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Groin Pain Rehabilitation

[embed]https://www.youtube.com/watch?v=0gnAmWIjLCc[/embed]

Groin pain is a common complaint in athletes and active populations as well as a common source of frustration. What makes it so frustrating is the poor understanding of proper management because of the number complexities related to the true cause of groin pain.

15% of all injuries responsible for competition time lost in hockey players is due to groin pain from common conditions such as groin strain, femoral acetabular impingement (FAI), labral tears, and sports hernia.

Sports hernia is one of the most difficult causes of chronic groin pain to identify and manage. Sports hernia is a weakness and/or injury to the abdominal wall and supporting musculature which can result in groin pain. The difficulty in diagnosis lies the fact that most sports hernias do not produce a palpable hernia and are not seen on advanced medical imaging such as radiograph, ultrasound, MRI, or CT. Surgical exploration is generally the most excepted method in producing a definitive diagnosis of sports hernia after other potential sources of groin pain have been eliminated.

Diagnostic methods in determining the presence of sports hernia may include the identification of five classic signs and symptoms:

  1. Complaint of deep groin/lower abdominal pain,
  2. Exacerbation of pain with participation of sport activities that is relieved by rest,
  3. Tenderness with palpation of the pubic ramus,
  4. Pain with resisted hip adduction,
  5. Pain with resisted sit-up test
Disclaimer: Do not attempt to diagnosis your own condition. Proper evaluation and diagnosis of your pain or problem should be left to licensed medical professionals only.
Surgical intervention has been shown to be an effective method, both in the short-term and long-term, for the management of sports hernia while little is understood about the long-term effects of conservative, non-surgical treatment of this condition.

Here we show a glimpse inside the rehabilitation of post-surgical sports hernia for one of our hockey athletes. Early rehabilitation focus on core control and stability with progressive demands of the extremities.

This model will be vital for proper progression through treatment and functional training prior to return to sport. Rehabilitation must address underlying functional deficits of the core and hips while building a foundation of movement control and awareness necessary for the future development of strength, speed, and power.
For more related reading:

https://gallagherperformance.com/exercise-hacks-ep-11-train-abdominal-slings-functional-core

https://gallagherperformance.com/training-maximize-athletic-potential/

https://gallagherperformance.com/low_back_pain_treatments_that_just_wont_help/

https://gallagherperformance.com/understanding-methods-application-training-rehab/

https://gallagherperformance.com/makes-sports-rehabilitation-chiropractor/

https://gallagherperformance.com/prevent-re-injury-integrated-training-rehabilitation/

6 Tips for Hockey Training

When it comes to athleticism, there is a sad misconception among far too many individuals that athletes are "born not made". People that believe this will often say, “You can’t teach speed” or “That’s just a gifted athlete”. While genetics can play a role in athleticism, arguably the greatest impact on an athlete’s development (or lack thereof) is the training system that is implemented. This would include all elements from its organization to exercise selection and other variables.

While all sports have their own unique considerations, ice hockey demands high levels of athleticism. The transfer of training from off-ice preparation to on-ice performance presents a host of challenges. With the nature of today’s game, proper off-ice training can provide youth and elite level hockey players with the advantage they need to elevate their game.

Here are some tips: 
1. WARM-UP PROPERLY 
In preparation for exercise, the body should be moved through large ranges in all three planes of motion (sagittal, frontal and transverse). Movement prepares the brain and body for exercise by activating the nervous system, warming tissues such as muscles and tendons, and lubricates joints. Movements performed in all planes of motion on a consistent basis will improve stabilization patterns, mobility, coordination, balance, and movement efficiency. Making the time to properly warm-up with allow you to get more out of your training. Simply put, it makes training more productive and will reduce the risk of injury.

2. TRAIN MOVEMENTS, NOT MUSCLES 
The human body operates as an integrated system. Joints and muscles are all coordinated by the central nervous system to produce movement. Muscles never work in isolation, meaning that there is always a pattern of muscle recruitment that occurs with every movement we make. Depending on how we recruit muscles, movement will occur in efficient or inefficient ways. Athletes require mastery of movement. Unlike those who train to for basic fitness or simply to ‘look better’, athletic development and performance-based training programs aim to improve how an athlete moves. Goals focus on strength, stability, mobility, speed, and skill execution with a high degree of movement efficiency.  Sure many athletes look good, but this is often a by-product of their training, not the primary goal.

There can be a mistake in young athletes simply go to the gym and “working out”, either by themselves or with their friends. Especially when they have no plan. If most young athletes are honest, they don’t know what to do during the off-season. Even some trainers have no idea what they are doing with athletes and just “make-up” a training session as they go or select a random workout off the Internet. As the saying goes, “One program on a dry erase board for your group of clients/athletes isn’t training, it’s babysitting.” Higher quality strength and athletic development programs are becoming more available to young athletes; those athletes not involved in those programs will be left behind.

This concept was detailed in our article on Training for Elite Athletes.

3. GET IN TOUCH WITH THE GROUND
This point builds off the previous one. The majority of sport movements and skill execution are initiated by applying force to the ground with the feet/legs. As with land-based sports, the more force a hockey player applies to the ice, the greater acceleration and speed they generate. Strength and power development exercises should be selected based on their ability to enhance ground-force reaction. The same can be said for both speed and conditioning drills.

Utilizing squat and deadlift variations, Olympic lifts, medicine ball throws, jumps, plyometrics, sprints, and hockey-specific agility/change of direction drills would be the most beneficial in developing ground-force reaction. Unilateral movements such as single-leg squats and jumps, lateral bounds, split squats, and lunge variations will also help to develop the movement proficiency need for a powerful skating stride.

4. TRAIN THE CORE FOR FUNCTION, NOT LOOKS
The core is the body’s center of force transfer and movement control. The core is not simply your abs. It includes almost 30 muscles that attach to the spine, shoulders and hips, which function to stabilize the areas during movement. When the function of the core is compromised, inefficient movement results and risk of injury is increased. Hockey and its movement skills require high levels of core stabilization, endurance, strength and power transfer. The demands of athletics on the core will never be met by performing thousands of crunches. Your core training needs a more specific, specialized focus.

Stabilization exercises should focus on things such as maintaining proper lumbo-pelvic posture and the ability to resist or control movement in all planes of motion. Once proper stabilization is achieved, greater attention can be given to rotational power and force generation exercises for increased transfer of training into sport.

5. BE SMART ABOUT YOUR CONDITIONING
The sport of ice hockey places demands on both the anaerobic (alactic and lactic) and aerobic energy systems of the body. For the most part, hockey is an anaerobic game, characterized by intense bursts followed by periods of rest. The anaerobic system is challenged during these intense bursts while the aerobic system is utilized during the recovery period between shifts. This illustrates the need for both systems to be well developed for optimal performance.

Thus conditioning for hockey should focus on an interval-based approach to meet the energy system demand of the sport. Place a priority on developing the capacity and power of the anaerobic-alactic system along with the use of tempo runs/bike sessions to develop the aerobic system. Anaerobic-lactic training is extremely taxing on the body and difficult to recover from. This form of exhaustive conditioning should be used less frequently in the training program.

Remember, conditioning does not mean the same thing as speed training. For more information of developing hockey speed, read this article.

6. RECOVER, RECOVER, RECOVER
Recovery from exercise can be accelerated with proper attention to flexibility, mobility, massage, chiropractic treatment, nutrition and sleep. These approaches facilitate the body’s ability to recover from exercise. Nutritionally, ingesting the proper amounts of whole foods and supplements at the appropriate times during the day can prove to be a huge part of the recovery process. Replenishing energy stores (i.e. muscle glycogen) and providing the building blocks (i.e. protein, fats, vitamins, minerals) for tissue repair and regeneration are just some of the primary goals of proper nutrition. Self-management strategies such as foam rolling and stretching/flexibility work are valuable components in the recovery process. Maintaining proper muscle function and joint range of motion is critically important to minimize injury risk and ensure that you get the most out of your training.

Conclusion
Keep in mind the above tips serve as guidelines. Individual considerations cannot be met in an article of this nature. However, if applied correctly, these guidelines can serve to provide aspiring hockey players with a better understanding of how to go about their off-ice training. For those interested, GP specializes in the training and preparation of hockey players. Contact us for more information.