Wednesday 16 March 2011

Understanding The "Sports Hernia"

- by Jay Stone, Physiotherapist, Co-Owner Sun City Physiotherapy


One injury that hockey players should be familiar with is the “sports hernia”. It can be very disabling for the athlete and proper treatment is often delayed because vague symptoms can make diagnosis difficult. For years now, the term “sports hernia”, has been used as a diagnosis for some of the more difficult cases of groin and abdominal strains. Unfortunately some health care providers are still unfamiliar with it though, so the athlete and parents should possess a little knowledge about the condition themselves.

A hernia occurs when an organ or body part protrudes through the structure meant to contain it. This can happen just about anywhere in the body (for example, herniated disk in the back). The groin is the most common place for a hernia to develop. In the groin there is a space known as the inguinal canal that allows the spermatic cord in males and the round ligament in females to pass out of the abdominal cavity. Occasionally, some of the lower intestine can push into this space after a heavy lift or strain. This creates pain worse with lifting, coughing and pushing movements.

A sports hernia is different from a regular hernia in that technically it is not a hernia at all. There is no protrusion of an organ through its usual confines. This sports hernia is a disruption of the groin or lower abdomen characterized by weakening of part of the inguinal canal, which leads to unilateral groin or lower abdominal pain. Unfortunately, the diagnosis isn’t given until after a groin or abdominal strain doesn’t seem to get better in a “normal” period of time. The athlete that has this condition will often present with groin pain, which has been very slow, or non-healing over a number of months. Their pain usually increases when accelerating, twisting and turning, cutting and kicking and sometimes coughing and sneezing.

Hockey and soccer require repetitive twisting and turning at high speed. The action of the adductor muscles (muscles along the inside of your thigh) are very important in these sports and the frequent contraction can cause shearing forces across the front of the hip/groin causing stress to the inguinal canal. An NHL study found that nearly 20% of their players suffered from groin and abdominal injuries.

Treatment for these types of injuries has improved a lot as we’ve learned more about the importance of the trunk and pelvic stabilizing muscles. Often, weakness in the trunk stabilizers or inflexibility across the hips and pelvis can lead to poor mechanics that cause increased shearing on the lower abdominal and groin areas. Proper muscle balance must be restored to this area to allow the injury to heal.

If you believe that you have a sports hernia, you should have your health care provider perform a thorough exam. Your physician should be able to rule out other more serious pathology and order tests that may help with the diagnosis. A skilled Physiotherapist should be able to assess all aspects of pelvic flexibility, strength and stability and design a program for you that will address the weaknesses that may be making you prone to this injury.

Since preventing this condition is easier than treating it, any athlete who participates in recreation or competitive hockey or soccer should be on an off ice or field prevention program. Pelvic and hip inflexibility, instability or imbalance may all contribute to the development of injuries to this area so exercises to increase flexibility of the hip flexors, abductors, adductors, abdominal and pelvic stabilizing muscles should be a staple of this program. Functional, controlled sport specific core stability exercises should also be emphasized. The NHL players have been incorporating these for years now to help improve performance and prevent injury. I don’t believe our bodies are any less important.

This is provided as general information only and is not intended to be relied upon as medical advice. Jay Stone is a co-owner of Sun City Physiotherapy in Kelowna, BC. Jay has a special interest in Sport Injury Rehabilitation. He can contacted at Sun City Physiotherapy's Glenmore clinic by calling 250-762-6313 or at jstone@suncityphysiotherapy.com

Wednesday 9 March 2011

Trochanteric Bursitis (or, A Pain In Your Hip)

- by Robina Palmer, Physiotherapist, Co-Owner Sun City Physiotherapy


Are you experiencing pain to the outer side of your hip when walking, climbing stairs or sleeping at night? You may be developing trochanteric bursitis. Trochanteric bursitis is an inflammation of the bursa (bursitis) that is located on the outer side of your hip.

A bursa is a fluid filled sac that lies over a bony prominence in the body. We have multiple bursas throughout our body. They are designed to cushion and decrease the friction that is created when a tendon or muscle moves across the bone.

The greater trochanter is a bony prominence of the upper leg bone (femur) that is located on the outside of your hip. Here is a quick way to find your greater trochanter. Stand, let your hand hang straight down by your side, the crease of your wrist is at the same level as your greater trochanter. This bony prominence is an attachment site for many muscles, including the glut muscles that help control hip movement.

Inflammation of the bursa occurs when additional friction is created, either from tight overlying muscles, or from direct trauma. Tightness in the glut muscles or the Iliotibial Band (IT Band) can create extra friction as it crosses over the bursa. A fall onto the side of the hip or a direct hit during contact sports can also result in inflammation to the trochanteric bursa.

Once the bursa is inflamed, point tenderness to the side of the hip usually develops. Pain is often described as a deep aching sensation. The pain can often radiate into the thigh and knee, and occasionally into the lower leg. The pain can also refer into the lower back and tailbone area. Pain is reproduced when climbing stairs and hills due to the compression action of your glut muscles on the bursa. You may even experience difficulty laying or sleeping on the affected side, as this also directly compresses the bursa.

If you suspect you have trochanteric bursitis, the best thing for you to do is to avoid the irritating activities. Stop running or walking, and minimize stair climbing. Icing the inflamed bursa for ten minutes at a time will help to reduce the inflammation. Avoid things that compress the bursa, for example bucket seats and lying on your side. Begin stretching the IT Band, the glut muscles, and other hip muscles to minimize the friction placed on the bursa

If you are not familiar with these stretches, your Physiotherapist will be able to provide you with the appropriate stretches, and develop an individual program. Your Physiotherapist will also be able to confirm the presence of bursitis (ruling out other possible diagnosis), provide strengthening exercises, and may use different modalities such as ultrasound and electrical stimulation to further decrease the inflammation.

This is provided as general information only and is not intended to be relied upon as medical advice. Robina Palmer is a registered Physiotherapist and co-owner of Sun City Physiotherapy. She can be contacted at Sun City Physiotherapy’s downtown, St. Paul Street clinic by calling 250.861.8056, or via email at rpalmer@suncityphysiotherapy.com

Friday 4 March 2011

Core Strengthening Q & A

- by Vanessa Milot, Physiotherapist, Sun City Physiotherapy

Have you ever been told to strengthen your core, but feel unclear about what that means? You are not alone! While the benefits of core stability have become a common topic, the “how” and “why” of core strengthening seem to be less well known. Here are answers to a few frequently asked questions about core exercise.

Question:

My lower back was injured in a car accident 2 years ago. Since then, my back has never been the same. I have heard that core strengthening can help in reducing back pain. Is this true?

Answer:

Yes, this is true. Your body has a group of small muscles which, when working together, provide stability to your spine. This essential muscle group is commonly referred to as the “inner core” or “inner unit”. It is comprised of 4 deep muscles: multifidus at the back of the unit, transversus abdominus (TA) at the front, pelvic floor muscles at the bottom, and the diaphragm at the top. Together, these muscles allow the rest of the body to perform challenging tasks, all the while keeping the trunk stable.


Question:

I am about to start training for a new sport this summer. Can core strengthening help me to prevent an injury?

Answer:

Most definitely! Core strengthening is a great way to get your body conditioned for a new sport. Many of my patients have come to the clinic with injuries to their back, hips or knees; where quite often, the common cause is core instability. In trying a different sport, they placed new physical demands on their bodies and their core was not up for the challenge. As a result, other body parts were recruited to help provide stability with the outcome being an overuse injury. Such pain could have been easily avoided by first preparing the inner core for the new task.

Question:

How do I find my inner core muscles?

Answer:

Start by lying on your back with bent knees and feet flat on the floor. Put your index fingers over your hip bones and roll them in and down 3 cm. Your fingers are now lying over your TA muscle. To activate this muscle try bringing your bellybutton toward your spine and draw your two hip bones together. If you feel the muscle flattening under your fingers, you will have successfully found your TA muscle!

The great thing about the inner core muscles is that by activating one, you activate them all. Once you are comfortable finding these muscles, you can then begin to challenge the inner unit by changing the position of your arms and legs or by using exercise equipment such as a Bosu ball or foam roller.

This is provided as general information only and is not intended to be relied upon as medical advice. Vanessa Milot is a Registered Physiotherapist and Associate of Sun City Physiotherapy in Kelowna, BC Canada. She can be contacted at Sun City Physiotherapy's Glenmore clinic by calling 250-762-6313.