Recurrent adductor strain.

Hi!
Just want to know a bit more about this kind of hip problem.Wish someone could kindly give me some advices.

I got a patient who injuried his right adductor during squash playing on May 2005. He had about 4-5 sessions of myotherapy done and he was pain free, but he realised that he can feel something at the groin area when he return to play squash, and he did injury that part again on last week .
He was in a lot of pain on the 1st day, he could barely walk, but he felt better after taking the anti-inflmmatory medicine. He only complained of mild pulling pain at the adductor in stair climbing.
Well, I noticed that his hip level is higher on the right side and his right leg is longer than the left about 2cm. His low back movements are painfree but stiff.
His adductor strength is pretty good. I just wonder would the By the way, apart from this right groin pain, he feels his left hip got stiff since started of his groin pain.
Besides, if a patient got hip pain, would the weakness most likely to be on the extenors, abductors and flexors?
Any good way to assess the hip muscle strength?
Many thanks.:lol

[Physiobase]

With an apparent LLD (leg length discrepancy) and altered heights on the ASIS, check the levels of the pubic symphysis and for pain at the symphysis.

You might have found out that this guys got a pelvic torsion of some kind and this can lead to adductor issues. If so, and you feel one of the inominates has rotated, then you could use MET (muscle energy techniques) to try to release it. Look at greenman's work for a thorough over view or anything on Nordic Therapy. Give us some more info if you can 8o

[alophysio]

I agreee with Physiobase.

I would first assess his pelvis (SIJ and Pubic Symphysis), L/S and Hip joints.

I would also check his external obliques for their activity since they have a fascial attachment to the contralateral adductors via the pubic symphysis.

As for hip muscle testing, can do them in their standard prone/supine positions - i do. I also do functional testing using everyday activities such as step up/down, walking, squats, etc.

But in my experience, a "stiff" back with groin trouble is more likely to be a pelvis problem.

I have had a patient with recurrent adductor strain, that was due to tension in the piriformis, externaly rotating and abducting the femur. This altered position meant that the patient was using his adductor instead of his rectus femoris to flex the thigh on the hip in walking. The resultant and recurrent aductor strain was resolved when the tightness in piriformis was addressed. Piriformis could also be contributing to pelvic torsion, resulting in pelvic obliqity and LLD.

- Peter
Chatered Physiotherapist & Registered Osteopath, U.K.

Diane Lee PT has also written much good information re assessment and treatment of the lumbopelvic hip complex. I would reccomend having a read through her books and or articles. I agree it's likely you have found a pelvic malalignment and the underlying muscle imbalance would need to be found and addressed. Marj

[neurospast]

Playing squash means always an involvement of the back. have a look at vertebrae T9-T12 as well look for triggerpoints in the quadratus lumborum and use the good advice the others have given you.