Adductor Tendinopathy Treatment

[Music] hi guys this video is about a doctor tendinopathy and I'll automatically show you how to treat it but I first want to discuss a bit about the anatomy and how it's caused as well so that you can understand why the treatment will work so we're going to look at their anatomy what it feels like when you've got a doctor tendinopathy because there are other things that can feel similar we're going to look at the mechanism of injury other conditions that can feel similar like I said and then the treatment and specifically for treatment we're going to look at rehabilitation exercises I'm also going to show you three exercises that you need to be really careful of and then running style adaptations that can help to offload your adductor tendons and lastly what other treatment options may be available if rehab and running adaptation doesn't work for you my name is Marika I'm one of the physiotherapist from sports injury physio calm we can get online physiotherapy assessment as well as treatment for your injuries so have a look at the description of this video the link to our website is in there if you want to know more about that excellent so let's dive into their ngata me first because there's something I want to show you about where the adapters are so if you look at that video of her picture the adapters basically run on the inside of the thigh bone and they all come and attach over the pubic symphysis or around the pubic area so if I can show you on myself that means that they run along this line you've got quite a few different ones that attach at different levels there but they've all come on to this part of the pubic bone so right in the middle as your pubic symphysis you can feel it as a dip there and then to the side is your your pubic bone where the adductors in touch and they even attach right into there and that's where you can feel a lot of your pain when you have a doctor teaming topic you can feel it right in there and further into the back as well a bit but the thing I wanted to point out specifically is if you look at these slides can you notice so that's the pelvis and can you see the stomach muscles coming from the top your rectus abdominus and how they attach to the top end of your pubic bone today so pubic bone is this bone that you can feel their stomach muscles come and attach into the top bit of it also if you look at the picture at the bottom can you see there's white stuff that kind of surround the stomach muscles they've cut some of it away there to show you that better and there's also white things that attaches the adductor muscles onto that pubic bone as well as the the stomach muscles onto the pubic bone so the white things that attach them to the pubic bones are they tendons and that's where you get the tendinopathy in the adaptors the white stuff that surrounds the muscles is fasciae and we've got fasciae around every single muscle fiber we've also got fasciae around bundles of muscle muscle keeping them together and then we've also got fasciae around muscles as a whole and then besides the fact that it surrounds a single muscle it also groups some muscles together so like for instance the stomach muscles has several layers of fasciae and that all interconnect with each other and at this pubic symphysis the fasciae from the top comes and meets the fasciae from the bottom so the fashion air from the stomach muscles comes in kind of meets the fasciae from the adaptors and they become a single structure to an extent so any injury to the adductor muscles often causes injury to their to their abdominal muscles as well and vice versa and if you've got a strength deficit in the one it can cause issues and the other also because they run over the pubic symphysis any issues with the pubic symphysis or in either of those groups can affect the pubic symphysis or pubic symphysis affect them now there's fasciae crosses over there and the fasciae from both sides come and touches into each other so if left side is injured for long enough it will affect right side eventually and that's something that we do see with - did not at this you may have the pain at the beginning on the one side but it quite often switches over and also involves the other side later on so I just wanted to point that out now if we think of if I can remember what the next slide is oh yes what it feels like so I'm gonna get this slide back up so that we can think about what it feels like so ad after T mengapa thee is when the tendon that attaches to the bone there on the pubis becomes damaged and injured and that's where it creates most of its paint so you can get your pain deep in the groin you can get the pain actually referring up into the stomach muscles you can get the pain referring down sometimes if the little nerve is irritated as well but I'll talk more about that in a minute you can get a little bit of tingling and stuff as well you can get that all combined then the pain can cross over to the other side and feel it in the middle as well a bit but the pain is very much located around that area adapter tendinopathy often also you can get it in isolation but more often than not it is seen worth together with a condition like osteitis pubis or abdominal tenderness of these and I've made a whole video about osteitis pubis if you want to know more about that on link to that in the description of this video as well as at the end of it if I remember they may be a link popping up now that thank you to the osteitis pubis video as well okay so that's basically where you feel your pain the things that can be quite painful let me just get my notes here cuz I'm always worried that I'm gonna forget stuff and then I'm gonna kick myself by the end of the video okay so baby the groin abdominal yeah pretty much it then mechanism of injury the mechanism of injury is basically that it's a overload injury and it can be chronic overload or it can be acute overload so what do we mean with chronic chronic overload is when those tenders have to work really hard and they don't get enough time to recover between exercise balance so remember whenever you do exercise you first get some micro damage in the in the tendons muscles bones everything that's normal that's how we grow stronger your body then repairs it and you're ready for the next session but if you can if you continue to train a really hard sessions too often and workout structured really hard it may not get enough time to recover between your exercise balance and that's when the damage accumulates and can cause an injury like a tendinopathy but you can also strain those tendons through an acute overload say for instance your tendons are strong enough to deal with an hour's running in the mountains and then suddenly you decide well I fancy doing a marathon in the mountains so there's lots of downhill running loads more than what it's used to and that can cause a massive overload of that they know and caused an acute tendinopathy for you so typically for runners it's if they do a lot of downhill running that can cause a lot of over you overload onto the tendon it's also if you run with poor mechanics so say for instance you've got poor stability in your hips and your glutes are rather weak then that could mean that the addict is over strain it can be if you've got a muscle issue with your abdominals that they don't work as strongly as they should that the adductors can overstrain so biomechanics when you're running is quite important but then certain sports like for instance if you're doing the sport where like football where there's a lot of twisting a lot of aceleration decelerations those are all actions that really work that are actors really hard and that's why footballers are quite prone to this type of injury as well so that is how you tend to get or the mechanism of injury now other conditions that can feel very similar is I've already spoken about abdominal dinner dinner nobodies so actually it did not the attendant weather abdominals come and attach to the pubic bone that Bain is often more towards the top of the pubic bone but it can refer into the groin as well it's also common that you can have both of these conditions together osteitis pubis major one that can feel like that as well osteitis pubis is where you get the remember where the pubic bones come together you put a little disk of cottage and it's where you get a lot of strain on that joint in the middle of the pubis there and it's often accompanied by a dr. thin not be as well as abdominal tendinopathy you can get stress fractures of the pubic bones that can be in the same area and give very similar pain to that so but how you distinguish between the two is through the history of how it's developed through how the pain acts when you when you exercise or when you're at rest and a physiotherapist should be able to help you distinguish between the two through a careful interview with you and getting you to do some test movements and things as well but if there's any doubt or there's a high suspicion of a stress fracture it's best to get some imaging now stress reactions and bone don't always show on x-rays so a MRI scan is really the best way to to differentiate between the two okay so then what else sports hernia so where you've got a tear of the inguinal ligament anything in that area can feel very similar again it can be in combination with a doctor did an OP of you that you can have a sports hernia as well yes and then you can get operated nerve entrapment which can cause pain in that area but actually it's the little nerve that's been squeezed so if you're getting any pins and needles funny sensation its numbness in this area or down the leg it's worth consulting a physio about that because it may actually be that it's not an addict that they mengapa the-- and if you're going to go and strengthen their doctors severely you can make the entrapment worse so there's your treatment program has to be a tweaked a little bit differently for that okay recovery times don't have that on that list but luckily I put it here if it is an adapter tendinopathy and it's a plane adapter didn't not with you without osteitis pubis and everything else that goes with it you're looking at at least three months recovery and then that will get you to about ninety ninety-five percent better and then you're gonna have to really work for several more months to get it to full capacity if however you've neglected it for quite a while and you've got osteitis pubis and everything that plays into that I find recovery times are usually six months or longer so all depends on how quickly you identify it how quickly you react to it and getting the right treatment and the right rehab advice quite soon good so treatment advice the first important thing with treatment is I always start with activities you do in daily living I so often come across certain things that people do in the day that just keeps those adductor tendon is painful and it's not because it's causing damage but it's more it's irritating it constantly like pressing on a bruise what are the things that I should have said under what a doctor then nobody can feel like is it can hurt quite a lot of you cross your legs so for instance if you're sitting cross-legged like I'm sitting now but is not that great so if you sit like this that can cause pain in the groin or if he's sleeping at night and especially when that injured leg is on top and it drops down that can cause pain in the groin or if you sit in a really in a squishy chair or with your knees slightly higher than your pelvis that can often cause pain in the groin and I think what happens is that because the bones move closer together there's less space for the tendons and the bursa and the muscles and things that's in that corner and because the tendons are so sensitive that pressure is just enough to kick it off I often see dramatic changes in my base of patients day to day pain levels if they can just stop themselves from crossing their legs from sitting enough in those taking that compression component out of their day it can really really bring your pain levels down to a much lower level throughout the day so if your leg crosses stop crossing your legs it can make a big difference and I'm going to talk more about that issue as well when we get to the rehab exercises in a minute then you may see that on the internet they they tell you about a doctor tendinopathy being caused by really really tight adaptors and tight structures around the hips yes technically I guess that could cause it and you'll you'll see it mentioned here and there in my experience most often that's not the main cause most often it's a overuse injury and that you've got muscle imbalances in other places and you will find if you do a ductus stretches it's further especially during the early stages you often just play the pain up because tendons that's irritated do not like being stretched so if you're doing a doctor stretches and your pains just not getting better stop doing them because they're likely making it worse even if you don't feel it at that moment it's okay to add them in towards the later stages of your rehab where the tendons calm down a little bit more if you need them but it's not something that I routinely give my patients to do okay so that's those things then something else in day to day life if you think of the adductors work quite hard in any position where you're on a single leg especially it helps to stabilize the leg so if you're gonna step down from high heights suddenly or jump off stuff or just play with the kids or with a dog or something in the garden all of those things may just be a bit too high load if your tendon is really irritated so watch what you do during the day that you don't do your rehab perfectly but then go and annoy it because you're doing things in day to day life that the tendon is just not happy with good now as with most rehab programs actually all rehab programs load management is the first important step of your rehab and what I mean with load management is that you have got to establish what type of the statement can take throughout the day with all your activities that does not take it above the capacity that it can cope with so as soon as you have an injury to your tendon it loses some of its strength so it won't be able to do all the stuff you were able to do before you injured it and when we think of load management we don't just think of your sports so yes fine you may not be able to run at this point but going for very long walks or walks on really uneven terrain or jumping rope things like that can also overload the tendon at this point so it's not just about running that you've got to think all about football about whatever your sport is you've got to think of your day-to-day life as well now there's no use of just resting it because plain rest does not let anything get better it's much better if you can establish a baseline of activity that you can do that doesn't flare it up now for some runners that may mean that they have to stop running all together for a period of time and to be honest in most cases for adductors in monopoly I do find that you need a bit of a break from running but it doesn't mean that you can't cycle you can usually still walk as well for exercise often the guys can do cross-training or they can go swimming with the and if kicking a noise it you just put a pool boy between your legs so be innovative there's different things and think about what things are more likely to irritate it than others okay so you figured out your load management then we've got to think about strength training exercises so that we can strengthen the tendon back up I first want to talk about three exercises I want you to be really careful with and the reason I'm highlighting these is because there are exercises that are often prescribed during the initial stage of injury and it just makes people worse so let me get them up to here where are my exercises there now okay so let's start from top to bottom the first exercise on there where the guy's lying on his side lifting his leg up I don't understand why people give this exercise to patients because it's in my books are pretty useless exercise especially if you've got a high hamstring tendinopathy and I'll explain to you why remember how I said hamstring tendons do not like being compressed in the groin when they injured now look at that position that guy's forcing that leg as high as it can off the floor into that compressed position so he's pushing on the bruise he's just gonna make his pain worse second he's thinking the leg into a position that's really not functional now I'm not on about all exercises have to be functional but that is not a position that's useful for any sport in fact we want to try and avoid people over adapting their legs when they're running or when they're doing sports second it's an extremely low load exercise even if we think of isometrics for pain management it's got to be isometrics with some weight or resistance behind that and that is just not doing anything really so I really want to plead with therapists just don't give that exercise to patients I've seen so many people come to me saying I can't do exercise because what the physio gave me just made me worse and then this thing is on the list and as soon as we take it off and they don't do it for a week or two they're as happy as anything because their pain levels have dropped and it's not because I've given them brilliant exercises I've just told them to take the compression component out of it so avoid that exercise especially in the first stages of your of your injury now the second one is a useful exercise but I just want to point some things out there I often also get people who make themselves worse through that exercise and it's because they've been legally they've not actually been told to do it in a way that's less likely to irritate them it is an exercise that you'll even see in the research is included in rehab programs but it's often with something like a football between the legs now if you place a football between it means that the links are for most people unless you've got really wide hips a little bit adducted as well as external you rotate it so it's taken out of that compressed position and then if you squeeze it it's not going to go into compression so even with that ball that that guy's got between his legs because it's such a squishy ball it's likely going to take him into a compressed position and it will likely also annoy his tendons if they're really sensitive the other point about this is do not the first few times that you do it Dragic press as hard as you can you've got to test it because it's not gonna necessarily like being press the hundred percent or tensions those tendons are hundred percent so a better way of doing it would be place if it balls something between your legs that keeps your legs separated they don't go into the compressed position and then only press it about 60% of your maximum contraction first and hold it for whatever time you were told to hold it and relax and do that and check your 24-hour pain response and if it's no worse and or even feels a bit better that you know that's the safe level then you can press a tiny bit harder the next time but check the pain response and if you find a level that it doesn't like to go above just then go above that work it at the level that it's happy so ball squeezes useful exercise but just if it's done right I don't actually give that one to my patients I tend to like to use progressive planks rather than that and I'll explain to you how I use them in a minute third exercise I want you to be careful of again it can be a useful exercise if you do it in the right way or at the right time during the rehab so what she's got there is its adduction with AB and C pulling the band towards you see isolating the adductor muscles I find that in their cube stages with the adductors tendons are still really aggravated it's better not to choose exercises that really isolate the adaptors that's for later it's better to work with global exercises that kind of works them but they've got a bit of some from other muscles and I'll go into detail about that in a minute the other thing that she's doing there is can you see that just crossing her leg over she's taking into a compressed position so it would be better if she just stopped at neutral and let it go out then it would be less likely to irritate her now I'm not saying to avoid that forever and that it's bad exercise if your footballer you've got to be able to use your leg in that range but it's something that I would put into your program maybe six to eight weeks after we start a treatment because it's something that we want to only do once the adductor tendon is ready to do it for runners I wouldn't bother going that fire would just work to neutral with it so if you look at that adduction with band exercise I wouldn't do it in the first few weeks because often I find it just flares people up I would use quite a low resistance to start with it and I wouldn't cross the legs over in the initial stages the other thing that I have to say as well when you do do that exercise it's actually a brilliant one if you do them right at the right stage is the leg that's supporting you the adductors in that leg has to work really hard as well but in a supporting function so make sure when you do add this exercise in that you don't just do the pulling bit with the injured leg you have to also pull with that other leg and stabilise on the injured leg then you really work both of them adapt in two ways so first exercise just ignore it the other two useful but do them at the right stage and in the correct way okay so let's move on to general then exercise you've got to think about the healing process in roughly three stages see I'm not going to talk about what happens to the cells I'm going to talk about the pain levels and how sensitive your tendon is so in the initial stages where the tendon is really sensitive and you can easily aggravate it I tend to go for exercise that works global muscle groups so remember your adductors help with hip flexion the both storybird of the back part helps with leg extension they work through squatty movements they they are active during deadlift up movements so we can use all of those things to start strengthening them in positions where they don't have to work on their own they've got support from other muscles so it's easier for them to cope with it so the first type of exercise I get my patients doing are just regular old front planks because you're tensioning them at the front you're getting the stomach muscles working and remember the stomach muscles crosses over into the adductor tendon so we tension all of that and when my patients are really sensitive I sometimes have to start them with things like hovers with actually are all forced its lifting knees off instead of planks or knee planks and then front plants and later stages will progress it - from planks lifting legs up if they're ready for the cross over forces to be increased but the beginning double leg just front blanks I'll also add inside plants if the label tolerate it but I'll often place a cushion between the legs so we don't get that compression and I'll start with side planks with their knees on the floor and the reason I had these in is when you do a side plank the leg at the top does isometric induction into the leg at the bottom and I have found that that works better for me than the ball squeezes because people don't tend to over squeeze it and irritate things but remember that cushion between the legs then as soon as they can do it for 30 to 40 seconds I move them on to straight leg side planks against often stall with a cushion between the legs progressing - without the cushion between the legs when they can do that I move them on to a doctor hangs short levers onto long leaves off chairs but I have to be honest with that one I choose my patients so if it's an athletic person who does strength train quite often I'll definitely add that in if it's more one of my deconditioned runners that are often gets who is not used to strength training that exercise is usually a bit overwhelming for they add so I tend to not do hangs I still do the side plants and stuff but I don't progress it to the hands of the of the bed I tend to add other things like the band exercise in men rather okay say that side blunts then for the posterior a function so if we've now got our isometric double leg exercise for the front that's in the regular planks we've got side planks that gets the actors more then if we want to work the post or a part of the adaptors more bridges brilliant I love them and I'd end too if the patient can tolerate them I tend to go for high bridges so with your feet on the chair that you get more of their more hamstring dominant and work the adductors a bit more start with double leg ones as soon as they feel it's stable enough the tendon is okay with it you start lifting one leg up that we're getting it a crossover force through everything and increasing the force so those would be typically my starting things also double leg squats at the beginning just bodyweight later on goblet type squats I'll start with good morning type movements or deadlift depending on what the patient can tolerate but everything is double leg everything is lower load at the beginning to see what the the movements are and often there are symmetric now as the patient recovers and the tendon can start tolerating more load and becomes less sensitive I then move on to single leg type exercise but again quite stable at the beginning so we're thinking single leg supported squats or split squats we're thinking static lunges often lunges just forwards backwards at the beginning before we go sideways as well what are other things do we add in at that stage I may start doing light band work we supported on that one leg pulling the other one in and then crossing over as well what else to add in there have her written anything down yeah so all of these things will some exercises we'll be able to progress quite quickly while others movements I'll be a lot more careful with and have to progress more slowly with and then once they're happy with controlled single leg stuff and loading and quite heavy and positions I'll move on to more dynamic things so fast lunges lunges to the sides where the adductors have to work eccentric these slides a sliding sheet so if you don't have a sliding sheet tiled floor towel on there works brilliantly well start with some hops if it's appropriate for them and their sport and depending on the on the level of my athlete that I'm working with to be honest because I find for less conditioned runners who don't hop as a rule or don't have a lot of explosive force I often find yes double leg biometrics but then getting them back to running works as a pretty good plyometric exercise for them but most of the time I'll use a combination of those type of things so make sure you start with really stable things and progress them through slowly what am i leaving out here yeah so the later stages absolutely isolate those adductors and work them hard but be careful in the early stages now then we get to running I think let me just see if that's the next thing yes okay so running style what the research is showing is you can strengthen muscles up as much as you want and have the strongest speeds ever but if you are used to running with a certain pattern having strong muscles won't necessarily make you run with a better pattern so it's important to look and what your athletes are doing when they're moving as well I'm going to talk about runners specifically because that's the caseload that I work with most so if we think of things in running style that can specifically affect your adductors and give you a tendinopathy or contribute to it in not the it's over stride is in there of course is the first because over stride when you land with your heel strike quite far in front of your body it means your impact forces are quite large and especially if we think of running downhill and things like that if you really bang into it that becomes even more of a problem so getting them to land with a foot slightly more underneath them while leaning slightly not leaving forwards like bending but just kind of whole body leaning forwards that can be able way to reduce that also if you're running with a narrow great see if you can just get the feet slightly that it's not as if you're running on a tightrope if you if you're quite her hard heel strikers see if you could maybe get yourself to just come a little bit more to the mid foot so again just getting those feet underneath you more when you land already help with that if you if your cadence is below 160 see if you can get it up to 160 570 at least because that will meet mean that your impact forces again is lower going through the leg what you also if you've got a pelvic drop when you look at yourself if somebody forms you from the back and you look at yourself running you can see your pelvis does that when you run you want to try and teach yourself to run with the pelvis that only drops slightly so not that excessively and also if you see your means moving in quite excessively as you run you want to think about running with knees that's pointing slightly further for more forwards when you run and don't quite work in so much an easy way to get things these things all of these components in there without really having to think about it is if you increase your cadence that's one of the best ways to get that or think about running with soft feet or soft landing because again that's going to speed you up a little bit but always start with first observing what you do what you feel like when you run and if you can let somebody video to you based on the thread well it's a bit hard when somebody's running behind you with her with a camera but you can still actually get a pretty good video from from that so see what you can do there now for some people even though they do everything absolutely by the book they paint just continues I will say that often I find it's because patients aren't quite patient enough with how long rehab takes and I have gone through the same thing myself that I think instead we're gonna get better why's it still saw and then I go and count on the calendar go in six weeks okay fine it takes 8 to 12 weeks for both serious injuries to go so make sure that you mark on the calendar where you are in your recovery process and what the prediction was for when you will be back to full lab full strength and as long as you can see that you can see progress week on week then it means you're recovering and you likely don't need further an intervention but if you look at that and you look at your progress you see that it's not just that progressing it's just too painful you can't get on with proper rehab then there are other options that can help so shockwave can help with pain management that can allow you to do rehab there are injections that can be done like PRP and stuff like that I have to be honest I have not prepared any of that so I don't know what the latest research is saying on those things for you I haven't prepared it for this video because I wanted to talk about rehab more but those are options and if you if you find you can't progress with your rehab the best person to go and see is a sports physician because they are extremely good with diagnosing stuff so they can have a good look at you and decide is it just that a doctor tendon is something else going on as well and then they have the ability to offer you a variety of injections or shockwave or other treatments as well so let me know if you've got any questions if you need more help if your injury you're always welcome to consult one of us via video pull link to the website is in the description of this video thank you

Channel: Sports Injury Physio

Views: 71,742

Rating: 4.9488215 out of 5

Keywords: adductor tendinopathy, adductor tendinopathy treatment, adductor tendinopathy runners, groin pain runners, groin pain running, adductor tendinopathy rehab exercises, adductor tendinopathy exercises, adductor tendonitis, adductor tendonitis treatment, adductor tendonitis rehab exercises, adductor tendonitis strength training, adductor tendonitis runners

Id: 2b26JOO4pkU

Length: 33min 38sec (2018 seconds)

Published: Mon Jun 22 2020