THIGH FROM THE FRONT Cause: Inflammation of the tendon (tendinitis) occurs upon repeated uniform (over)loads. Microscopic ruptures can thus occur in the tendon and in particular at the point of attachment, which causes inflammation. Inflammation of the tendon is a warning that the activity is too strenuous on the particular muscle tendon, and that if the load is not reduced a rupture may occur with a significantly longer subsequent rehabilitation period. The adductor longus muscle, which feels like a firm string in the groin, is one of the adductor muscles, that are most frequently damaged. The muscle is especially susceptible to injury in sports characterized by activity with sprinting with sudden directional changes, a lot of weight training and modest agility training (soccer, hockey), while it is very rarely seen in sports where there is typically great agility (gymnastics). In some cases the inflammation can spread to the fastening of the abdominal muscle on the pubic bone and to the pubic bone joint (symphysis). Symptoms: Pain when applying pressure along the tendon, worsening upon stretching and activation of the muscle tendon (closing of stretched legs against resistance). Acute treatment: Click here. Examination: In light cases medical examination in not necessarily required. Severe cases or cases not improved by treatment should be evaluated by a doctor so that a precise diagnosis can be made. A normal medical examination is usually sufficient in order to make the diagnosis. If in the medical examination there is pain when applying pressure on the muscle attachment point in the groin, and aggravation at the same location upon stretching and activation of the adductor, there is hardly any doubt about the diagnosis. The diagnosis of groin pain can be particularly difficult (article) However, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. Ultrasound is well suited to evaluate the muscles in the area. Treatment: Since tendinitis of the adductor (M adductor longus) in the thigh is one of the sports injuries with the highest risk of becoming chronic, it is imperative that treatment starts as soon as the first symptoms are felt (and not after months of increasing discomfort). The treatment involves relief, stretching and slowly increasing load within the pain threshold (article). Ice treatment should be used after training if tenderness is felt in the groin. If there is a lack of progress with relief and rehabilitation, medical treatment in the form of rheumatic medicine (NSAID) or the injection of corticosteroid around the inflamed part of the tendon may be considered. The injection of corticosteroid is always part of long-term rehabilitation of a very serious chronic injury. It is therefore necessary that the rehabilitation period after the injection treatment stretches over several months to reduce the risk of relapse and ruptures. The tendon can naturally not sustain maximal load after a long-term injury period and only a short-term rehabilitation period. It is not unusual for rehabilitation to stretch over six months, before maximal load in the form of running with directional change is permitted. In cases where there is lack of progress after rehabilitation and conservative treatment, operative treatment can be attempted. The long-term results of operations are often disappointing. Complications: If satisfactory progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. In particular the following should be considered: Special: Shock absorbing shoes or indlays will reduce the load in the groin. In case of lack of progress or relapse after successful rehabilitation, a running style analysis can be considered to evaluate whether correction of the running style should be recommended. [Back] Unlimited: Cycling. Swimming. (10 min) Lie on your back. Draw the injured leg up towards your head so that the muscles in the back of the thigh become increasingly stretched. Perform the exercise with outstretched as well as bent knee. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be performed standing with the injured leg outstretched on a chair while the upper body is bent slightly forwards. Stand with support from the back of a chair or the wall. Using your hand, bend the knee and draw the foot up and your knee slightly backwards so that the muscles in the front of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done lying down. If you lie on your stomach you can draw the foot up by using a towel. Lie on your side on a table. Bend one leg up under your body and let the other hang over the edge of the table so that the muscles in the outer side of the thigh become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. The exercise can also be done standing by placing the outstretched injured leg behind the good leg at the same time as bending over the injured leg. Lie on your back with one leg outstretched and the other bent with the foot on the other side of the outstretched leg. Draw the knee up towards the opposite shoulder so that the buttocks become increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. Squat with the injured leg outstretched behind you as far as possible with the foot on a box. Thrust your hip forward and down without swaying your back so that the front of the hip becomes increasingly stretched. Hold the position for 20 seconds and relax for 20 seconds before repeating. (5 min) Seesaw. Balance on two legs, possibly using a hand as support against the wall, balancing subsequently on one leg without support. Look straight ahead and keep knees bent. (45 min) Lie on your back with a ball between your feet. Squeeze your feet together for 25 seconds, and rest for 10 seconds before repeating. Lie on your back with legs bent and a ball between your knees. Squeeze your knees together for 25 seconds, and rest for 10 seconds before repeating. Lie on your back with knees bent. Lift your head and shoulder 15 cm from the floor and hold the position for a few seconds. Repeat 10 times. Lie on your back with legs bent and a ball between the knees. Squeeze the ball between the knees while lifting your head and shoulders 15 cm from the floor, and hold the position for a few seconds. Repeat 10 times. Stand with the injured foot on a cloth on a smooth surface, with toes pointing straight ahead. Slide the injured leg sideways and back again. Repeat the exercise with the toes pointing to the side. Sit on a chair with elastic around the ankle, facing the elastic. Lift the leg and slowly bend and stretch the knee. Lie on your back with a ball or firm round cushion under the injured leg. Lift your backside up from the floor and stretch the healthy leg. Hold the position for a few seconds. Sit on a chair with elastic attached to the ankle. Raise the leg and slowly stretch and bend the knee. Stand with the elastic around the injured leg, facing away from the elastic. Move the leg forwards and slowly backwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be. Stand with the elastic around the injured leg, facing towards the elastic. Move the leg backwards and slowly forwards. The elastic can be moved up and down the leg depending upon the strength of the knee – the stronger the knee, the lower the elastic should be. Stand on the healthy leg with the elastic around the inside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load. Stand on the healthy leg with the elastic around the outside of the injured leg. Move the injured leg from side to side in a slow smooth movement. Moving the position of the elastic lower down the leg can increase the load. Lie on your stomach across a chair and bend both knees. Tighten your buttocks and lift your legs upwards. Stretching is carried out in the following way: stretch the muscle group for 3-5 seconds. Relax for 3-5 seconds. The muscle group should subsequently be stretched for 20 seconds. The muscle is allowed to be tender, but must not hurt. Relax for 20 seconds, after which the procedure can be repeated. The time consumed for stretching, coordination and strength training can be altered depending on the training opportunities available and individual requirements. Original article and pictures take http://www.sportnetdoc.com/groin/inflammation-of-the-adductor-of-the-thigh site
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