The famous GROIN has reared its ugly head again in the NHL. Several years ago there were a plethora of p[layers that had groin injuries that kept them out of the line up for an extended period of time. Players like Tom Fergus, Mike Mcphee, Basil Mcrae and Tod Gill all had groin injuries and some even needed surgery. Now we have such star players as Eric Lindros, Paul Kariya, and Claude Lemieux are missing a large chunk of games due to groin injuries. The classic groin injury is an injury that affects the tendon of the muscle that adducts the leg or brings the leg in.
Due to the nature of the skating motion in hockey that the leg is propelled outwards makes these structures vulnerable to injury. It does not occur in straight ahead running sports. The groin can be injured in an acute injury. This occurs when there is a sudden pull on the groin muscle. A player is hooked around the leg and it is pulled out. This can occur as a player tries to accelerate quickly and places too big a load on the muscle and it tears when the force is too great. I also commonly see this in beginner water skiers whose legs split apart as they try to get up.
There is acute pain in the groin area and people will describe a burning sensation. The injury is graded in three degrees. The tear almost always occurs where the tendon joins the muscle. A first degree is a minor strain to this area while a third degree involves a significant tear. A first degree injury resolves quickly with a short period of rest within a couple of weeks. A third degree tear is more significant.
The person may be unable to weight bear and will have to use crutches. Within a few days a large bruise will become evident. In the most dramatic cases there will be a large black bruise that will start at the groin and extend all the way down the leg past the knee. The recovery can take several months and up to a year in the most severe. The important thing is to regain full strength and flexibility in a good sports medicine clinic.
The more common scenario is a chronic or slow developing groin injury. Over the years of playing there is repetitive stress placed on the groin muscle. Although this may develop from an acute injury the athlete can not usually recall a specific injury to their groin. Slowly the pain gets worse and worse and they can not function the way they want to. At this point they seek help. In the early stages the groin seems to get better with short periods of rest and the athlete may be fooled into thinking it is getting better until they try to stress it again and the pain and disfunction returns. Gradually it requires longer and longer periods of rest to settle down and the athlete is forced to take an extended period of rest.
The other common situation in especially hockey and soccor is the ""high"" groin injury where it is not actually the groin muscles that are affected but it is the lower abdominal muscles that become inflamed as they insert into the pelvis bone. The pain radiates down into the groin mimicking the groin pull. The pain is reproduced by resisting the groin muscles as in a classic groin injury further confusing the diagnosis. This is common in soccor and called Pubalgia in Europe. In Canada it is affectionately called ""Slapshot Gut"" as it is the repetitive shooting motion which places all the stress on the abdominal muscle which eventually breaks down.
The groin injury can be one of the most aggravating and persistent injury. It is crucial to treat this injury early and thoroughly so it does not linger into a chronic problem. I tell these athletes to expect a long course of recovery. They have to avoid the side to side motion and thus maintain their fitness on the bike and stairmaster. The inflammation is reduced with medication and physiotherapy. Once the inflammation is reduced the next job is to increase their flexibility and strength of their groin, hip, pelvic, and abdominal muscles. The athlete is then slowly introduced to their sport. The groin is wrapped for protection. The important thing is to maintain their strengthening program as they go back to play and to make sure the groin remains pan free. While Eric. Paul, and Claude are all following this program, we hope to see them back paying soon.