Case of the Week Update! "Adductor" Strain Part 2 | Modern Manual Therapy Blog

Case of the Week Update! "Adductor" Strain Part 2


When we last caught up with our friend the "groin strain" we had found that all of his left intermittent groin pain was reproduced only with right hip motion.

Visits 2: He reported compliance with his ther ex. He did not have a chance to either play basketball or walk his dog "briskly." I checked ASLR and on the left, that reproduced his groin pain, was DP moderately limited. Hip IR on the right was still DN but improved over the first visit.

Treatment included, IASTM to the upper and lower lateral leg patterns, mobilization with movement to further improve hip IR and review of his HEP. I also added functional release to the posterior right thigh patterns. ASLR on the left had improved but was still DP. With appropriate breathing "blow out" and bracing, he was able to improve the ASLR and make it nearly pain free with only an uncomfortable stretch perceived at the end range.

Visit 3: The patient reported playing basketball and walking his dog with no reproduction of left groin pain or right knee pain. He was very pleased. The only treatment added was some IASTM to right posterolateral thigh patterns in addition to the treatment above.

Visit 4: The original complaints of right knee pain and left groin pain were completely gone in all ADLs. However, he now complained of left lower lumbar pain which he described as hip pain. What is the first repeated motion I checked?

If you said, SGIS to the left, you're correct! He had full ROM with SGIS to the right, but moderately obstruction to the left. Flexion in standing reproduced left lumbar pain. After several sets of shift correction in standing, flexion in standing was no longer painful. He was instructed on self SGIS against the wall. He was also instructed on weight shift/acceptance for shoveling and to take frequent breaks.

Visit 5: SGIS in standing was full and pain free bilaterally. RFIS was full and pain free and REIS was full with minor end range discomfort. Hip IR was FN bilaterally, ASLR was FN bilaterally. He felt he could manage his complaints with HEP and was instructed to take frequent breaks during his ADLs that required bending/twisting and perform some REIL. He was discharged to HEP.

2 comments:

  1. At 5-6 years out from L THA, what precautions, if any, do you take with ROM or manual therapy to that area?

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  2. Great question Ben. Many of the surgeons in my area have stopped instructing on precautions because apparently their literature showed no difference in the amount of dislocations whether or not a patient was instructed on them or not. I still followed them for at least 6 months to be sure. With manual therapy, I mainly stick to IASTM, FR, and neurodynamics. If you would've seen his golf pro's dynamic hip routine he was doing! NOTHING I've ever done would be more aggressive than that.

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