Sports | Inability to recover from lower abdomen, groin and hip

How stem cells heal degenerative joint disease after years of cortisone and painkillers

Ross Hauser, MD

We will often see athletes in our office who are frustrated and confused by their seemingly inability to recover from problems circulating in the lower abdomen, groin and hip. Long periods of rest, missed competitions, difficult recoveries are all the hallmarks of a patient ready to have a surgery because nothing else is working.

The subject of hip instability causing groin pain is covered at length in our website. Links in this article will take you to those articles.

To get at these patient problems, one must identify the patient’s problems, then we can assist the athlete in their desire to return-to-play.

Is it a problem of the groin? The hip? The lower back?

Hip instability may commonly manifest itself as groin or inguinal pain. When a patient asks why they cannot heal, we explain to them that someone suffering from groin pain should be examined at the pubic symphysis, groin pain generators should need to be explored in the sacroiliac joint, iliolumbar ligaments. A complete examination of the hip joint and its range of motion is also needed. Below you will see research explaining how doctors can determine treatment courses based on the hip range-of-motion.

When the hip joint becomes unstable, the hip muscles over the joint compensate for the instability by tensing. As is the case with any joint of the body, ligament instability initiate muscle tension (muscle spasms) in an attempt to stabilize the joint. This compensatory mechanism to stabilize the hip joint eventually causes the gluteus medius, piriformis muscle, and iliotibial band/ tensor fascia lata muscles to tighten because of chronic contraction in an attempt to compensate for a loose hip joint.

The contracted gluteus medius can eventually irritate the trochanteric bursa, causing a trochanteric bursitis. A bursa is a fluid-filled sac which helps muscles glide over bony prominences. Patients with chronic hip problems often have had cortisone injected into this bursa, which generally brings temporary relief. But this treatment does not provide permanent relief because the underlying ligament laxity is not being corrected.

Prolotherapy injections to strengthen the hip joint and iliocapsular ligaments will provide definitive relief in such a case.

Chasing the sciatica diagnosis may not be helpful

It is interesting to note that trochanteric bursitis, piriformis syndrome, and weakness in the iliotibial band also cause “sciatica.”

We find that patients suffering from so-called sciatica often have weakness in the sacroiliac joint, hip joint, sacrotuberous and sacrospinous ligaments, trochanteric bursa, and iliotibial band/tensor fascia lata. The sciatic nerve runs between the two heads of the piriformis muscle. When the piriformis muscle is spastic, the sciatic nerve may be pinched. Lumbosacral and hip joint weaknesses are two main causes of piriformis muscle spasm. Stretches and physical therapy directed at the piriformis muscle to reduce spasm help temporarily, but do not alleviate the real problem.

Off-centered low back pain is often caused by a posterior hip sprain. This hip sprain can often be the cause of groin pain that radiates down the leg to the big toe. Prolotherapy is very effective in this area. Some patients benefit from a combined low back and hip treatment course if there is noted weakness, instability, and/or pain in both the low back and hip.

The iliotibial band/tensor fascia lata extends from the pelvis over the hip joint to the lateral knee. Its job is to help abduct the leg, especially during walking so the legs do not cross when walking. When this band/muscle is tight, it puts a great strain on the sacroiliac and lumbosacral ligaments.

Stretching this muscle is beneficial to many people with chronic hip/back problems. Stretching and massage feels good to people with chronically “tight IT bands.” Take this one step further though to understand why the bands/muscles become tight in the first place, which is joint instability generally in the hip or the knee. This instability needs to be properly identified and treated for the chronic tightness to be eliminated, along with the need to regularly stretch or massage the area in order to feel relief. Once the joint becomes stable, the continual tightness subsides.

Limited range of hip motion seen as risk factor in kicking athletes

Research lead by Dutch University researchers and published in the British Journal of Sports Medicine found that “there was strong evidence that total rotation of both hips below 85 degrees measured at the pre-season screening was a risk factor for groin pain development.”1

Research from another team of Dutch researchers and published in The Journal of sports medicine and physical fitness says that soccer players with groin injury refrain from kicking with maximum strike force because of previous groin injury related to decreased hip range of motion.2 The thinking is come up with a kicking kicking strategies for athletes with injury, or in our thinking, come up with a better way to repair the hip-groin damage.

In new research, doctors acknowledge that dance, gymnastics, figure skating, and competitive cheerleading require a high degree of hip range of motion and the use of the hip joint in a mechanically complex manner. Because of the extreme hip motion required and the soft tissue laxity in dancers and gymnasts, these athletes may develop instability, impingement, or combinations of both.3

Decreased muscle strength increases risk for future groin injury

University researchers in Spain and Canada teamed up to examine the unique problems of hip-groin injuries in tennis players. Writing in the medical journal Musculoskeletal science and practice, they found that despite the hip-groin injury prevalence in tennis, no studies have assessed the extent to which intrinsic groin injury risk factors, such as hip muscle strength, affect tennis players with a history of previous high-groin injury.

Study highlights:

 

If you have questions about hip instability causing groin and pelvic dysfunction and disrupting your sports, get help and information from our Caring Medical staff

1 Tak I, Engelaar L, Gouttebarge V, Barendrecht M, Van den Heuvel S, Kerkhoffs G, Langhout R, Stubbe J, Weir A. Is lower hip range of motion a risk factor for groin pain in athletes? A systematic review with clinical applications. Br J Sports Med. 2017 Apr 21:bjsports-2016. [Pubmed] [Google Scholar]

2 Langhout R, Tak I, van der Westen R, Lenssen T. Range of motion of body segments is larger during the maximal instep kick than during the submaximal kick in experienced football players. The Journal of sports medicine and physical fitness. 2017 Apr;57(4):388-95. [Pubmed] [Google Scholar]

3. Weber AE, Bedi A, Tibor LM, Zaltz I, Larson CM. The hyperflexible hip: managing hip pain in the dancer and gymnast. Sports health. 2015 Jul;7(4):346-58. [Pubmed] [Google Scholar]

4 Moreno-Pérez V, Lopez-Valenciano A, Barbado D, Moreside J, Elvira JL, Vera-Garcia FJ. Comparisons of hip strength and countermovement jump height in elite tennis players with and without acute history of groin injuries. Musculoskeletal Science and Practice. 2017 Jun 30;29:144-9. [Pubmed] [Google Scholar]

 

 

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