Groin Injuries in Hockey

These are the two words that get an instant reaction of sympathy pain from anyone who has played the game – “Groin Injury”. There are more devastating injuries in hockey to be sure but groin injuries are probably the most common and can be more difficult to manage properly.

A groin “pull” or strain is a general term for any one of several possible injuries involving the structures supporting the hips or pelvis.

Abductors (Tensor fascia lata, gluteus medius and minimus) are responsible for the lateral movement of the leg away from the midline of the body.
Hip flexors (rectus femoris, iliopsoas) are responsible for bringing the leg forward and up.

Hip extensors (Gluteus maximus and hamstrings) are responsible for bringing the leg straight back.

Adductors or true groin muscles (Adductor longus, brevis & magnus, Pectineus, and Gracilis) are responsible for bringing the leg back toward the midline of the body.

Abductors and hip extensors function together during the push off phase of skating and adductors and hip flexors function during the recovery phase of the skating stride. Adductors are also extremely important during cross-overs. A muscle strain to any of these individual muscles or groups could be termed a groin strain but most often a groin strain involves injury to the hip flexors or adductors.

All of these muscle groups work synergistically in performing the coordinated movements involved in skating, therefore the muscle groups must be in some sense of balance both in strength and flexibility. A groin strain typically occurs because there is an imbalance among these groups that leads to a dynamic overload. This means that while the muscle is in an elongated position more force was placed on the muscle than its was able to handle. This leads to some degree of muscle tearing from very mild (1st degree strain involves micro tearing of some muscle fibers) to very severe (3rd degree strain is a complete muscle tear). Each of these will cause pain, muscle spasm, and some degree of restricted movement depending on the severity of the injury.

PREVENTION
90% of all groin strains could be classified as preventable injuries. It is not just a coincidence that most groin strains occur in the early part of the season or even at training camp. Proper off-season and preseason conditioning can help address muscle imbalances. Strength training and a comprehensive flexibility program including proper warm-up during the season will minimize the risk of injury from flexibility imbalances. As far as off-season and preseason conditioning goes I would like to particularly stress one point: Athletes cannot simply train like bodybuilders!! Bodybuilders typically train using exercises that isolate a target muscle group. When an athlete performs an activity or plays their sport, they almost never use any one muscle group in isolation! Isolation training is simply not the best functional training for athletes (at least, not all the time).

One of the best lower body exercises for athletes (but usually most ignored) is the lunge. During a walking lunge, all major muscle groups are activated in a coordinated fashion. Don’t think for a second that you can only do lunges one certain way. You can add variety to your workouts by lunging in different directions (straight, 45 degree angles, and laterally). This is a much more functional strengthening exercise for the groin muscles than sitting on an Abduction/Adduction machine at the gym.

When it comes to proper warm-up and stretching remember one thing: never stretch a cold muscle! You must begin your warm up by doing some light cardiovascular activity first (light jog, skipping, stationary bike) to work up a sweat then follow that with slow static stretches for all major muscle groups (hold each stretch 20-30 seconds, 2-3 times per side). Closer to game or practice time begin more functional warm-up exercises like Dynamic Flexibility Stretches (see SST’s article on Dynamic Stretching). This prepares the muscle for contracting/relaxing during a full range of motion. In order to maintain any gains in flexibility make sure you follow-up every workout or game with a proper cool down that includes all the static stretches you used during your warm-up. This helps muscles to recover and prevents stiff and sore muscles in the days following a strenuous training session or game.

IMMEDIATE CARE FOR AN INJURY
Even with proper preparation, injuries may still occur. Now what? Regardless of the degree of damage, all injuries undergo a similar reaction in the first 2 to 3 days post injury. This is called the Inflammatory phase. The signs and symptoms involved with inflammation can be summarized by the acronym S.H.A.R.P.
S - Swelling
H - Heat
A - Altered form or function
R - Redness
P - Pain

These signs and symptoms can last anywhere from 2 to 72 hours post injury (duration depends on severity of injury).

Luckily, the treatment during the first few hours or days following an injury is just as easy to remember - R.I.C.E.
R - Rest (restrict activities that cause pain)
I - Ice (Ice packs - 20 minutes every hour)
C - Compression (tensor bandage or compression shorts to limit swelling)
E - Elevation (ideally above the level of the heart but sometimes difficult with a high groin strain)

An important point to remember when icing – gel freezer packs can actually reach temperatures colder than ice – make sure to have 1-2 layers of paper towel between the ice pack and your skin.

In cases of moderate or severe groin pulls where pain occurs during walking or persists for several days post injury – seek medical attention and /or an assessment by a Qualified Sports Therapist. You should follow medical advice or undergo a proper program of rehabilitative therapy before returning to sport, but in the meantime, it is important not to lose the level of conditioning you worked so hard to achieve. The key is to find activities that do not aggravate the groin injury such as upper body strengthening, biking (pain-free only) etc. This will help you return to your sport at a higher functioning level than if you just took complete rest.

With proper conditioning and warm-up procedures and by following sound injury care practices, you can minimize time away from sport due to this common but pesky injury.

Phil Lamont, CAT(C), Certified Athletic Therapist, Dynamic Sports Therapy