A great overview by Mike Kennedy
As a sports physiotherapist I work in a number of diverse settings which gives me access to a wide range of clients from the elite professional footballer to the office worker who is a keen triathlete at the weekends. For each client the need is the same “how can I get the most out of my body following injury in order to improve my performance.” Pain at the hip and groin region particularly can be very debilitating for the athlete, quite often it is very poorly understood area and as a consequence the problem can become chronic and result in an extended period on the sideline’s.
Diagnostics & Collaborative working
Diagnostics play an important role as the hip and groin is a very complex area and problems can be difficult to diagnose. Orthopaedic consultant opinion together with radiographic imaging and specialist reporting is important in pinning down the correct diagnosis. A collaborative approach in assessment from leading specialists in Sports Medicine and the Sports Physiotherapist is the most effective route in treating the athlete in terms of getting them back to action as soon as is safely possible and providing a solution to ensure their long term fitness.
Focused & Progressive Rehabilitation
First of all it is important to educate the athlete about their injury, the mechanism of injury often involving video analysis and the rehabilitation plan that will allow them to return to sport and avoid any injury reoccurrence. It requires a ‘buy in’ from both the therapist and the athlete to commit to a rehabilitation programme which will allow them to return to full fitness.
Hip and groin injury can be multifactorial in nature but it is important to focus targeted rehabilitation at the region initially and then progress to more dynamic loading as symptoms improve. I have found the following progressive stages of rehabilitation to be most effective within the sporting population:
- Intersegmental control and strength (such as a deadlift or double leg squat)
- Linear mechanics and running load (such as barbell/overhead running and leg change drills)
- Multidirectional mechanics and sprinting (such as a lateral shuffle or Zig Zag cutting)
Within these 3 phases the therapist encourages correct execution in technique and correct lumbo-pelvic form. Furthermore, a gradual increase in load progression, speed intensity and multi-directional movement patterns is also encouraged. Other treatment methods may also be incorporated if deemed necessary, such as improving the mobility of the lower extremities and spine with manual therapy and sports yoga, application of strength and conditioning principles, Shockwave therapy and clinical Pilates.
It is also important to keep the athlete focused and interested within rehabilitation. In order to achieve this outcome the therapist must make rehab specific to their sport; jointly develop drills with the athlete to mirror scenarios encountered within a game situation and make rehab proprioceptively demanding in order to retrain reaction timing and load response.
Profiling & injury prevention
There is now a growing trend towards profiling of the athlete to highlight any injury risk factors and movement dysfunction that may predispose the athlete to injury.
A specific screening tool devised by the therapist specific to the demands of the sport and/or the athletes overall physical capabilities is generally used twice a year in both a squad environment or on an individual basis to measure athletic performance. The screen may broadly include the following battery of tests:
- Range of motion eg. Shoulder mobility
- Strength testing eg. Adductor Squeeze test
- Balance testing eg. Single leg landing
- Work Capacity testing eg. Push up to failure
- Movement Patten analysis eg. Squat form
- Outcome measure eg. Triple hop for distance
Data produced from the screen allows us to flag up any potential weaknesses that could be a contributing factor to injury and have an adverse effect on overall physical performance.
In order to nullify these weaknesses the athlete who presents as a high injury risk is given outlined bespoke action points to work on and then they are assessed more regularly, every few months throughout the year on key tests relevant to their profiling findings. This detailed monitoring allows us to prevent potential injury occurrence in key area’s such as the hip and groin and ensures the athlete remains fit, strong and pain free in order to achieve optimal performance.
Mike Kennedy MSc BSc (Hons) MHCPC MCSP MACPSEM
Manchester United Football Club Academy Physiotherapist
Lead Physiotherapist, Mike Kennedy Chartered Physiotherapy & Pilates
Highly Specialist Musculoskeletal & Sports Physiotherapist, Spire Perform Manchester
Consultant Physiotherapist to the Professional Footballers’ Association (PFA)
Associate Research Physiotherapist to the FASHIoN trial – Studying Hip Impingement