The Pain is Here

It's Thursday.  Practice was Monday.  It hurts slightly to walk, unless I do a sorta half-limp.  There is a tenderness in the adductor area when I press it.  When sitting on a chair, I get pain in the left adductor when I spread my legs.  I also get a sharp adductor pain when I bring my knees together to touch.  I'm hoping this is just a really sore muscle from the session Monday.  I really hope this isn't the return of the sports hernia.

If the "good" soreness subsides but some deeper bad pain remains next week, then I'll know something is wrong.

Really Sore or Sports Hernia?

Monday's Session

• 10 Minute Mile on Treadmill
• Toprock/1990s
• 5 X 6 Windmills
• 2 X 1 Halo
• I also did some mill-headspin combos, and attempted headspin taps a few times, maybe hitting 5-10 taps.

Monday's Conditioning
3 X 25 Knee Raises
Incline Treadmill, 1 Minute Facing Each of 4 Directions at 3MPH (Forward, Sideways, Backward, Sidways) with 1 Minute Breaks
Waddled Around 1 Minute with Ball Between Knees
1 X 30 Second Standing Floor Squeeze (Wide Feet)
1 X 30 Second Standing Floor Squeeze (Shoulder Width Feet)

Monday Post Workout
I came home and iced for about 20 minutes on the left adductor with an ice pack, just to facilitate recovery.  I felt happy that I had NO PAIN throughout the session/conditioning.

Tuesday
I felt a really good type of soreness.  I felt like I got an amazing lower body workout on Monday. The slight soreness felt pretty even on both right and left hip areas.  I felt strong, like I was getting stronger. 

Today is Wednesday.
Rolling over in bed last night I felt pain in the left adductor and inner thigh.  It felt like a good soreness, not unlike what I felt twinges of soreness pain I felt after my physical therapy theraband workouts.

Wednesday Test
Laying on my back with knees at 90 degrees, I squeezed a mini soccer ball between my knees.  I immediately feel a shooting pain in my left thigh and adductor area.  I feel no pain in my right side doing this.  When I stand up and do some very light stretches, I feel some "good muscle soreness" pain on both sides, but it is way more intense on the left.

The muscle soreness is so intense on the left, that I hope its not soreness + injury. 
 I plan to do an ice bath tonight.

Close Call... Don't Stop Now!

This week I practiced bboying three times.  The first time I just did a couple windmills, some 90s, and back handsprings.   The next practice I did sets of 6 windmills, and windmill to headspin combos.  Then last night I was doing a lot of combos, working on trying mill-headspin-90.  I got kinda carried away.

I talked to a friend who said that I need to keep doing my physical therapy exercises.  He's right.  I don't want to get injured again!  I need to keep my strength up as to prevent injury and stay strong.  I cant let myself forget that I'm still in the ongoing "pre-hab" phase!

Here is a regimen I will do several times a week:
Treadmill: 10 minute mile
Incline Treadmill:  1 minute facing forward, each side, and backwards at 3mph, full incline
Knee Raises:  3 X 25 reps of knee raises, supported by my elbows
High Kicks:  2 X 25 high front kicks on each side, kicking my hand at about head level
Floor Squeeze (Wide):  2 X 30 seconds, with feet about 5 feet apart, "squeeze the floor"
Floor Squeeze (Narror): 2 X 30 seconds, with feet shoulder width, "squeeze the floor"
Theraband:  1 X 1 minute, with each leg, 4 directions per leg
Ball Knee Waddle:  2 X 1 minute, waddle around with a mini soccer ball between knees
Stretch Routine: each stretch once, 30 seconds to a minute

Stretches:
"swivel chair" internal rotation stretches
"yoga twist" TFL and gluteus stretch
"laying turn" TFL and gluteus stretch
"knee hung" laying on the back hugging each knee to chest
"hectic leg cross" laying on back, crossing legs and pulling legs toward chest

Sorry some of the exercises might be hard to follow, but they're in my jargon.  Let me know if you want clarification.

Progress!! Graduated from PT!

I've been seeing my physical therapist for a month.  Today was my third meeting.  My exercises have escalated nicely.  I did some breakdancing at the session today!  My PT said I can start dancing again, but to start off with shorter sessions for now.

I'm going to start dancing, then icing after practice.  I'm going to keep doing the exercises my PT gave me as "pre-hab" to stay in shape and prevent any future groin pain.  Today is a happy day!  I did headswipes and 1990s today at the PT session, painlessly!  My only continuing symptom is a slight aching pain when sitting in my car or in a chair, but it doesn't happen during exercise.  I have no pain getting out of bed no pain getting out of the car!

Hopefully I'll be doing windmills, 1990s, headspins, etc, within a few weeks!  Powermove training here I come!

New exercises my PT gave me are:
1.  Hang from a pull up bar.  Spread legs and twist side to side, simulating power move spinning.
2.  Put a ball between the knees, and waddle around the room, walking while squeezing it.  The ball should be a bit smaller than a soccer ball.
3.  I can stand in one place and with legs farther than shoulder distance.  I can do an isometric clenching of my adductors to "squeeze the floor."  This exercise was my suggestion.

Conclusion - My Theory
I think I had/had a flexibility imbalance and was putting too much strain on adductors that were relatively longer than my TFL/gluteal muscles.  With really long adductors and a tight TFL, it puts more work on the adductors just to remain in a neutral position.  For example, just to sit normally upright in a chair, with good posture and my femurs parallel, I can feel it working my adductors!  This should be a natural position! 

I am retraining myself to have better internal rotation throughout the day, while exercising, and even sleeping.  I sleep with a body pillow and I frequently catch myself rolling over in to hip external rotation.  I think my constant external rotation caused a groin pull to become a chronic groin pull!  Always being externally rotated means a constantly long adductor, which prevented healing.  I informed my doctor and PT about this theory and they said its a good "working diagnosis" at this point.  Bottom line:  I'm happy to be dancing again!

Inguinal Hernia Explaination

So, a sports hernia is a "pre-hernia."  Specifically, its a "pre-inguinal hernia" so to speak.  Its basically an inguinal hernia but there isn't a bulge.


Normal:

Normal (close up):

AHH INGUINAL HERNIA!:

Apparently you can't do any specific exercises to strengthen this odd little area, but you can do exercises/stretches to balance your overall hip strength/flexibility which will prevent this.

Physical Therapy Update

Right now I'm going through week 3 of physical therapy.  Here are the exercises I'm doing:

Swimming - breast stroke
Running - on the treadmill 6-8mph
Sprints/Jumprope - intervals of jumping rope 1 minute or sprints in place for 30 seconds
Theraband - I get creative, kicking in different directions
Sideways Shuffle - on the treadmill at 3MPH at full incline for 1 minute at a time
Internal Rotation Stretches - yep

I can do all of this stuff without pain!  I have very minor twinges of pain throughout the day, but its basically non-existant at this point. 

I'm gonna keep going with these exercises and I meet with my PT again on 5/22.  Hopefully at that point I can take things to the next level and possibly start breakdancing again soon!

Compression Shorts & Massage

Compression Shorts
I'm wearing my compression shorts every workout now.  It's my third week of physical therapy.  So far, so good.

Found these on Amazon for a little cheaper than the stores, with free shipping and free tax, ha.  Might get a few more pairs.









Massage
It would be nice if I were an elite athlete with a team of trainers, etc, but that's not the case.  I watched a YouTube video called "How to Massage Groin Strains" and today I massaged the area with a D battery.  It seems to do give be a pretty good, deep massage.

Internal Rotation Epiphany!?

Back in 2010 my physical therapist said I had poor internal rotation.  Now in 2012 my physical therapist said the same thing.

I realized when I'm sitting at the desk or driving, my legs are almost ALWAYS in external rotation.  No wonder my internal rotation sucks.   I started really taking these stretches seriously.  Is this stretch the key to alleviating my pain?

Some Articles!

"The TFL is also involved in internal rotation of the hip along with the gluteus medius and minimus, adductors, and iliacus. If the TFL becomes inhibited, a greater burden is placed upon these other muscles. I often find facilitation of the adductor magnus and iliacus, which can lead to groin pain."
http://neurokinetictherapy.wordpress.com/2012/03/15/the-often-overlooked-tensor-fascia-lata/


"Lack of internal rotation may lead to a compensatory increase in hip abduction with stepping and cutting manoeuvres. This may then lead to excessive force being placed on to the adductor muscles and an injury may result."
http://www.sportsinjurybulletin.com/archive/groin-injuries.html 

 Interesting article on preventing groin pulls, specifically under the heading "Mobility/Flexibility Training" it mentions stretching particular muscles that help internal rotation.  I'm not sure this article directly supports my theory, but its of interest:
 http://optimumsportsperformance.com/blog/?p=819

Great Physical Therapy Today!

I went to physical therapy today.  The PT had me sprinting in place with high knees, violently kicking an exercise ball, and doing super quick leg lifts while laying on my back.  No pain whatsoever!  I also hit the treadmill for a few minutes at 7.5 MPH.  No pain!

My next appointment with the PT is in two weeks.  At this rate I'll be breakdancing by the end of the month.  Maybe physical therapy is truly the key.   I'm optimistic!

Research, Research, Research

Here are the most useful links I've found so far...

Lets Run Thread
Here's a giant thread I found on letsrun.com.  It's 162 pages of discussion on the topic:
http://www.letsrun.com/forum/flat_read.php?thread=559820


Runners World Thread
Here's a shorter but very informative thread on runnersworld.com.  Are we seeing a trend here?  I thought this injury was common amongst hockey and soccer players, but I guess runners too:
http://www.runnersworld.com/community/forums/injury-prevention/injuries/sports-hernia-3/.0

............Alan's Miles
Here's blog of a runner named Alan who dealt with a sports hernia.  Specifically, check his posts around September 2008
http://alansmiles.blogspot.com


Dr. William Brown
I knew sports hernias were common amongst ice hockey players, I so I searched for the surgeon that the San Jose Sharks use.  Turns out its Dr. William Brown:
http://www.sportshernia.com/

My 2010 *MEDICAL* History

Hey everyone.  I've decided to share my medical record notes below.  This is the more "technical" notation taken by doctors and physical therapists in 2010 while I was at UCLA.

JUNE 15, 2010:  SPORTS MEDICINE VISIT

SUBJECTIVE

24 y/o with L groin pain.

Small improvement since last visit.  Went running on beach, no pain.  Less pain getting in and out of car.

Adductors don't feel weak.

Pain is medial groin on L, doesn't radiate to medial thigh.  Is not burning or electric sensation.

Pain with L leg adduction.

(+) h/o pain and stiffness in adductor region in morning, now better

(-) pain with coughing/sneezing

OBJECTIVE

NAD

ttp just distal to R pubic symphysis on proximal adductor tendon.  (-) conjoint tendon tenderness. (-) hernia appreciated in superficial inguinal ring. (-) ttp at pubic symphysis or at rectus abdominus attachment.

(-) pain with sit-up

(+) pain with resisted adduction L medial thigh

Sensation normal over medial L thigh

5/5 strength hip adduction, abduction bilaterally in seated and supine position

ROM o-135 hip flexion, 10 of IR in full flexion and 50 ER in full flexion.  No pain with these movements.

(-) FADDIR

ASSESSMENT

24 y/o man with 6 months L groin pain.  Most c/w sports hernia.  Also in ddx = obturator neuropathy however no adductor weakness on exam so less likely.  Adductor attachment and pubic symphysis appear normal on recent MR arthrogram (though limited because can only see in coronal sections per radiologist).  Slight labral tear but patient's sxs do not support primary diagnosis of intraarticular pathology.  Overall he is gradually improving, though slowly.

Diagnosis

GROIN INJURY

MAY 15, 2010:  SPORTS MEDICINE VISIT

INITIAL ASSESSMENT

Reason for consultation:  left groin pain x's 5 months

SUBJECTIVE

24 y/o man here with L groin pain.

Started 12/09.  2/10 persisted --> Told not a hernia, dx'd with pulled groin.

PT since 2/10 but PT wondering if had MRI b/c injury persisting.

No swelling, no acute injury.  Dancer, noticed pain with practice over time.

+ click during stretching a couple weeks ago, happend 2x, painless, felt deep

pain when wakes up in morning, stretching

pain getting in and out of car, with lateral motion of hip

hurts worst with active adduction on theraband adduction

Goal = return to dance.  hip hop.

Otherwise was training gymnastics, contortion, chinese acrobatics

(-)  nighttime  awakening

(-) weight loss, except with hard training 2009, dropped 20-30#, was training a lot, then injured.

Eats 6 meals a day, no h/o eating d/o. No anorexia, bulemia.  Drinks milk.  Unsure if has fhx osteoporosis.

Meds: ibuprofen OTC.

Overall has had improvement with PT but cannot return to his sports.  Minimal daily activity.

OBJECTIVE

NAD

Palpation: nontender lateral hip, nontender at ASIS, AIIS, tender just distal to L pubic symphsis with resisted adduction L hip.  Worse with sit-up.

Seated IR L 25, R 30, no pain.  ER 60 bilaterally.

Supine minimal IR bilaterally

Strength 5/5 hip flexion, knee ext, pain with resisted adduction, no pain with abduction

Sensation intact light touch B LE

(-) FABER bilaterally

(-) FADDIR B

(-) SLR B

(-) inguinal LAD

ASSESSMENT

L groin pain, ddx includes adductor strain, rectus strain, less likely intraarticular give (-) FABER, (-) FADDIR however could be labral tear given lack of improvement with PT after 2-3 months and decreased IR.  Sports hernia also in ddx but dx of exclusion.

Diagnosis

GROIN PAIN

APRIL 28, 2010:  PHYSICAL/OCCUPATIONAL THERAPY - PROGRESS REPORT

SUBJECTIVE

1/10.  usually when wake up in morning.  can adduct v. yellow band without pain.  feels it pinch a little while walking around campus.

OBJECTIVE

L groin pain reproduced with Adduction

PT / OT FUNCTIONAL ASSESSMENT

poor posterior hip glides, poor SIJ stability.  pt instructed to start planks for increasing strength of pelvic stabilizers.

check leg length.  foam roll marching.  squats on balance board.  lunges.

MUSCLE STRAIN, GROIN

APRIL 20, 2010:  PRIMARY CARE VISIT

INITIAL ASSESSMENT

Reason for visit: f/u groin pain

SUBJECTIVE

no known drug allergies

OBJECTIVE

Vitals

BP - 108/61; Temp=98 F Oral; Pulse=72; Resp=16

ASSESSMENT

physical therapy x 6 SX same.  Pt doing no exercise at all since 12/09, gained 8 lb.

SX same:  Pain L groin, mild, lasts seconds, 10-15 x day.  SX still brought on with lat abduction L leg like hold door open with foot.

Physical therapy suggest pt needed MRI.

Will get sports med evaluation.  Again discussed with pt.

Pt should not "baby" self but resume usual ADLs as I told him last appt.

Diagnosis

GROIN PAIN

APRIL 10, 2010:  PHYSICAL/OCCUPATIONAL THERAPY - PROGRESS REPORT

SUBJECTIVE

0/10. Pain was worse over the last few weeks moving and cleaning apartment.  Didn't do exercises for a week.

OBJECTIVE

Needs to return to break dance:  L leg is power leg with head spin.

hip resting anterior and in external rotation

PT / OT FUNCTIONAL ASSESSMENT

poor hip arthrokinematics and adductor strain.  Adductor tightness when established correct hip position.  Pain with active adduction today.

plan: continue clocks and strengthening.

MUSCLE STRAIN, GROIN 

MARCH 15, 2010:  PHYSICAL/OCCUPATIONAL THERAPY - PROGRESS REPORT

SUBJECTIVE
woke up in AM yesterday without pain.  Today it did hurt in hip 2/10 when stretching in the AM.  Not having pain when getting out of the car.

PT / OT FUNCTIONAL ASSESSMENT

Symptoms improvement noted with improved activity tolerance.  Improved ability to recruit core muscles while moving the leg, even when unsupported.  Able to progress to more challenging stabilization exercises in a functional context related to patient's dance form to assist in return to such activities with good core recruitment and less strain on groin.

MUSCLE STRAIN, GROIN

MARCH 10, 2010:  PHYSICAL/OCCUPATIONAL THERAPY - PROGRESS REPORT

SUBJECTIVE
1/10 twinges of pain with running.  Hurts with stood up straight.

pt injured left groin - seeing PT - going twice weekly

PT / OT FUNCTIONAL ASSESSMENT

Poor pelvic stabilization and weakness in psoas and pain in Adductors delating healing process.

Plan:  pelvic stabilization and hip flexor strengthening progress hip adductors isometrically and then conc/ecc when tol

MUSCLE STRAIN, GROIN  

FEBRUARY 20,  2010 PHYSICAL/OCCUPATIONAL THERAPY - PROGRESS REPORT

ICD Coed(s):  MUSCLE STRAIN, GROIN

SUBJECTIVE EXAMINATION

CURRENT / PREVIOUS HISTORY

L groin pain with Abduction L leg x 6 wk.  Dance (tumbling, hip-hop, hand balancing) & gymnastics

Onset: Dec.  Nov started using martial arts stretching machine and was doing this a few times a week for a couple of months for 20 min (to help splits)

Mechanism:  once after practice noticed pain, still danced after a week

1/10 now

PLOF: T, THR gymnastics, 2-4x/week dance class

If he tried to dance it would be a 10/10

BEHAVIOR OF SYMPTOMS

Aggravates (activity, posture, severity, duration):

dancing (windmills with legs in full abduction)

Eases (activity, posture, duration):

not using it (ibuprofen)

Morning pain: hurts more in the AM when stand up

Day pain:  decreases after moving around

Night pain:  pain rolling around in bed

GENERAL HEALTH

Medications:  ibuprofen

Special Questions:  no other hip/knee injuries, denies other medical conditions

OBJECTIVE EXAMINATION

stands in slight hip external rotation

CLINICAL ASSESSMENT

Pt is a 24 yo male with groin pull from doing hip hop dance (head spins) and martial arts stretching (with a crank machine).  Pt presents with pulled groin, poor hip mobility into internal rotation and poor hip capsule motor posterior.  Pt would benefit from hip flexor stretches.  DTM for tissue healing, and glute strengthening and hip stretches to improve internal rotation.

Rehab Potential  Excellent

 
FEBRUARY 10, 2010 MEN'S HEALTH EVALUATION

Patient dances and does gymnastics.  Pain L groin onset late December.
Intensity: mild
Character: pinching
Duration: second
Frequency: approximately 15 x day and with gymnastics
No radiation SX.
No previous SX.
No new ADL's or exercise program
SX brought on with ADL's lat abduction L leg like getting on bike or hold door open with foot
SX improved with ice & ibuprofen.

Alert, no distress.
Back FAROM no SX
No pain palpation bilaterally over trochanteric bursa or hip
R hip FPROM no SX, L FRPOM pain on external rotation (miniman int rotation)
Knee bilateral FPORM no pain.  Pain with abduction knees against resistance but not adduction.
Gait normal.
No SX with squat.
Genital: both testes normal without tenderness, masses, hydroceles, varicoceles, erythema or swelling.
No inguinal hernia noted.  No inguinal lymphadenopathy, mass or tender to palpation.

Defer X ray at this time as not change management
Continue PRN ice and ibuprofen

Diagnosis:  MUSCLE STRAIN, GROIN
Referred to : Physical Therapy

My Sports Hernia History

May 1st,  2012

I saw my sports medicine doctor in San Francisco and told him my history.   He said he respected the diagnosis that my UCLA doctor made and he was willing to send me to a local hernia surgeon.  I decided to do one last month of physical therapy to monitor my symptoms.  I needed to research and figure things out for myself before going under the knife.

Early April 2012

I was on a treadmill and I felt a nagging sharp pain.  It faded.  I went on to train at my local gymnastics gym, doing adductor exercises, core work and some tumbling.  The next day I woke up frustrated.  It was a flashback to 2010.  The pain was back.  Pain rolling over in bed, getting in and out of the car, and with hip flexion/adduction.  Ahh!

January - March 2012

I lost 15lbs.  I was running, doing core work, leg circles, kicks, and exercises I learned from physical therapists back in 2010.  I was gradually escalating my training, using gymnastics to condition myself.  Back-handsprings and back-tucks on the trampoline felt great.  I was in the best shape of my life.  I added in breakdance vocabulary into workouts, feeling out the very dynamic movements.  I added in more moves to where I was doing about 30% of my breakdance vocabulary.  But then...

January 2012

I was taking a class at my community college when a classmate told me had been in a horrific car accident where he had been revived twice.  That prompted him to pursue his dreams.  His story resonated with me.  It clicked:  I needed to breakdance again.

June  2010 - December 2011

I no longer trained.  Dance left my life completely.  I didn't know it at the time, but I was depressed.  The hernia symptoms subsided completely.  I lived a normal life, commuting to work, occasionally hitting the gym, etc.  My sports hernia was a non issue.

June  2010

I was definitively told by my sports medicine doctor at UCLA that I had a sports hernia.  I had never heard of it before.  This was a transitional time for me.  Discouraged by the injury, after graduating from UCLA I moved 350 miles away to San Francisco and started working in the corporate world.

 Late May 2010

Little did I know, but at this point the sports hernia was on the doctor's radar.  My sports medicine doctor at UCLA thought I either had a labral tear or sports hernia, but there aren't good tests for sports hernias.  They're largely diagnosed by excluding other possibilities.  I was sent for an MRI (actually, an MR Arthrogram in this case).

March- May 2010

The physical therapist's assessment was that I require more core work because my adductor was working too hard.  I went to physical therapy twice a week.  The pain persisted.  Pain was worst in the morning when getting out of bed, but it was only about a 2/10.  One day my physical therapist asked if I had gotten an MRI.  This should have set off a red flag.  The physical therapist had expected me to be better by now. but I wasn't.

Mid February 2010

I went to UCLA's health center and no inguinal hernia was found.  I was instructed to take ibuprofen, use ice and I was referred to physical therapy.  

January - February 2010

I would go weeks without training, the pain would almost dissappear and then I would attempt to breakdance and the pain would return.  One day I went running on the beach, with no pain, but then the next day the pain was worse than it had been for weeks.  I was so confused.   Was I inadvertently re-injuring myself?  Would it help if I were to literally stay in bed motionless for, say, two weeks?  I needed guidance.

December 2009

One day after breakdance practice my left groin in the adductor area was a little painful and I had a few sharp pains while walking home.  It was about 1/10.  Meh, that's normal I thought.  My body always had various little pains here and there.

The next day I returned to practice.  I warmed up, stretched, and attempted a windmill and felt extreme sharp pain in my left adductor area! For that moment during the windmill, the pain was 10/10!  I left practice, but figured my normal "rest a couple days and drink water" mentality would be fine.
For the next few days my pain was back at 1/10 or 2/10.  I sometimes had pain getting in and out of the car.  I had occasional pain while walking/standing.  The pain was hard to recreate on demand, but it struck about 15 times a day.

Purpose/ Goal / Vision!

Purpose:
After a lot of research, I realize I'm only at the tip of the iceberg in terms of research and treatment of my sports hernia.  Navigating the internet is overwhelming.  I've made this blog to help others, and to help myself stay organized!

Goal:
Return to breakdancing 110% by September 1st, 2012.

Vision:
This blog will be a collection of research, valuable lessons, stumbling blocks and epiphanies.