When a groin strain injury happens, can knowing the symptoms help in the diagnosis, treatment, and recovery times?
Groin Strain Injury
A groin strain is an injury to an inner thigh muscle. A groin pull is a type of muscle strain affecting the adductor muscle group (the muscles help pull the legs apart). (Parisa Sedaghati, et al., 2013) The injury is caused when the muscle is stretched beyond its normal range of motion, creating superficial tears. Severe strains can tear the muscle in two. (Parisa Sedaghati, et al., 2013)
A groin muscle pull causes pain and tenderness that worsens when squeezing the legs together.
There may also be swelling or bruising in the groin or inner thigh.
An uncomplicated groin pull takes four to six weeks to heal with proper treatment. (Andreas Serner, et al., 2020)
Symptoms
A groin pull can be painful, interfering with walking, navigating stairs, and/or driving a car. In addition to pain, other symptoms around the injured area include: (Parisa Sedaghati et al., 2013)
A popping sound or snapping sensation when the injury occurs.
Increased pain when pulling the legs together.
Redness
Swelling
Bruising of the groin or inner thigh.
Groin pulls are graded by severity and how much they impact mobility:
Grade 1
Mild discomfort but not enough to limit activities.
Grade 2
Moderate discomfort with swelling or bruising that limits running and/or jumping.
Grade 3
Severe injury with significant swelling and bruising can cause pain while walking and muscle spasms.
Signs of a severe groin strain
Difficulty walking
Groin pain while sitting or resting
Groin pain at night
A healthcare provider should see severe groin pulls because the muscle may have ruptured or be on the verge of rupturing.
In severe cases, surgery is necessary to reattach the torn ends.
Groin pulls are sometimes accompanied by a stress fracture of the pubis/forward-facing pelvic bones, which can significantly extend healing and recovery time. (Parisa Sedaghati et al., 2013)
Causes
Groin pulls are often experienced by athletes and individuals who play sports where they must stop and change directions quickly, placing excessive strain on the adductor muscles. (Parisa Sedaghati et al., 2013) The risk is increased in individuals who: (T. Sean Lynch et al., 2017)
Have weak hip abductor muscles.
Are not in adequate physical condition.
Have a previous groin or hip injury.
Pulls can also occur from falls or extreme activities without the proper conditioning.
Diagnosis
A healthcare provider will perform a thorough investigation to confirm the diagnosis and characterize the severity. This involves: (Juan C. Suarez et al., 2013)
Medical History Review
This includes any previous injuries and specifics about where and when the symptoms started.
Physical Examination
This involves palpating – lightly touching and pressing the groin region and manipulating the leg to understand better where and how extensive the injury is.
Imaging Studies
Ultrasound or X-rays.
If a muscle rupture or fracture is suspected, an MRI scan may be ordered to visualize soft tissue injuries and stress fractures better.
Differential Diagnosis
Certain conditions can mimic a groin pull and require different treatments. These include: (Juan C. Suarez, et al., 2013)
Sports Hernia
This type of inguinal hernia occurs with sports and work injuries.
It causes a portion of the intestine to pop through a weakened muscle in the groin.
Hip Labral Tear
This is a tear in the cartilage ring of the labrum outside the rim of the hip joint socket.
Hip Osteoarthritis
This is the wear-and-tear form of arthritis that can present with groin pain symptoms.
Osteitis Pubis
This is inflammation of the pubic joint and surrounding structures, usually caused by the overuse of the hip and leg muscles.
Referred Groin Pain
This nerve pain originates in the lower back, often due to a pinched nerve, but is felt in the groin.
Treatment
Beginning treatment is conservative and includes rest, ice application, physical therapy, and prescribed gentle stretching and exercises.
Individuals may need crutches or a walking device to reduce pain and prevent further injury if the pain is significant. (Andreas Serner, et al., 2020)
Physical therapy will be a part of the treatment plan.
Over-the-counter pain medications like Tylenol/acetaminophen or Advil/ibuprofen can help with pain relief short term.
If there is severe pain from a grade 3 injury, prescription medications may be used for a short period to help minimize pain. (Andreas Serner, et al., 2020)
Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. doi.org/10.5812/traumamon.12666
Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic journal of sports medicine, 8(1), 2325967119897247. doi.org/10.1177/2325967119897247
Lynch, T. S., Bedi, A., & Larson, C. M. (2017). Athletic Hip Injuries. The Journal of the American Academy of Orthopaedic Surgeons, 25(4), 269–279. doi.org/10.5435/JAAOS-D-16-00171
Suarez, J. C., Ely, E. E., Mutnal, A. B., Figueroa, N. M., Klika, A. K., Patel, P. D., & Barsoum, W. K. (2013). Comprehensive approach to the evaluation of groin pain. The Journal of the American Academy of Orthopaedic Surgeons, 21(9), 558–570. doi.org/10.5435/JAAOS-21-09-558
Individuals with fixed sagittal imbalance, a condition where the normal curve of the lower spine is greatly reduced or absent altogether that can cause pain and difficulty balancing. Can chiropractic treatment, physical therapy, and exercise help improve the condition?
Fixed Sagittal Imbalance
The condition is commonly known as flat back syndrome and can be present at birth or can happen as a result of surgery or a medical condition.
Individuals with flat back syndrome position their head and neck too far forward.
A major symptom is difficulty standing for long periods of time.
Symptoms
The spine has two curves. The lumbar spine in the lower back and cervical spine in the neck curve inward. The thoracic spine in the upper back curves outward. The curves are part of the spine’s natural alignment. They help the body balance and maintain the center of gravity.
If these curves begin to disappear the body can have trouble and difficulty standing up straight.
The loss of curvature causes the head and neck to pitch forward, making it hard to walk and do regular normal activities.
A chiropractor and/or physical therapist can recommend exercises and other forms of treatment. (Won-Moon Kim, et al., 2021)
Life-Changing Chiropractic Relief
References
Columbia University Irving Medical Center. Flatback syndrome.
National Health Service. Common posture mistakes and fixes.
Lee, B. H., Hyun, S. J., Kim, K. J., Jahng, T. A., Kim, Y. J., & Kim, H. J. (2018). Clinical and Radiological Outcomes of Posterior Vertebral Column Resection for Severe Spinal Deformities. Journal of Korean Neurosurgical Society, 61(2), 251–257. doi.org/10.3340/jkns.2017.0181
Kim, W. M., Seo, Y. G., Park, Y. J., Cho, H. S., & Lee, C. H. (2021). Effect of Different Exercise Types on the Cross-Sectional Area and Lumbar Lordosis Angle in Patients with Flat Back Syndrome. International journal of environmental research and public health, 18(20), 10923. doi.org/10.3390/ijerph182010923
When the body shifts out of homeostasis or when something in the body is out of balance, the body sweats. Sweating is a process known as perspiration that releases salt-based fluids from the body’s sweat glands to help the body stay cool and regulate body temperature. Sweat is commonly found under the arms, on the feet, and on the palms of the hands. Body temperature, outdoor temperature, or emotional state changes can cause sweating.
Sweating
An individual has around 2-4 million sweat glands, which begin to become fully active during puberty. There are two types of sweat glands: eccrine and apocrine. The most common areas of sweating include:
Face.
Armpits.
Palms of the hands.
Soles of the feet.
Sweating in normal amounts is an essential bodily process.
Not sweating enough or sweating too much can cause problems.
Sweat is mostly water but contains small amounts of salt.
Sweat also contains electrolytes and minerals – including potassium, chloride, magnesium, zinc, copper, proteins, urea, and ammonia.
Electrolyte levels need to be replenished after heavy sweating.
Causes
Sweating is normal. However, a variety of causes can stimulate increased sweating.
High Temperature
Elevated body temperature.
Elevated outdoor temperature.
Are the primary cause of increased sweating.
Emotions and stress
Emotions and conditions can also make the body break out in a heavy sweat.
Emotional stress
Anxiety
Anger
Fear
Embarrassment
Foods
Sweating may be a response to certain foods. This type of sweat is known as gustatory sweating, which can be caused by:
Spicy foods
Caffeinated drinks – like soda, coffee, and tea.
Alcoholic beverages.
Medications
Illness and Medications
Sweating may be caused by medication use and certain illnesses:
Individuals can become dehydrated and have an increased risk of heatstroke.
Chiropractic Adjustments
The nervous system coordinates and oversees all functions of the body. Some can be consciously controlled, and others are automatic. The autonomic nervous system– ANS regulates involuntary processes, including blood pressure, heart rate, digestion, respiration, gland function, sweating, etc. The ANS is divided into the sympathetic and parasympathetic systems.
The sympathetic nervous system – when activated, creates a state of elevated activity and attention or the fight or flight response.
This process increases blood pressure and heart rate, preparing the body to respond to various stressors.
The parasympathetic nervous system promotes resting and digesting processes that lower heart rate and blood pressure.
The parasympathetic calms the body.
Chiropractic adjustments have been known to affect the autonomic nervous system. This is achieved by increasing parasympathetic activity/relaxation and down-shifting the sympathetic/fight or flight response and inflammation. A chiropractic adjustment can remove subluxations, which cause interferences in the nervous system. Chiropractic restores and improves the brain and body system communication.
Thoracic Spine Pain
References
Baker, Lindsay B. “Physiology of sweat gland function: The roles of sweating and sweat composition in human health.” Temperature (Austin, Tex.) vol. 6,3 211-259. 17 Jul. 2019, doi:10.1080/23328940.2019.1632145
Cabanac, M. “Temperature regulation.” Annual Review of Physiology vol. 37 (1975): 415-39. doi:10.1146/annurev.ph.37.030175.002215
Cui, Chang-Yi, and David Schlessinger. “Eccrine sweat gland development and sweat secretion.” Experimental dermatology vol. 24,9 (2015): 644-50. doi:10.1111/exd.12773
Kiani, Aysha Karim, et al. “Neurobiological basis of chiropractic manipulative treatment of the spine in the care of major depression.” Acta bio-medica : Atenei Parmensis vol. 91,13-S e2020006. 9 Nov. 2020, doi:10.23750/abm.v91i13-S.10536
McCutcheon, L J, and R J Geor. “Sweating. Fluid and ion losses and replacement.” The Veterinary clinics of North America. Equine practice vol. 14,1 (1998): 75-95. doi:10.1016/s0749-0739(17)30213-4
Orthopedic massage is part of injury rehabilitation that focuses on the muscles and soft tissues surrounding the joints and ligaments. Pain could be caused post-surgery, an acute injury, or overuse/repetitive motion injury from work or sports. The objective is to:
Decrease pain
Release tension
Restore balance
Increase mobility and flexibility
Preparing the body to return to everyday routines and activities.
Whatever the cause of the muscle damage or injury, an orthopedic massage will lengthen and soften the muscles and ligaments, allowing for a better range of motion of the affected joints.
Orthopedic Massage
All massage techniques can improve joint movement and function. Orthopedic massage is specifically designed to return the joints to their normal position function and alleviate pain with movement.
Swedish massage focuses on overall relaxation.
Deep tissue massage reduces deep muscle pain and strain.
Orthopedic massage therapists have an extensive understanding of anatomy, soft tissues, and misalignment of the musculoskeletal system that can cause pain and injury. It is similar to sports massage targeting damaged areas for recovery and rehabilitation from conditions and injuries. Sports massage helps the individual strengthen and retrain the damaged areas back to optimal performance and prevent injury. Orthopedic massage utilizes:
Massage benefits many symptoms and conditions. It has been shown to help with:
Sprains
Pulled muscles
Torn ligaments
Carpal-tunnel syndrome
Frozen shoulder
Tennis elbow
Tendinitis
Sciatica
Bulging discs
Post-surgery
Techniques
A therapist will look at the range of motion, flexibility, and rotation of the tissues. This will help determine what muscle groups and tendons are involved and which techniques to use. Massage therapists use an assortment of approaches to loosen muscles and tendons. These include:
Active Engagement
This is used to reach deep, hard-to-reach muscles by applying pressure and massaging lengthwise in a perpendicular motion.
It is beneficial for whiplash and/or back pain.
Positional Release
This is a gentle treatment for inflamed muscles and tissues highly sensitive to other techniques.
Soft tissues are manipulated into comfortable positions and held in place for a specific time.
This lengthens and softens tissues to bring pain relief.
Nerve Mobilization
Also known as neural mobilization, this method addresses strained nerves and pain sources.
Muscle Energy Release
The therapist provides resistance while the individual voluntarily contracts muscles.
Effective with low back pain.
Trigger Point Therapy
Pressure intervals are held on trigger areas to release lactic acid and promote circulation.
Myofascial Release
Gentle pressure is applied to stretch fascia tissues.
Body Composition
Brittle Bones
The reason bones become weaker is that bone tissue is living tissue that constantly forms new bone material and absorbs the old bone material. As the body ages, the rate at which bone is reabsorbed becomes faster than newly formed bone material. One reason for rapid bone loss is lack of exercise and physical activity. The Mayo Clinic has stated that individuals that spend a great deal of time sitting, whether at home or work, have an increased risk of osteoporosis than more active individuals. Sitting too much with little to no activity can lead to weakened bones. Just like the muscles, bones get stronger when they are in use. Walking, running, jumping, and getting the body moving along with using some resistance, can increase the strength and durability of the bones.
References
Kim, Seung-Kook et al. “Clinical outcomes and cost-effectiveness of massage chair therapy versus basic physiotherapy in lower back pain patients: A randomized controlled trial.” Medicine vol. 99,12 (2020): e19514. doi:10.1097/MD.0000000000019514
Klein, Ifat et al. “Lymphatic treatments after orthopedic surgery or injury: A systematic review.” Journal of bodywork and movement therapies vol. 24,4 (2020): 109-117. doi:10.1016/j.jbmt.2020.06.034
Loew, Laurianne M et al. “Deep, transverse friction massage for treating lateral elbow or lateral knee tendinitis.” The Cochrane database of systematic reviews vol. 2014,11 CD003528. 8 Nov. 2014, doi:10.1002/14651858.CD003528.pub2
Majewski-Schrage, Tricia, and Kelli Snyder. “The Effectiveness of Manual Lymphatic Drainage in Patients With Orthopedic Injuries.” Journal of sport rehabilitation vol. 25,1 (2016): 91-7. doi:10.1123/jsr.2014-0222
Taking it slow after spinal surgery is recommended to optimize a full recovery. What usually happens is that an individual starts feeling normal/better, so they begin to engage in a few daily activities. Then pain presents, letting the individual know that they have done too much too soon. The pain does not necessarily signal re-injuring the area, but recovery should be treated seriously. More than 50% of patients have successful spine surgery, but repeat surgeries do not tend to be quite as effective. Doing too much too early during recovery can result in severe re-injury or creating new injuries. So when can an individual get back to everyday life?
Surgery Recovery
Recovery after back surgery is different for everyone. Low back lumbar fusion surgeries usually require more recovery time than lumbar non-fusion surgeries, like:
Laminectomy – when the lamina portion of a vertebra is removed.
Microdiscectomy – the removal of abnormal disc material
Cervical spine surgeries.
Individuals who have undergone a procedure where two or more vertebrae have been surgically fused should expect a longer recovery. A typical timeline for lumbar fusion usually involves around three months. What happens is individuals want to get up and move, doing household activities almost immediately because they feel so good, but this is because of the pain medications. Strong pain medication use ends by four to six weeks. It is not until after 12 weeks or three months with post-operative chiropractic rehabilitation and physical therapy that individuals are encouraged to engage in specific physical activities that will optimize the healing process.
Taking It Slow With Certain Activities
Specific activities should not be engaged in after lumbar fusion surgery, as it requires a higher level of caution during recovery.
No Bending, Lifting, and Twisting
Bending, lifting, and twisting all require the direct use of the back muscles. Performing these movements can cause serious damage and hinder proper healing. Therefore it is recommended not to bend, lift, or twist for six weeks.
No Taking Baths or Swimming
Taking showers can be done right away with protective plastic or a sponge bath for a few days after surgery, but it is advised not to take baths or go swimming for three weeks.
No Cardiovascular Exercise
While the back may be feeling better after the spine surgery, cardiovascular exercise is not recommended for at least six to 12 weeks as it is too strenuous on the back. Light walking is fine, but the doctor and a chiropractor and physical therapist will develop a controlled, progressive exercise program for the individual. The program usually starts between 6 weeks and three months after surgery. This can include working out on an elliptical machine, a stationary bike, or easy treadmill walking.
Listening to The Body
The doctor will be clear about what can and can’t be done immediately following back surgery. Therefore it is crucial to follow the instructions to avoid any complications and listen to the body. Don’t push through activity or try taking on too much. Give the body and spine time to heal, taking it slow. There is time to get back to normal activities, but if re-injury or new injuries occur, rehabilitation/recovery could become the regular activity.
Body Composition
Malnutrition
Malnutrition is defined as deficiencies, excesses, or imbalances in an individual’s energy intake and/or nutrients. Protein-energy deficiency is one of the most common forms of malnutrition, and this health condition has an immediate and negative impact on body composition. The deficit wreaks havoc on skeletal muscle mass as the body progressively goes into starvation mode, breaking down the protein stored in the muscle for fuel.
Micronutrient deficiency is a lack of minerals and vitamins that support vital bodily processes like cell regeneration, immune system health, and eyesight. Common examples include iron or calcium deficiencies. Micronutrient deficiency has the most significant impact on normal physiological functions, processes and can happen in conjunction with a lack of protein-energy. This is because most micronutrients are obtained from food. Nutritional deficiencies of specific micronutrients can affect processes like building and repairing muscle; protein deficiency has a more pronounced effect on body composition because lowered protein intake can lead to muscle mass loss. Malnutrition and nutritional deficiencies in adults include:
Physical function, including handgrip strength and physical performance, diminishes.
Serious medical conditions can result from fluid accumulation like edema.
References
Daniell, James R, and Orso L Osti. “Failed Back Surgery Syndrome: A Review Article.” Asian spine journal vol. 12,2 (2018): 372-379. doi:10.4184/asj.2018.12.2.372
Individuals don’t like to read the warning signs of their spinal health, saying to themselves the pain will go away. Individuals will feel their back seize up or sting for a moment and then goes back to normal. The body is doing its job to warn you that something is not right. This is where choices come into play:
Ignore the warning because the tingling or pain went away.
Pay attention to the warning before more damage is done.
This is where waiting, hoping that it will resolve on its own, is not recommended. This is because something did happen but did not fully present, like a loose part that is still functioning. However, time, movement, or action, can throw the body off balance and create all kinds of health issues.
Paying attention to the Warning Signs
The body is always adapting to the internal and external environments. For example, external adaptation is sweating during a hot summer day. The body adapts to the heat by sweating to cool down and bring down the temperature. An example of internal adaptation is the spine has been slowly shifting out of alignment. The muscles that support the spine have been adapting to this shifting. However, it is not the ideal adaptation situation as some muscles over/under stretch while others under/over-contract to compensate, causing pain. The body gets stressed out physically, with possible damage occurring. This is where an individual knows something is not right and needs to listen to their body.
The Impact
A spine that is misaligned/subluxated does not move properly or function correctly. Improper movement damages the spinal:
Bones
Discs
Cord
Nerves
The spinal cord and nerves transmit and receive all the vital information the body needs to function. These include:
Heart function
Intestinal function
Lung function
A misaligned spine can hurt or cause symptoms for a split second. The effects of an untreated misaligned spine can affect an individual for life. If you have experienced any of these or other warning signs, contact a chiropractor. Injury Medical Chiropractic and Functional Medicine Clinic will help assess your symptoms and develop a personalized treatment plan.
Body Composition
Work On Goals One at A Time
To reach goals faster, it’s best to target one goal at a time. How to decide which goal to begin with:
Fat Loss First
This goal is best for individuals whose body compositions have a high body fat percentage and high overall weight.
Lean Body Mass First
Individuals may want to begin by increasing Lean Body Mass if they are skinny fat. Skinny fat means the individual is not overweight but has low amounts of Lean Body Mass and high amounts of Fat Mass.
Resistance training to build muscle will likely bring down Fat Mass as well. Increasing Lean Body Mass will increase the calorie needed by the body to maintain itself. This increased calorie need can lead to the body acquiring energy by burning extra fat. The calories burned in resistance training also speed up fat loss. Everyone is different in how the body responds to programs targeting fat and those designed to build muscle. Consult with our health coach, nutritionist, and fitness chiropractic team with any questions you may have.
Flynn, Diane M. “Chronic Musculoskeletal Pain: Nonpharmacologic, Noninvasive Treatments.” American family physician vol. 102,8 (2020): 465-477.
Sanzarello, Ilaria et al. “Central sensitization in chronic low back pain: A narrative review.” Journal of back and musculoskeletal rehabilitation vol. 29,4 (2016): 625-633. doi:10.3233/BMR-160685
Summer footwear, although light and comfortable can lead to low back pain. Individuals with low back pain conditions/issues should opt for custom flip-flops or sandals. A few tips on how to choose the right summer footwear and avoid back pain. With the temperature going up we’re all ready to take out the shorts, t-shirts, and flip-flops or sandals. That’s when back pain can flare-up.
There are a variety of things that can generate back pain like improper posture, muscle spasms, and various medical issues. However, everyday shoe choices can also impact the spine and cause back pain. NCBI studies backed by podiatrists have found that unstable shoes, e.g., cheap flip-flops, and sandals can cause low back pain. �
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Improper footwear allows biomechanical abnormalities affecting the feet to be compounded and worsened. This leads to increased pain in the knees, hips, and lower back. Accurately fitted shoes and orthotics are some of the best footwear for lower back pain. While flip-flops and sandals unless they are orthotic based offer little to no support.
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Summer Footwear Back Pain
Like any type of mechanical system, if there is something wrong in one area, other problem issues begin to arise in other areas. It is the same with the body. If there is an issue with the feet it can affect the knees and hips, rising up to the spine causing back pain.
Summer shoes can worsen any of these underlying issues that often individuals don’t even know they had until they see a doctor for their back pain. This usually begins with the foot type. Those with flat feet tend to force the muscles and tendons in the feet to work more leading to tendinitis.
Arches that have fallen or droppedand remain unsupported can lead to arthritis development in the knees and the wearing down of the medial meniscus. Knees that do not function properly place added stress on the hips and lower back. This can lead to disc degeneration of the intervertebral discs. �
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Foot Arch Type
Anatomical anomalies like fallen arches/flat feet and high arches can cause back pain differently. Hyperpronation happens in flat feet causing the arches to collapse. This places more pressure on the inside of the legs and knees, which creates more imbalance in the hips and low back. �
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Hyper supination happens in high-arched feet causing the arches to rise. This places the pressure on the outside of the legs and knees, leading to muscle imbalances on the outside of the legs along with the hips and low back. Wearing unsupportive shoes like flip-flops, sandals, and heels for a long time, can cause back pain or make an existing condition worse. �
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Either flat feet or high-arched feet left untreated can lead to long-term injuries and extended/over wear and tear of the spine’s vertebrae and intervertebral discs. Summer footwear choices can influence discomfort and back pain.
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The Right Shoes
Summer footwear that doesn’t generate back pain doesn’t mean that you have to throw out the flip-flops. Look for shoes or flip-flops that are highly durable, sturdy, that don’t bend in the middle, and only at the toes.
For those with flat feet look for sufficient arch support to prevent hyperpronation. Pay attention to the details of the shoes/flip-flops/sandals. For example, added cushion, or ankle support could mean the difference between pain and relief. There are sandals that have ankle straps to keep the feet in place. This prevents the feet from slipping out, provides better stability during walks, and can help prevent tendinitis. �
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It is better to avoid anything with a heel, especially sandals or flip-flops that have a heel/high lift. These force the individual to shift their center of gravity forwardforcing the arching of the spine when standing. This position definitely contributes to back pain.
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Customized Footwear
Customized flip-flops or sandals that won�t cause any back pain are available with the help of a podiatrist or a chiropractor that helps and works with podiatrists. 3D-scans can be done to make fully-customized flip-flops that support the arches based on the scan. �
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Excessive Foot Pronation and Custom Foot Orthotics
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The scope of our information is limited to chiropractic, musculoskeletal, physical medicines, wellness, and sensitive health issues and/or functional medicine articles, topics, and discussions. We use functional health & wellness protocols to treat and support care for injuries or disorders of the musculoskeletal system. Our posts, topics, subjects, and insights cover clinical matters, issues, and topics that relate and support directly or indirectly our clinical scope of practice.*
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