Overuse groin injury with very specific cause

[wmc1103]

Great site guys, and kudos to all the professionals who take the time to help the needy like myself.

My groin injury is one of overuse. That is it is onset only by performing my specific sport (which is not actually a sport). I partake in ultra-distance (7 hours plus over consecutive days), load-bearing (carrying 22kgs upwards), hill running (running downhill and flats, walking as fast as you can uphill). The entire exercise is performed at maximum effort and high intensity. As one can imagine it puts an uncommon amount of stress upon one's body.

It is actually a course i am undertaking for a specific part of the British Army, and it involves me doing such 'events' for 2 days every week, lasting a total of six months. Having been on the course before i developed a groin issue which troubled me and i had to withdraw. I am about to start training again and seek genuine informed advice.

The issue is certainly chronic. I first noticed the issue on a particularly long run where i found it very uncomfortable (though not really painful) to lift my thigh parallel to the ground. This was limited to the hip-flexor muscle. The onset was gradual and worsened. The following day it was slightly painful, but more significantly i was almost incapable of lifting my leg (from the hip) past 20 degrees and had to pull out of the run on the second day. I rested, stretched and was ready for the event 2 weeks later where i performed exceptionally well on the first day and noticed no problem. However, again i had to pull out of the run on the following day because of the same problem i had two weeks earlier.

I also experience pain/discomfort/tightening on the very inside of the groin where it meets the pelvis and the tendons/muscles which extend along the medial side of the injured leg down to the knee.

What I really need is advice as to what might be causing the problem and how i overcome it.

I understand this is a very complex issue and not one that is easy to digest; if it is possible i would very much appreciate being forwarded details of specialists in this area in the United Kingdom. I have seen 3 'run of the mill'/NHS physios who seem out of their depth with my specific issue.

All replies muchly welcomed and hugely appreciated.

[ginger]

WMc1103
Several aprioris seeem to loom large before considering your problem, firstly ,calling your problem an "injury" ,suggests you are certain there is breakdown in the process of creating pain and altered behaviour of your adductor region. Also that this supposed breakdown of your body, is due to "overuse", , neither are likely.
The most common cause of altered behaviour of muscle, such as tightness, poor patterns of recruitment, and altered sensations, are the sequelae of spinal facet joint hypomobility , referred neural events , brought about by a protective response of the vertebral spine. It is the nature of mammalian spines to have the means to increase the tone of paraspinal musculature , to limit movement of joints.( and by so doing limit the mechanical risks associated with percieved threat ) .
Your problem is most likely to be a referred pain/dysfunction event derived from inflammatory irritants operating at the L1 and L2 nerve roots. These irritants are the common product then , not of an injury as such , but of normal , powerful and quite non pathological protective spinal events. To reverse these events one needs to reacquire normal movements at L1 and L2. The best means is a manual therapy known as Continuous Mobilisation. This is most often accomplished over one to three treatmets by a suitably qualified therapist , ideally a physiotherapist. , By this means spinal facet joint movements are restored and these protective responses turned off. Inflammatory pain issues are quickly resolved ( pain and abnormal behaviour can usually be seen to resolve in as little as ten minutes )Much time and wasted money and effort is often directed at the groin in cases like yours, where poor understanding may prevail, and the real and likely prospect of referred pain not fully explored.

[wmc1103]

Wow.

Boy am I glad I came on this site.

I really cannot thank you enough; finally someone who knows what they are talking about. Is there any significance that I get this in only one leg?

Is this 'continuous mobilisation' available in the UK? If so do you have any trusted physios you could pm me the names of?

Thanks again and.....thanks again. You really have no idea how much this means to me.

Wmc1103

[ginger]

Wmc, no significance at all in a one sided problem, at least not in a sense that one side of your pelvis/lumbar spine is necessarily abnormal. We are all assymmetrical, some more than others. Spinal Protective responses are the ubiquitous element in our lives, the degree to which we are ultimately elert to them depends on a variety of factors , intrinsic and extrinsic.
Continuous mobilisation has been developed over twenty yearsof clinical practice, it's not difficult to learn, has a lot in common with other forms of facet joint manual therapies, such as Mulligan and Maitland methods. Most Aussie trained physios will be at least familiar with the latter. Unfortunately UK physiotherapytraining has historically been short on these therapies. It is possible that UK graduates from the past ten years may be more familiar with referred pain as a theme, but I wouldn't count on it.
Best of Luck.

[jerryhesch]

This most certainly could be a groin injury, iliopsoas tendonitis or joint dysfunction of the hip, a peripeheral neuropathy, and of course as already stated a lumbar problem but as described does not appear to be primarily spinal in origin.
I have done other posts on the topic, you can google, avery hard to give comprehensive advise over the internet.nd check this site. If you ever come to Las vegas Nevada USA I can have a look. I appreciate that your inquiry was last year! How are you doing?
best regards
Jerry Hesch

[peachey]

Having been in your same situation, I also suggest you look at your load distribution (heavier items closer to your back, and lower in your pack as close to your centre of gravity as possible), and also look at the set-up of your webbing / belt kit... training for this particular course that you speak of, a tendency is to want to have as many pouches on as possible to increase carrying capacity. If you have too many, your main ammunition pouch / utility pouch will be to much to the front.

Especially on an uphill, the tendency to improve biomechanical efficiency is to lean forward, reducing propulsion needed and instead increasing leg lift to allow a controlled falling forward (ie - the POSE or chi running method). This then increases active insufficieny of the hipf flexors, combined with added resistance from the webbing, and altered COG is actually a very common cause of psoas overuse in the forces.

Hopefully no post means you've passed selection and am now on RIO... if not, pm me as an aussie with a background in your situation.