Expert Interview - Physiotherapist on groin strains
Premiership Physiotherapist Neal Reynolds talks about initial treatment of groin strains, stretching, strengthening and late stage rehab.
In the early stages it is important to consider the mechanism of the injury which gives an indication of exactly what has happened and how severe it may be.
Treatment-wise, ice and compression are applied immediately. This can be a little more difficult due to the location of the injury so compression machines may not be as effective. Ice baths are good for groin injuries, as are compression shorts. The aim of this treatment is to get the injury into the inflammation stage as quickly as possible, and then out the others side again. Neal recommends icing for 20 minutes every hour!
Electrotherapy such as ultrasound, short-wave and laser may then be used up until the first week. Then hot and cold would be used to flush out waste products. Massage wouldn't be used in the very early stages as it is very tender and may still be bleeding. Massage then starts lightly after 4-5 days, with increases in depth and pain allows.
With the groin it is important not to flare up the injury or to push it too hard. Stretching should start very gently as early as possible.
Then you need to think about loading the groin muscles to increase strength and improve the tensile strength of the scar. Loads in the groin area are quite high, especially in sports like football and rugby where there is lots of twisting and kicking. Football players often have quite weak groin muscles compared to their abdominals, which is why groin injuries are so common.
Isometrics are the first step, which are contractions without movement. Followed by isotonic - where there is movement. Eccentrics are important and can be started fairly early at a very low level.
Functional exercises are difficult to do to mimic the movements used in the sport. Neal uses a lot of cables so that they can change angles etc and mimic kicking etc.
Usually the player can run quite early on so this can be done to maintain fitness, but any kind of cutting or turning movement is where they tend to run into problems.
Late stage rehab with a groin strain is very different to a hamstring strain. You need to look at targeting the groin muscles with twisting and turning or striking a ball.
Neal would go outside, building up sharper and sharper turns and circles, increasing speed as they go. Then he would look at ball work to test they can do that before returning to full training.
