tear
4 . They will develop a weaker abdominal wall, and secondary adductor pain. Further aggravating problem.
5. Look for restricted joints that should be more mobile especially hip, ankle , shoulders.
So you may have a client come in who demonstrates all these points or just some of them. like the venn diagram shows, groin / hip / adductor pain involves several structures like a true kinetic chain injury. It is thought the injury complex stems from our evolution as quadrupeds who became bipeds dependent on the hip and the gluteus to keep us erect.
History and Diagnosis: Can be challenging because it's easy to focus on only one body part.
After taking a detailed history, speak to trainers (essential)and others who may have worked with the athlete to get their perspectives. Then begin a careful physical examination.
Ask the patient to do some crunches and see if there is pain. Then have the patient do a crunch with the leg in slight flexion. That puts a little load in certain areas of the abdomen. Next, have the patient crunch with a leg in flexion and adduction against resistance, this combines hip/thigh musculature and abdominal function together. These problems are almost always multifactorial.
Get patient to do action that makes it really hurt
Do fundamental movement exam
Record: movements that are the most painful and tender
From this point a picture should be forming of the main aggravating factors and the activities the athlete is unavble to do. This will help you narrow down why they developed the problem in the first place and how you will go about treating / rehabilitating it.
A 19-year-old man presents to his GP with a 2-month history of lower back pain and stiffness. The pain is intermittent, achy, and usually worse in the morning than it is later in the day or evening. He has also noticed a progressive decrease in flexibility in the back, eg flexing to tie laces etc. The pain sometimes awakens him at night. It is improved with exercise. He also reports a several-month history of low grade malaise, and loss of appetite. The patient has no history of rash. He does not have any known chronic medical conditions. He takes one multivitamin per day. He has never smoked, but he does drink an occasional glass of wine with dinner. There is no significant family history of disease.
On physical examination, the patient has a blood pressure of 125/67 mm Hg and a heart rate of 60 bpm, (taken due to the malaise) The patient has no photophobia, or eye redness. On examination of the back, flexion of the lumbar spine is clearly decreased when the patient attempts to bend down to touch his toes. He also has pain and limited range of motion with rotation and lateral flexion at the lumbar spine. He feels he can't get a big enough breath in. He is awaiting a blood test results for Rheumatoid factor , ESR and a genetic marker his GP said.
Possible diagnoses are
2. Spinal Stenosis
4. Ankylosing Spondylitis
Let us know your thoughts , I'll print the answer in a few days.
Low Back Pain is a Benign and Self Limiting Condition.The term 'non-specific back pain' is a slightly misleading term. Low back pain (LBP) may come and go but the reasons for the persisting back pain are still present, causing the client to be constantly susceptible. The longer this situation remains the more likely it will continue and an acute more debilitating episode is on the way.