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Groin Pain – Blog by Kara Giannone

The story of Osteitis Pubis…

Osteitis Pubis (OP) was a very fashionable diagnosis in Australia for a very long time. It seemed every footballer with chronic groin pain was diagnosed with OP. You may be reading this thinking “I had OP, it must exist!”. However in fact, the labelling of OP was far from correct. As many of you will know, the term “itis” refers to inflammation and therefore Osteitis Pubis is suggesting that this is an inflammatory condition of the pubic bone. However, studies involving biopsies of patients diagnosed with OP have in fact revealed no inflammatory markers present. In fact, what we now know is that rather than inflammation, there is a stress response occurring in the pubic bone, similar to that which one may get in a stress reaction or stress fracture.

A funny story came out of the AFL recently, where an Adelaide Crows Footballer was seen reporting to media that he had OP. Meanwhile, coaches were reporting to the media that this player had pubic related groin pain – both parties talking about exactly the same injury, however using different terminology. Quite hilariously, the media went into a frenzy spinning a story that there was conflict within the Adelaide Crows as players and coaches were not in agreement. Maybe the media reporting this story should read this blog hey!

So I’m sure you’re thinking…“I’ve got pain in my groin and if it’s not OP, what is it then?”

Well, turns out pubic joint pain is only one small piece in a large puzzle that can lead to groin pain.

In 2014, the medical experts came together in Doha and decided on universal terminology. They concluded that groin pain should be classified as one or a combination of the following:

  1. Adductor-related groin pain
  2. Pubic-related groin pain
  3. Iliopsoas-related groin pain
  4. Inguinal-related groin pain (which includes abdominal related groin pain)
  5. Hip-related groin pain

 

So, what does this all mean?

The groin is a very complex region of anatomy as shown in the image above. As a result, pain in the groin can be referred from multiple structures. Thanks to the Doha agreement outlined above, we have universal understanding that groin pain can be referred from a wide range of structures including muscles such as the adductors, hip flexors (Iliopsoas) or abdominals and from joints including the hip joint and pubic bone joint.

So what should you do?

If you are suffering from groin pain, it is integral to determine what structure is causing this pain as this will guide treatment. Our physiotherapists are trained in assessment of a wide range of musculoskeletal conditions including groin pain. During this consultation, our physiotherapists will assess:

  • Posture
  • Gait
  • Biomechanics
  • Tenderness via palpation
  • Strength, endurance, power and flexibility – particularly of abdominals, adductors and Iliopsoas
  • Joint integrity – particularly of the hip joint and pubic bone joint

Following this assessment, our physiotherapists will ascertain the cause of your groin pain and treat you accordingly.

What will treatment involve?

It is paramount that any muscle deficits in terms of strength, power, endurance and flexibility are addressed. Therefore, a graduated exercise based rehabilitation program must be at the core of intervention. In addition, treatment of groin pain may include, but is not limited to:

  • Education regarding pain management and load management strategies
  • Soft tissue mobilisation
  • Taping
  • Dry needling
  • Sport (or activity) specific training

So if you’re experiencing groin pain make an appointment below at one of our clinics at Total Physiocare Heidelberg, Reservoir, Camberwell and Footscray

Book an appointment today for your assessment!

 

Posterior Cruciate Ligament (PCL) Injury

What is the Posterior Cruciate Ligament?

The Posterior Cruciate Ligament (PCL) is a ligament inside the knee joint. The PCL attaches to the shin bone (tibia) and to the thigh bone (femur). Along with the anterior cruciate ligament (ACL), these ligaments provide stability to the knee.

The main role of the PCL is to prevent the shin bone from sliding backwards on the thigh bone.

Mechanism of Injury

A direct blow to the upper area of the shin bone is the main cause of a PCL injury. In the general public this is seen during motor vehicle accidents where the top of the shin hits the dashboard. In the sporting population, PCL injuries occur when the athlete falls onto their bent knee causing the shin to hit the ground first. This type of mechanism is common in:

  • Football
  • Soccer
  • Basketball
  • Skiing

Signs and symptoms

  • Pain and/or swelling immediately following the injury
  • Difficulty walking
  • The knee may feel unsteady. It may feel like it is going to give way

Grading of Injury

PCL injuries are often graded I, II, III. Grade I and II are partial tears of the PCL whilst a grade III signifies a complete rupture of the ligament

Grade I – The PCL is overstretched resulting in a small partial tear. The knee remains stable.

Grade II – More of the PCL is torn when compared to a grade I. The ligament is now loose. The knee may start to feel unstable at this grade.

Grade III – This PCL is completely torn. The knee joint is now unstable.

Assessment

Isolated PCL injuries are uncommon. It is more likely for additional injuries to occur to other structure of the knee. These include damage to the meniscus and/or medial and lateral collateral ligaments and even the ACL.

A thorough physiotherapy assessment is required to discover the extent of the injury and if any other structures are damaged. After gaining you subjective history, your physiotherapist will put you through a series of special tests to determine the extent of the injury.

After a knee injury, you may be referred for an MRI scan. This is often necessary to confirm a PCL injury and other associated injuries. Your physiotherapist, doctor or surgeon can refer you for this scan. You may require a X-Ray if an avulsion fracture (small component of bone pulled away by the ligament) is suspected.

Treatment

The PCL can be treated either conseratively or surgically. This is dependent on the grading of the PCL injury and and other associated injuries.

In the immediate stages following a knee injury, it is advisable to follow the POLICE principle for the initial 48-72 hours. This involves Protection, Optimal Loading, Ice, Elevation and Referral for medical management. It is also advisable to follow the NO HARM program to reduce further bleeding and swelling into the joint: NO Harm, Alcohol, Running or Massage

Conservative Management – May include other injuries as well

Patient who have grade I or II PCL tears usually receive conservative treatment. This treatment can consist of a period of immobilisation of the knee with bracing. During the initial period of rehabilitation it is important to focus on strengthen both the quadriceps and hamstring muscles and to regain full movement of the knee.

Sport and skill specific training is crucial in the latter stages of rehabilitation in order to provide ongoing stability to the knee and to provide a successful return to sport or activity.

Surgical Management

Injuries which involve other structure of the knee and Grade III PCL injuries are likely to require surgical intervention. If a period of conservative management has failed to provide stability to the knee, surgery may also be required.

Similar to that of the ACL, the PCL can be reconstructed arthroscopically. This involves the use of tissue grafts to rebuild you PCL. The graft can be taken from another part of your body, often the hamstring or quadriceps tendon, or from another human donor (cadaver). It can take several months for the new ligament to fully integrate with the bones of your knee.

Rehabilitation

Regardless of whether you have opted to treat your PCL injury surgically or conservatively, it is important you participate in a rehabilitation program under the guidance of your physiotherapist.

The aims of physiotherapy are to:

  • Restore range of motion of your knee
  • Improve strength of the surrounding muscles
  • Address poor biomechanics
  • Improve jumping and landing strategies
  • Skill Retraining/ Sport specific activities
  • Return to Sport
  • Prevent Re-injury

At Total Physiocare we treat hundreds of knee injuries and work closely with multiple orthopaedic surgeons in order to accurately diagnose, manage and rehabilitate clients following an acute knee injury. 

Book an appointment today for your assessment!

Blog By Ryan Harris (Physiotherapist)