Post on 12-Jan-2016
Buyer Beware
• The hip is the new shoulder.• New technology now allows hip surgery
that was not previously possible.• Do your homework. Don’t believe
outcome stats.• Many of the “repairs” being done today
will look like the lateral releases or the 80’s.
Dr. James Andrews
• “want an excuse to operate on a baseball players shoulder? Just do an MRI”.
• This probably applies to hockey players hips.
• Don’t lose a finger for a hangnail.
Trauma vs Overuse
• Surgery for trauma ( acute onset) is usually necessary and successful.
• Surgery for gradual onset often does not target the causative factors and has a limited success rate with a progression to other issues.
Standard Procedures Include:
• Multiple incisions to “release” adductors.
• Q- Can scar tissue creation promote motion?
• Labral repairs including “reshaping the bones with osteoplasty and rim trimming”?
The Three I’s
• Ingest
• Inject
• Incise
• Make sure you have exhausted all options prior to surgery.
A Different Thought?
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Solution?
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Trim the Door or Fix the Cause?
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Gray Cook
• “ I think a good rehab program without surgery would have the same outcome as with surgery if you could get the player to stop playing”.
• Surgery may be forced rest?
The Problem
• The sports hernia is like a “shin splint” or a “groin pull”
• Sports hernia is a non-specific diagnosis
What We Know
• Sports hernias seem to “acquired”.
• The injury generally begins with a “groin pull” and progresses to an abdominal issue.
• Not a classic inguinal hernia
Groin Pulls?
• Groin is another non-specific term used to describe all of the muscles that flex and adduct the hip.
Hip Flexors and Adductors
• 7 muscles can flex the hip or assist in hip flexion ( 2 are classified as adductors)
• 5 muscles can adduct
• 2 adductors are “flexor/ adductors” (pectineus and brevis)
• 3 are extensor adductors
• 1 is also a heavy neutralizer ( magnus)
Flexion / Adduction
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The Plot Thickens
• Hip flexor weakness leads to strain of the flexor/ adductor group.
• Strain of the flexor/ adductor causes excessive pelvic motion as compensation
• Excessive pelvic motion causes migration of symptoms to the adbomen.
Fake Hip Flexion w/ Pelvic Implications
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“Benign Neglect”
• The “groin pull” is often viewed as a nuisance to be tolerated.
• A “training camp injury”. In fact, it is the first step that begins the process
• Step 2 is the minimization, the benign neglect, that facilitates the process.
Potential Rationale For Neglect
1. Culture?( training camp injury)2. Time constraints?( soft tissue work is
labor intensive)3. Reliance on modalities?4. Skill issues?( many trainers are not
comfortable performing soft tissue work)
5. Location of lesions?
Potential Training Related Causes• Technology- bikes, climbers, rowers• Sports hernias were relatively unheard
of until the advent of aggressive bike programs.
• Hockey players dislike running and the aerobic demands of many misinformed teams may have caused a slippery slope phenomenon.
• The bike conditions the circulatory system but, not the muscular system responsible for hip flexion.
Other Contributing Factors
• Lack of Hip Internal Rotation or HIRD
• Excessive frontal plane flexibility with limited sagittal plane flexibility ( long adductors, short flexors) Peter Freisen- Carolina Hurricanes
Long Adductors
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Short Flexors- Sagittal
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Prevention
• 1- Screening• FMS, Hurdle
Step appears to be the key problem pattern
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•www.functionalmovement.com
Prevention• 2- Aggressive soft tissue work. Regular
maintenance
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Prevention
• 3- Static Stretching/ Hip Mobility
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Prevention• 4- Proper Warm-up ( Dynamic Mobility)
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Activation
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Prevention• 5- Run don’t jog, avoid technology
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Prevention• 6- Slideboard in the off-season
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Prevention• 7- Sled Crossovers
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Prevention
• 8- Single Leg Strength
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Functional Anatomy
Prevention• 9- Specific Strength-P1 Limit Compensation
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Add Stability Demand
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Add Flexion/ Adduction Component
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Multi-planar Deceleration
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Rehab
• Gradual return to normal training
• Think of rehab as a velocity continuum from slow to fast.
• Many concepts will be similar to low back rehab or hip labral rehab.
• Proper, well thought out, progression is key.
• “Does It Hurt?”
Anti-Extension?
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Anti-Rotation
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Diagonal Patterns
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Conclusion
• We need to understand sports hernias and look to prevention
• #1 is the avoidance of “benign neglect” and the progression of the process
• #2 is the increased use of soft tissue techniques versus modalities
• #3 is putting a prevention program in place.