Originally published in Massage Bodywork magazine, February/March 2001.
Copyright 2003. Associated Bodywork and Massage Professionals. All rights reserved.
American football remains the most popular contact sport, and rightly so. It provides the public with amazing spectacles for a few months each year. In fact, I learned it's not a good idea to schedule a class during the last weekend of January, since most people -- regardless of gender -- will be spending Sunday in front of the television watching the Super Bowl. I became a football enthusiast after I consulted briefly with the Houston Oilers (now the Tennessee Titans). Although my consulting job did not last long due to proximity, I was able to gain a better understanding of American football as a sport, as well as the injuries it brings. In these next few columns, we will cover treatments for some of the injuries that occur in this serious contact sport, as well as some injury prevention ideas.
We are familiar with a multitude of knee injuries -- meniscus (lateral or medial) tear, anterior cruciate ligament tear, collateral ligament tear, etc. In fact, there are so many we could spend a paragraph just listing them. There are many factors that contribute to knee overuse, and subsequent injury. Let's start by covering one, commonly known to the public and football players alike as a groin injury. Groin Injuries
What we refer to as a groin injury may be a strain of the vast muscle structure in the medial thigh region. The muscles there perform several functions: abduction or adduction of the hip, flexion of the hip, extension of the hip, medial (internal) rotation of the knee and flexion of the knee. Some of the muscles you will come in contact with when addressing groin problems will be: gracillis, sartorius, semimembranosus and adductor brevis, longus and magnus. It is very important to know location, name and action of the muscle or organ/tissue with which you come in contact. But what is more important is the palpation and the assessment that follows. The rest is simply geography. If your geography is medial thigh, your palpation will tell you much about the condition of the muscles and tendons which attach these muscles. We often spend a lot of time trying to dissect the tissue we are palpating and miss the obvious symptoms that are present. When assessing the client, I am more concerned with the dysfunction of the tissue (i.e., edema, muscle contraction, scar tissue formation, adhesions, etc.) rather than the names of the muscles. It's more about "what" you feel, rather than "where" you feel it.
So what will we observe when seeing a client with a general groin strain diagnosis? A common trait I have seen in all my groin strain clients is the basic complaint of pain. Groin strain injury pain is so debilitating the client can barely walk, let alone run. When the knee is overused, the muscles tend to contract to protect themselves. This contraction will occur in the belly of the muscle, but the tendons attached to the contracted muscle will be continually strained (or pulled) by the contraction. If this condition goes unnoticed, the joint attaching these tendons/muscles will begin abnormal function, leading to a problem within the joint itself. Since some of the groin muscles attach into the knee, the knee is at risk of injury. Thus, by preventing ongoing groin strain, we will actually prevent knee injury.Goals Objectives
Our primary goal is to decrease muscle contraction and to increase muscle/tendon elasticity. Only in moderate strains will we see presence of edema. If edema is present, then our primary goal is to remove it.
Although these goals sound simple, I have found through many years of practice that groin injuries are slow to respond. In fact, only with professional football players have I seen quick results. With weekend athletes suffering from groin strains, I've found it takes 15 treatments for the condition to improve and resolve. Unfortunately, the client will see only short-term signs of improvement until the 10th or 12th treatment. This makes for a difficult treatment program that is often hard for clients to finish.Treatment
If edema is present, we will drain it by performing repetitive gliding strokes over the anterior and medial sections of the thigh. Make sure you use rhythmical motions in order to create a pumping effect which will promote the drainage. You need to pay attention when gliding over the medial section of the thigh. Your hands will naturally be pointed into the groin. This presents a problem -- you will either have to discontinue your touch sooner (i.e., miss running into the private area with your fingers), or miss the medial section altogether. The solution lies in pointing the fingers of your inside hand to-ward the hip joint prior to the gliding as you place your hand on the medial knee. This way you will not run your hands into the groin, but you will cover the medial thigh through the belly of the muscle where the edema is. It will take you 5-10 minutes to decrease the edema depending on the severity of the condition and the physical lassitude of the athlete. More fit athletes respond to the treatment quicker than the general weekend athlete. Make sure you follow your gliding strokes with vibratory strokes in order to train the vessels to continue draining on their own. If the condition is not too severe, you may progress to the next set of goals (decrease muscle contraction and increase muscle elasticity) within the same treatment. If the edema is severe, you may want to wait until it is no longer present before continuing.
Your second set of goals will take several treatments to accomplish. First, divide the muscles you are working on into three groups: 1) from attachment into the knee through the mid-belly of the muscle (or mid-medial thigh); 2) from the mid-medial thigh to the attachments into the pubic area; and 3) the attachments in the pubic area.
In the first group, use the pads of all four fingers and administer pressure stretching beginning at the knee and gradually progressing into the belly of the muscle. You will feel muscle strain gradually decrease as you pressure stretch. Alternate pressure stretching with light shaking vibration so you don't overwork the area. Progressing to deeper forms of pressure stretching (like the crest or heel of the hand) within the same treatment is fine. You may want to check with finger palpation to see if the muscles and tendons have relaxed their contraction. This may take between 1-5 treatments to accomplish permanent results. Once you are finished with the first group, you will probably not have to return to it in the subsequent treatments, although I recommend checking the condition of the area to make sure the muscles and tendons are completely relaxed.
Progress to the next group in the same manner as outlined earlier with pressure stretching and vibration. This may take several more treatments, but you should see permanent changes by about the 10th or 12th session. You may need to work the second portion of the thigh until the treatment set is finished, but you will spend less time on the muscles and more time addressing the third group.
The third group is the hardest to work with because of its very private location. The pubic area is where most of the muscles will attach, and the attachments are what need to be addressed. Proper draping of the area is important in order for you to stay professional and non-invasive. I always recommend the clients remain in their underwear during this portion of the session. When treating males, I ask them to hold their privates pulled away from me during this portion of the treatment. In order for you not to be inappropriately invasive, I suggest the use of the ulnar side of your hand. Place the ulnar side of the near hand in the pubic crease (your cupped hand should face the knee), and with circular motions administer pressure stretching of the attachments into the pubic area. Your motion should begin with the pull toward the knee, and just allow the hand to return to the originating position. You will stay in one spot (not moving progressively as you did on the medial thigh) for 1-5 minutes, or as long as the client is able to tolerate this pressure stretching. By maintaining the same hand position, you may vibrate the area by moving the hand toward the knee and back to the originating position. This portion of the treatment should be done 2-5 times, and will last 5-10 minutes in duration. By the time the 15th treatment arrives, you should see no more muscle/tendon contraction, and the client should be able to resume his normal activity.
The treatment I've outlined here is 15 minutes long, and the client should be seen every other day for the best results. I recommend the client stretch the area by taking the muscles through the above-described motions in order to keep the muscles pliable and injury-free. Catching the groin strain before it is able to do damage to the knees or hips is important in preventing more serious injuries in the future.Zhenya Kurashova Wine has been teaching the Kurashova Method of Russian massage for 12 years in North America, Europe and Asia. For more information about Russian massage, call 800/791-9248.