Pilates for rehabilitating groin strain

Transcription

1 Pilates for rehabilitating groin strain Helen Turner 14 th June 2017 Guildford, Surrey & Wimbledon, London, UK Comprehensive Training Program 2016

2 Abstract This paper is about the use of Pilates to assist the recovery process of a client who suffered a groin strain. This case report is based on a 46 year old male ex-rugby player who sustained the strain during sporting activity and followed a careful process of rehabilitation beginning with rest and visits to a physiotherapist, followed by a 12 week course of Pilates in the equipment studio, enabling him to have a personalised program of exercises specific to his injury and needs. He was able to return to his regular activities with no lingering pain or concerns. 2

3 Table of Contents Abstract 2 Anatomical Description 4 Anatomical Diagram 5 The Client 6 Conditioning Program 7 Conclusion 10 Bibliography 11 3

4 Anatomical Description The muscles of the groin region involved in a typical groin strain are the adductors. There are five adductor muscles whose main function is to pull the legs together, towards the midline and are also responsible for stabilising the pelvis. Three are the short adductor muscles whose origin is the pelvis and insertion at the femur. Adductor Brevis (Primary muscle) Adductor Longus (Primary muscle) Pectineus (Secondary muscle) The other two are the long adductors whose origin is the pelvis and insertion at the knee. Gracilis (Primary muscle) Adductor Magnus (Primary muscle) It is useful for a physiotherapist or other medical professional to have performed an examination to determine the severity of the groin strain and identify which muscles are involved, to enable us devise a safe program to support the client s rehabilitation. Groin strain is a common complaint in athletes and a strain most commonly occurs when participating in sport which involves rapid accelerations, decelerations, change of direction or kicking. 4

5 Anatomical Diagram Diagram showing the adductor muscles. 5

6 The Client A 46 year old male ex-rugby player who mostly leads a more sedentary lifestyle nowadays working in an office 5 days a week but also participates in some extreme sports as a hobby. His injury occurred during take off to go paramotoring, foot-launched powered paragliding. Carrying a heavy paramotor and paraglider wing on his back and running along the flat he changed direction suddenly when a gust of wind caught the wing and he felt the strain occur sharply. His physiotherapist classified it as Grade 2. He saw a physio, rested during the acute stage and applied ice and did some gentle stretching, then returned to his regular Pilates lessons where I planned a program to rehabilitate and strengthen to help avoid risk of future injury. This was done through a 12 week program using the studio equipment. Due to his strength and bulk of muscle, previous rugby related injuries to the shoulder as well as the fact he now works in a desk job so spends a lot of the day sitting, working through the full block system held as much importance as the specific adductor work for the injury. In particular the spinal articulation and stretching blocks due to the tightness in his hamstrings and adductor muscles. Tight adductor muscles may have contributed to his injury. 6

7 Conditioning Program I researched and included specific exercises to strengthen the adductor muscles, detailed in the table below, including the Magic circle, below knees sitting, supine & prone series exercises. He found it interesting and useful feeling different muscles working in the leg, hip and groin are in each of positions in the magic circle in each exercise. The majority of these specific adductor exercises fell in to the Leg Block so I tried to avoid too many longer series elsewhere in each session to allow plenty of time for these. I also used assists such as a small ball between the knees during footwork to encourage use of the adductors in other exercises. My client found exercises that had an oblique muscle focus or emphasis caused him some discomfort. So I was particularly careful in the Abdominal and Lateral Flexion/Rotation Blocks to build up slowly and gently, starting with stretches in the Pole Series where the obliques come into play in the Side Stretch & Spine Twist. Then in the Lateral Flexion/Rotation block to the Side Lift on the Spine Corrector and Side Over Prep on the Ladder Barrel, which are more supportive than other equipment. Building up eventually to Side Over on the Ladder Barrel, Side Over On Box on the and Side Pike on the Wunda Chair. To strengthen the adductor muscles I gradually increased the load over the weeks by e.g. increasing springs on the Wunda Chair during the footwork series, progressing to single leg after a few weeks. This table is not exhaustive of all the exercises taught over the 12 weeks but highlights ones that I found particularly important for the client in recovering from a groin strain and his other needs. 7

8 Block Equipment Exercise Notes Warm Up Mat Pelvic Curl Spine twist supine Chest Lift CL w/rotation Leg changes Footwork Abdominals Wunda Chair Spine Corrector Footwork series including single leg Footwork series including calf raises & single leg Overhead Stretch Fundamental warm up essential before beginning the program, progressing to the Intermediate warm up I think it s important to include single leg in the series, to focus on the individual leg. He enjoyed Footwork most on the Wunda Chair as he felt himself working, the trunk stabilisers, engaged throughout; the back extensors work in sync with the abs to maintain the upright seated position and neutral spine, whereas he had a tendency to become lazy on the. Adding a small ball between knees to engage adductors. Cadillac Roll up w/ru Bar RU Top Loaded Mini Roll-Ups Mini RU s Oblique Breathing Working with caution on the Mini Roll ups Oblique. Breathing encouraged the mind body connection and the spinal articulation was helpful too. Hip Work Wunda Chair Cadillac Full Pike Basic Leg Springs Single Leg Supine Useful for working his scapular stabilization. Really working on hip disassociation and pelvic lumbar stabilisation. Spinal Articulation Stretches Wunda Chair Ladder Barrel Supine Leg Series Bottom Lift Bottom Lift w/ext Pelvic Curls Stretches Gluteals, Adductors, Hamstrings, Hip Flexors He suffers from tight hamstrings and enjoyed the release of hip work here. Ensuring his legs remained parallel and adductors engaged especially on extension. This series of stretches were a welcome part of the session, especially the Adductors stretch since it incorporated a nice lateral flexion stretch as well. Auxillary Pole Series Shoulder Stretch was good for his scapular stabilisation 8

9 Full Body Integ. Scooter Knee Stretch Series Up Stretch Series and the Side Stretch and Spine Twist good for gentle oblique focus, stretch and control. Scooter was a nice follow on from Standing Lunge. The Reverse Knee Stretch was good for working on scapula control and hip disassociation. The Up Stretch Series was good for his hamstring tightness. Arm Work Cadillac Ped-A-Pul Push Through Series Arms Series He really enjoyed the oblique stretch in the Side Reach in particular. Kneeling Cat Stretch was good for stabilising scapular whilst stretching the shoulder. Good for scapula stabilisation Cadillac Leg Work Auxillary - Magic Circle Auxillary - Ankle Weights Arms Standing Series Side Arm Kneeling Series Sitting, Supine & Prone Series Adductor Squeeze Gluteals Kneeling Series & Adductor Lift The client enjoyed the full body challenge of these two series not only working the arms but working to stabilise the whole trunk. These worked really well to focus on the adductor, in particular the Ankles position. On Hip Abduction I slowed the adduction on the inhale to increase focus. Adductor Lift he felt work most strongly. Lateral Flex/Rot. Spine Corrector Ladder Barrel Single Leg Skating Side Lift Side Over Prep Side Over Side Over on Box To work on the gluteals and pelvic lumbar stabilisation. Successfully building up over the weeks from Fundamental through to Advanced being careful to listen to feedback from his body. Back Extension Wunda Chair Ladder Barrel Cadillac Side Stretch Side Pike Basic Back Extension Prone 1 I kept the Back Extension block to the Fundamental / Intermediate range to ensure the scapula were stabilised and lower back not involved. 9

10 Conclusion The exercises in this program were selected to strengthen the adductor muscles, increase flexibility in the hamstrings, bring awareness of scapula movement and stabilisation and bring back confidence to his movement following his injury. He fed back that he had found it hugely beneficial to work the injured area gently and specifically and to feel the improvement over the weeks. He liked to be challenged and work hard in other areas and appreciated that I had made sure to add additional springs where needed and cue him into performing exercises slowly and with precision. He noted that he had become far more aware of his mind body connection. He has returned to his usual activities and reports no residual soreness in the groin area. He continues to practice Pilates with me attending a weekly group equipment class. 10

11 Bibliography Books Isacowitz, Rael. Study Guide: Comprehensive Course. Costa Mesa, California: Body Arts and Science International. Isacowitz, Rael and Karen Klippinger. Pilates Anatomy. Human Kinetics, Websites Sports Injury Clinic Pilates Interactive Groin Strain Image courtesy of DW Sports Massage 11