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. https://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. https://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. https://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. https://doi.org/10.5435/JAAOS-21-09-558
Athletes and physically active individuals who participate in activities, exercises, and sports that involve kicking, pivoting, and/or shifting directions can develop pelvis overuse injury of the pubic symphysis/joint at the front of the pelvis known as osteitis pubis. Can recognizing the symptoms and causes help in treatment and prevention?
Osteitis Pubis Injury
Osteitis pubis is the inflammation of the joint that connects the pelvic bones, called the pelvic symphysis, and the structures around it. The pubic symphysis is a joint in front of and below the bladder. It holds the two sides of the pelvis together in the front. The pubis symphysis has very little motion, but when abnormal or continued stress is placed on the joint, groin and pelvic pain can present. An osteitis pubis injury is a common overuse injury in physically active individuals and athletes but can also occur as the result of physical trauma, pregnancy, and/or childbirth.
Symptoms
The most common symptom is pain over the front of the pelvis. The pain is most often felt in the center, but one side may be more painful than the other. The pain typically radiates/spreads outward. Other signs and symptoms include: (Patrick Gomella, Patrick Mufarrij. 2017)
Lower abdominal pain in the center of the pelvis
Limping
Hip and/or leg weakness
Difficulty climbing stairs
Pain when walking, running, and/or shifting directions
Clicking or popping sounds with movement or when shifting directions
Pain when lying down on the side
Pain when sneezing or coughing
Osteitis pubis can be confused with other injuries, including a groin strain/groin pull, a direct inguinal hernia, ilioinguinal neuralgia, or a pelvic stress fracture.
Causes
An osteitis pubis injury usually occurs when the symphysis joint is exposed to excessive, continued, directional stress and overuse of the hip and leg muscles. Causes include: (Patrick Gomella, Patrick Mufarrij. 2017)
Sports activities
Exercising
Pregnancy and childbirth
Pelvic injury like a severe fall
Diagnosis
The injury is diagnosed based on a physical examination and imaging tests. Other tests may be used to rule out other possible causes.
The physical exam will involve manipulation of the hip to place tension on the rectus abdominis trunk muscle and adductor thigh muscle groups.
Pain during the manipulation is a common sign of the condition.
Individuals may be asked to walk to look for irregularities in gait patterns or to see if symptoms occur with certain movements.
X-rays will typically reveal joint irregularities as well as sclerosis/thickening of the pubic symphysis.
Magnetic resonance imaging – MRI may reveal joint and surrounding bone inflammation.
Some cases will show no signs of injury on an X-ray or MRI.
Treatment
Effective treatment can take several months or longer. Because inflammation is the underlying cause of symptoms, the treatment will often involve: (Tricia Beatty. 2012)
Rest
Allows the acute inflammation to subside.
During recovery, sleeping flat on the back may be recommended to reduce pain.
Ice and Heat Applications
Ice packs help reduce inflammation.
The heat helps ease pain after the initial swelling has gone down.
Physical Therapy
Physical therapy can be extremely helpful in treating the condition to help regain strength and flexibility. (Alessio Giai Via, et al., 2019)
Anti-inflammatory Medication
Over-the-counter nonsteroidal anti-inflammatory medications – NSAIDs like ibuprofen and naproxen can reduce pain and inflammation.
Assistive Walking Devices
If the symptoms are severe, crutches or a cane may be recommended to reduce stress on the pelvis.
Cortisone
There have been attempts to treat the condition with cortisone injections, but the evidence supporting its use is limited and needs further research. (Alessio Giai Via, et al., 2019)
Prognosis
Once diagnosed, the prognosis for full recovery is optimal but can take time. It can take some individuals six months or more to return to pre-injury level of function, but most return by around three months. If conservative treatment fails to provide relief after six months, surgery could be recommended. (Michael Dirkx, Christopher Vitale. 2023)
Sports Injuries Rehabilitation
References
Gomella, P., & Mufarrij, P. (2017). Osteitis pubis: A rare cause of suprapubic pain. Reviews in urology, 19(3), 156–163. https://doi.org/10.3909/riu0767
Beatty T. (2012). Osteitis pubis in athletes. Current sports medicine reports, 11(2), 96–98. https://doi.org/10.1249/JSR.0b013e318249c32b
Via, A. G., Frizziero, A., Finotti, P., Oliva, F., Randelli, F., & Maffulli, N. (2018). Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature. Open access journal of sports medicine, 10, 1–10. https://doi.org/10.2147/OAJSM.S155077
Dirkx M, Vitale C. Osteitis Pubis. [Updated 2022 Dec 11]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK556168/
For individuals suffering from allergies, could using acupuncture help relieve and manage symptoms?
Acupuncture Can Help With Allergies
Acupuncture is becoming a more respected alternative treatment for various medical issues, from anxiety to fibromyalgia to weight loss. There is evidence that acupuncture can help with allergies by alleviating symptoms and improving the quality of life. (Shaoyan Feng, et al., 2015) The American Academy of Otolaryngology-Head and Neck Surgery Foundation recommends doctors offer acupuncture to patients looking for nonpharmacological treatments for their allergies or refer them to an acupuncturist. (Michael D. Seidman, et al., 2015)
Acupuncture
Acupuncture is a traditional Chinese medicine/TCM practice in which extremely thin needles are inserted into the body at specific points, creating a network of energy pathways known as meridians.
These pathways circulate vital life energy/chi or qi.
Each meridian is associated with a different body system.
Needles are placed to target the organs associated with the condition being treated.
Acupuncture can help with allergies by targeting several meridians, including the lungs, colon, stomach, and spleen. These meridians are believed to circulate defensive life energy or a type of immunity energy.
A backup of defensive energy or a deficiency can cause allergy symptoms like swelling, watery eyes, runny nose, sneezing, allergic eczema, and conjunctivitis. (Bettina Hauswald, Yury M. Yarin. 2014)
The objective is to stimulate the points to restore balance in the energies and relieve symptoms.
Scientific Theories
One theory is the needles work directly on nerve fibers, influencing messages to the brain or the autonomic nervous system and transmission of signals within the body, including the immune system. (Tony Y. Chon, Mark C. Lee. 2013)
Another is the needles influence certain activities of cells, particularly the transport, breakdown, and clearance of bioactive mediators.
The combination of these actions is thought to decrease inflammatory conditions like allergic rhinitis – hay fever, in which the inside of the nose becomes inflamed and swollen after breathing in an allergen. (Bettina Hauswald, Yury M. Yarin. 2014)
A 2015 review concluded there have been high-quality randomized controlled trials demonstrating acupuncture’s efficacy in treating seasonal and perennial allergic rhinitis. Smaller studies have shown some preliminary benefits of acupuncture when compared with antihistamines, but more research is needed. (Malcolm B. Taw, et al., 2015)
Treating Allergies
Some individuals who choose acupuncture are seeking alternatives to standard treatment like medications, nasal sprays, and immunotherapy.
Others are looking for ways to enhance the effectiveness of medications already being taken, such as antihistamines or nasal sprays, or shorten how long or how frequently they are needed.
Initial treatment usually involves weekly or twice-weekly appointments over several weeks or months, depending on symptom severity.
Improperly administered acupuncture needles can cause serious side effects that range from infections, punctured organs, collapsed lungs, and injury to the central nervous system. (National Center for Complementary and Integrative Health. 2022) Before trying acupuncture, consult your primary healthcare provider, allergist, or integrative medicine specialist to make sure it’s a safe and viable option and the best way to integrate it into overall allergy care.
Fighting Inflammation Naturally
References
Feng, S., Han, M., Fan, Y., Yang, G., Liao, Z., Liao, W., & Li, H. (2015). Acupuncture for the treatment of allergic rhinitis: a systematic review and meta-analysis. American journal of rhinology & allergy, 29(1), 57–62. https://doi.org/10.2500/ajra.2015.29.4116
Seidman, M. D., Gurgel, R. K., Lin, S. Y., Schwartz, S. R., Baroody, F. M., Bonner, J. R., Dawson, D. E., Dykewicz, M. S., Hackell, J. M., Han, J. K., Ishman, S. L., Krouse, H. J., Malekzadeh, S., Mims, J. W., Omole, F. S., Reddy, W. D., Wallace, D. V., Walsh, S. A., Warren, B. E., Wilson, M. N., … Guideline Otolaryngology Development Group. AAO-HNSF (2015). Clinical practice guideline: Allergic rhinitis. Otolaryngology–head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery, 152(1 Suppl), S1–S43. https://doi.org/10.1177/0194599814561600
Hauswald, B., & Yarin, Y. M. (2014). Acupuncture in allergic rhinitis: A Mini-Review. Allergo journal international, 23(4), 115–119. https://doi.org/10.1007/s40629-014-0015-3
Chon, T. Y., & Lee, M. C. (2013). Acupuncture. Mayo Clinic proceedings, 88(10), 1141–1146. https://doi.org/10.1016/j.mayocp.2013.06.009
Taw, M. B., Reddy, W. D., Omole, F. S., & Seidman, M. D. (2015). Acupuncture and allergic rhinitis. Current opinion in otolaryngology & head and neck surgery, 23(3), 216–220. https://doi.org/10.1097/MOO.0000000000000161
Individuals with digestive problems that cannot be diagnosed could be experiencing functional gastrointestinal disorders. Could understanding the types help in developing effective treatment plans?
Functional Gastrointestinal Disorders
Functional gastrointestinal disorders, or FGDs, are disorders of the digestive system in which the presence of structural or tissue abnormality cannot explain symptoms. Functional gastrointestinal disorders lack identifiable biomarkers and are diagnosed based on symptoms. (Christopher J. Black, et al., 2020)
Rome Criteria
FGDs used diagnoses of exclusion, meaning that they could only be diagnosed after organic/identifiable disease was ruled out. However, in 1988, a group of researchers and healthcare providers met to devise strict criteria for the diagnosis of the various types of FGDs. The criteria is known as the Rome Criteria. (Max J. Schmulson, Douglas A. Drossman. 2017)
Vomiting and Aerophagia – cyclic vomiting syndrome, adolescent rumination syndrome, and aerophagia
Abdominal Pain-Related Functional GI Disorders include:
functional dyspepsia
IBS
Abdominal migraine
Childhood functional abdominal pain
Childhood functional abdominal pain syndrome
Constipation – functional constipation
Incontinence – nonretentive fecal incontinence
Diagnosis
Although the Rome criteria allow the diagnosis of FGDs to be symptom-based, a healthcare provider may still run standard diagnostic tests to rule out other diseases or look for structural problems resulting in symptoms.
Treatment
Although no visible signs of disease or structural problems may be identified as causing the symptoms, it does not mean that they are not treatable and manageable. For individuals who suspect they may have or have been diagnosed with a functional gastrointestinal disorder, it will be essential to work with a healthcare provider on a working treatment plan. Treatment options can include: (Asma Fikree, Peter Byrne. 2021)
Physical therapy
Nutritional and dietary adjustments
Stress management
Psychotherapy
Medication
Biofeedback
Eating Right To Feel Better
References
Black, C. J., Drossman, D. A., Talley, N. J., Ruddy, J., & Ford, A. C. (2020). Functional gastrointestinal disorders: advances in understanding and management. Lancet (London, England), 396(10263), 1664–1674. https://doi.org/10.1016/S0140-6736(20)32115-2
Schmulson, M. J., & Drossman, D. A. (2017). What Is New in Rome IV. Journal of neurogastroenterology and motility, 23(2), 151–163. https://doi.org/10.5056/jnm16214
Sperber, A. D., Bangdiwala, S. I., Drossman, D. A., Ghoshal, U. C., Simren, M., Tack, J., Whitehead, W. E., Dumitrascu, D. L., Fang, X., Fukudo, S., Kellow, J., Okeke, E., Quigley, E. M. M., Schmulson, M., Whorwell, P., Archampong, T., Adibi, P., Andresen, V., Benninga, M. A., Bonaz, B., … Palsson, O. S. (2021). Worldwide Prevalence and Burden of Functional Gastrointestinal Disorders, Results of Rome Foundation Global Study. Gastroenterology, 160(1), 99–114.e3. https://doi.org/10.1053/j.gastro.2020.04.014
Hyams, J. S., Di Lorenzo, C., Saps, M., Shulman, R. J., Staiano, A., & van Tilburg, M. (2016). Functional Disorders: Children and Adolescents. Gastroenterology, S0016-5085(16)00181-5. Advance online publication. https://doi.org/10.1053/j.gastro.2016.02.015
Fikree, A., & Byrne, P. (2021). Management of functional gastrointestinal disorders. Clinical medicine (London, England), 21(1), 44–52. https://doi.org/10.7861/clinmed.2020-0980
For individuals trying to achieve healthy posture, could using posture awareness training be effective in treatment and prevention?
Posture Awareness
Spinal curves help support the body’s weight, movement, and balance. Five areas include the neck, upper back, lower back, sacrum, and coccyx. The bottom of the spine or sacrum rests between the two hip bones that comprise the pelvis. Because of this location, the movements made with the pelvis significantly affect the spine. (Ibrahim Alkatout, et al., 2021) When the pelvis moves, the spine moves.
Posture-related back pain and associated symptoms are often caused by a weakened strength and flexibility ratio between the opposing muscle groups that hold the body upright.
Achieving healthy posture requires technique and consistent practice for maintaining a healthy pelvis and low back curve. (DeokJu Kim, et al., 2015)
Finding the low back curve and exploring how it responds when moving the pelvis is important to effective posture awareness training.
Kim, D., Cho, M., Park, Y., & Yang, Y. (2015). Effect of an exercise program for posture correction on musculoskeletal pain. Journal of physical therapy science, 27(6), 1791–1794. https://doi.org/10.1589/jpts.27.1791
Alkatout, I., Wedel, T., Pape, J., Possover, M., & Dhanawat, J. (2021). Review: Pelvic nerves - from anatomy and physiology to clinical applications. Translational neuroscience, 12(1), 362–378. https://doi.org/10.1515/tnsci-2020-0184
Żurawski, A. Ł., Kiebzak, W. P., Kowalski, I. M., Śliwiński, G., & Śliwiński, Z. (2020). Evaluation of the association between postural control and sagittal curvature of the spine. PloS one, 15(10), e0241228. https://doi.org/10.1371/journal.pone.0241228
Zemková, E., & Zapletalová, L. (2021). Back Problems: Pros and Cons of Core Strengthening Exercises as a Part of Athlete Training. International journal of environmental research and public health, 18(10), 5400. https://doi.org/10.3390/ijerph18105400
For women experiencing lower back and pelvic pain, could understanding symptoms help in the diagnostic process, treatment options, and prevention?
Low Back and Pelvic Pain In Women
In women, lower back and hip pain that radiates to the front pelvis area can have a variety of causes. The pain can feel dull, sharp, or burning. The main causes of lower back and pelvic pain in women fall into two categories. (William S. Richardson, et al., 2009)
Musculoskeletal and nervous system
Related causes of pain affect how your muscles, nerves, ligaments, joints, and bones move.
Examples include sciatica, arthritis, and injury.
Other organ system-based
Causes may stem from the following:
Acute/chronic conditions or infections
Kidneys – stones, infection, and other ailments or conditions.
Reproductive system – such as the ovaries.
Gastrointestinal system – inguinal hernias or appendix.
Musculoskeletal and Nervous System Causes
Musculoskeletal and nervous system-related causes can be from injuries like a fall or practicing unhealthy posture.
Overuse Injuries and Trauma
Frequent use and repetitive movements can lead to overuse injuries to the muscles, ligaments, and joints. :
Exercises, sports, and physical activities that require repetitive twisting and bending.
Lifting, carrying, and placing objects that require movements that are repeated regularly.
Trauma from vehicle collisions, accidents, falls, or sports accidents can inflict acute and chronic bodily injuries, like strained muscles or broken bones.
Depending on the type of trauma, healing and recovery time and treatment vary.
Both types of injuries can lead to numbness, tingling, pain, stiffness, popping sensations, and/or weakness in the legs.
Mobility Problems
Over time, a decreased range of motion and mobility in muscles and joints can cause discomfort and pain. Causes include:
Long periods of time spent in the same position.
Sitting for extended periods.
The pain often feels dull, achy, and stiff.
It can also lead to muscle spasms characterized by quick episodes of sharp and intense pain.
Posture
Posture while sitting, standing, and walking affects the body’s range of motion.
It can affect the nerves and blood circulation to the back and pelvic region.
Prolonged unhealthy postures can contribute to lower back pain and muscle strain.
Posture-related symptoms can feel achy and stiff and lead to quick episodes of severe or intense pain, depending on the position.
Sciatica and Nerve Compression
A bulging or herniating vertebral disc most commonly causes sciatica and pinched or compressed nerves.
The sensations can be sharp, burning, electrical, and/or radiating pain along the nerve pathway.
Arthritis
Arthritis inflammation causes swelling, stiffness, pain, and the breakdown of cartilage that cushions the joints.
Hip arthritis causes groin pain that can radiate to the back and becomes more intense when standing or walking.
Thoracic and lumbar spine arthritis, or degenerative disc disease, are other common causes of back pain.
Sacroiliac Joint Dysfunction
The sacroiliac joints connect the lower spine and pelvis.
When these joints move too much or too little, it can cause sacroiliac joint pain, leading to a burning sensation in the lower back and pelvic area. (Daisuke Kurosawa, Eiichi Murakami, Toshimi Aizawa. 2017)
Renal and Urinary Causes
Kidney Stones
Kidney stones are the build-up of minerals and salts, which form into hard stones in the kidneys.
When the kidney stone begins to move to the bladder, pain symptoms will present.
It can trigger severe back and side pain that radiates to the pelvic region.
Other symptoms include – a change in urine color, pain when urinating, nausea, and vomiting.
Kidney Infection and Urinary Tract Infections
Urinary tract and kidney infections are also causes of lower back and pelvic pain in women.
They cause fever, continued urge to urinate, and painful urination.
Gynecological Causes
Pelvic Inflammatory Disease
Infections, known as pelvic inflammatory disease, occur when sexually transmitted bacteria spread through the vagina, womb, fallopian tubes, or ovaries. Symptoms include:
Pain during intercourse.
Bleeding between periods.
Vaginal discharge.
Pain in the lower abdomen or groin.
Fever.
Ovarian Cysts
The cyst can be a solid or fluid-filled sac on the surface or within an ovary.
Small ovarian cysts are unlikely to cause pain.
Large cysts or those that rupture can cause mild to severe pain.
The pain can occur during menstruation or intercourse and present acutely in the back, pelvis, or lower abdomen.
During Pregnancy
Back pain and discomfort in the pelvis area are common.
As the body adjusts, the bones and round ligaments in the pelvis move and stretch, which can cause discomfort.
Symptoms are usually normal but should be discussed with a healthcare provider during check-ups.
Pain in the lower back and groin can be a sign of miscarriage or labor – including preterm labor.
Sexually Transmitted Infection
Sexually transmitted infections, like chlamydia or gonorrhea, can cause lower back and groin pain.
Other symptoms can include – painful urination, vaginal discharge, intercourse pain, and bleeding between periods.
Yeast Infection
A yeast infection – overgrowth of the fungus candidiasis.
A common vaginal infection with symptoms including – itching, swelling, irritation, and pelvic pain.
Other Causes
Appendicitis
When the appendix becomes blocked, infected, and inflamed.
In most cases, a major symptom is pain that starts near or around the belly button.
In other cases, it can start in the lower back and radiate to the right side of the pelvic area. (Johns Hopkins Medicine. 2023)
Associated pain can worsen over time or when coughing, moving, or taking deep breaths.
It involves soft tissue and part of the intestine, pushing through weak groin muscles.
Pain presents in the abdomen, lower back, or pelvis, especially when bending or lifting objects.
Pancreatitis
Inflammation in the pancreas.
Infection, bile stones, or alcohol can cause it.
One symptom is abdominal pain that radiates to the back.
The pain becomes worse during and after eating.
Other symptoms include nausea, vomiting, and fever.
Enlarged Lymph Nodes
Lymph nodes lie in the internal and external regions of the iliac artery in the pelvis.
These can become enlarged by infection, injury, and, in rare cases, cancer.
Symptoms include pain, swelling, redness, skin irritation, and fever.
Enlarged Spleen
The spleen is located behind the left side of the rib cage.
It filters the blood and supports new blood cell creation.
Infections and diseases can cause the spleen to become enlarged.
An enlarged spleen – a condition known as splenomegaly – causes pain in the upper left part of the belly and sometimes the left shoulder and upper back.
However, some individuals with an enlarged spleen experience abdominal symptoms – not being able to eat without discomfort. (Mount Sinai. 2023)
Diagnosis
Depending on the cause of your pain, a healthcare provider may be able to diagnose it with a physical exam and by asking questions about your condition.
Other tests may be needed to find the cause, particularly blood work and imaging (X-ray or magnetic resonance imaging).
Treatment
Treatment of symptoms depends on the cause.
Once a diagnosis is made, an effective treatment plan will be developed and contain a combination of therapies:
Lifestyle Adjustments
For injuries caused by muscle strains, joint sprains, overuse, and smaller traumas, pain can be resolved with:
Rest
Ice therapy
Over-the-counter pain relievers – acetaminophen or ibuprofen.
Braces or compression wraps can help support the body and alleviate symptoms during healing and recovery.
Exercises to improve posture
Paying attention to form when lifting objects
Stretching can help ease the pain.
Medication
Medications can be used in a variety of ways to help in the treatment of lower back and pelvic pain. If an infection is the cause, medications will be prescribed to remove the infection and resolve the symptoms, which can include:
Antibiotics
Antifungals
Antivirals
Medications may also be prescribed to help manage pain symptoms and may include:
Medication to relieve nerve pain
Muscle relaxants
Steroids
Physical Therapy
A physical therapist can help to correct problems with:
Posture
Decreased mobility
Walking gait
Strengthening
A physical therapist will provide exercises to help increase and maintain strength, range of motion, and flexibility.
Pelvic Floor Therapy
This is physical therapy that focuses on the muscles, ligaments, and connective tissues in the pelvis.
It helps with pain, weakness, and dysfunction in the pelvic area.
A treatment plan will be developed to help with strength and range of motion in the pelvic muscles.
Chiropractic Care
Chiropractors offer spinal and hip adjustments to realign the joints of the spine.
Some more severe conditions could require surgery.
Ovarian cysts, hernias, and other infections sometimes require surgery to remove infected or unhealthy tissue – ruptured ovarian cysts or appendicitis.
Recommended surgeries can include:
A hernia repair.
Hip replacement.
Gallbladder removal to prevent recurring pancreatitis.
Prevention
Not all conditions and diseases cause lower back and pelvic pain. Symptoms can be prevented and reduced by adopting lifestyle changes. Prevention recommendations can include:
Staying hydrated.
Using proper bending and lifting techniques.
Eating healthy foods.
Regularly engaging in some form of physical activity – walking, swimming, yoga, cycling, or strength training.
Maintaining a healthy weight.
Pregnancy and Sciatica
References
Richardson, W. S., Jones, D. G., Winters, J. C., & McQueen, M. A. (2009). The treatment of inguinal pain. Ochsner journal, 9(1), 11–13.
Kurosawa, D., Murakami, E., & Aizawa, T. (2017). Groin pain associated with sacroiliac joint dysfunction and lumbar disorders. Clinical neurology and neurosurgery, 161, 104–109. https://doi.org/10.1016/j.clineuro.2017.08.018
Santilli, V., Beghi, E., & Finucci, S. (2006). Chiropractic manipulation in the treatment of acute back pain and sciatica with disc protrusion: a randomized double-blind clinical trial of active and simulated spinal manipulations. The spine journal : official journal of the North American Spine Society, 6(2), 131–137. https://doi.org/10.1016/j.spinee.2005.08.001
Individuals who have gone through recent low back surgery, like a lumbar laminectomy and discectomy, could they benefit from physical therapy for full recovery? (Johns Hopkins Medicine. 2008)
Rehabilitation Exercise Program
A lumbar laminectomy and discectomy is a surgical procedure performed by an orthopedic or neurologic surgeon to help decrease pain, relieve associated symptoms and sensations, and improve flexibility and mobility. The procedure involves cutting away disc and bone material that presses against, irritates, and damages the spinal nerves. (Johns Hopkins Medicine. 2023)
Post-Surgery
The therapist will work with the individual to develop a rehabilitation exercise program. The objective of a rehabilitation exercise program is to help the individual:
Relax their muscles to prevent muscle tensing and becoming over-cautious
Regain full range of motion
Strengthen their spine
Prevent injuries
A guide on what to expect in physical therapy.
Postural Retraining
After back surgery, individuals have to work to maintain proper posture when sitting and standing. (Johns Hopkins Medicine. 2008)
Postural control is important to learn as it maintains the lower back in the optimal position to protect and expedite the healing of lumbar discs and muscles.
A physical therapist will teach the individual how to sit with proper posture and use lumbar support.
Attaining and maintaining proper posture is one of the most important things to help protect the back and prevent future back problems.
Walking helps to improve cardiovascular health and blood circulation throughout the body.
This helps to provide added oxygen and nutrients to the spinal muscles and tissues as they heal.
It is an upright exercise that puts the spine in a natural position, which helps to protect the discs.
The therapist will help set up a program tailored to the individual’s condition.
Prone Press Up
One of the exercises to protect the back and lumbar discs is prone press-ups. (Johns Hopkins Medicine. 2008) This exercise helps keep the spinal discs situated in the proper position. It also helps to improve the ability to bend back into lumbar extension.
To perform the exercise:
Lie facing down on a yoga/exercise mat and place both hands flat on the floor under the shoulders.
Keep the back and hips relaxed.
Use the arms to press the upper part of the body up while allowing the lower back to remain against the floor.
There should be a slight pressure in the lower back while pressing up.
Hold the press-up position for 2 seconds.
Slowly lower back down to the starting position.
Repeat for 10 to 15 repetitions.
Sciatic Nerve Gliding
Individuals who had leg pain coming from the back prior to surgery may have been diagnosed with sciatica or an irritation of the sciatic nerve. Post-surgery, individuals may notice their leg feels tight whenever straightening it out all the way. This could be a sign of an adhered/trapped sciatic nerve root, a common problem with sciatica.
After lumbar laminectomy and discectomy surgery, a physical therapist will prescribe targeted exercises called sciatic nerve glides to stretch and improve how the nerve moves. (Richard F. Ellis, Wayne A. Hing, Peter J. McNair. 2012)
Nerve glides can help free the stuck nerve root and allow for normal motion.
To perform the exercise:
Lie on the back and bend one knee up.
Grab underneath the knee with the hands.
Straighten the knee while supporting it with the hands.
Once the knee is fully straightened, flex and extend the ankle about 5 times.
Return to the starting position.
Repeat the sciatic nerve glide 10 times.
The exercise can be performed several times to help improve how the nerve moves and glides in the lower back and leg.
Supine Lumbar Flexion
After surgery, gentle back flexion exercises can help safely stretch the low-back muscles and gently stretch the scar tissue from the surgical incision. Supine lumbar flexion is one of the simplest exercises to improve lumbar flexion range of motion.
To perform the exercise:
Lie on the back with the knees bent.
Slowly lift the bent knees towards the chest and grasp the knees with both hands.
Gently pull the knees toward the chest.
Hold the position for 1 or 2 seconds.
Slowly lower the knees back to the starting position.
Perform for 10 repetitions.
Stop the exercise if experiencing an increase in pain in the lower back, buttocks, or legs.
Hip and Core Strengthening
Once cleared, individuals can progress to an abdominal and core strengthening program. This involves performing specific motions for the hips and legs while maintaining a pelvic neutral position. Advanced hip strengthening exercises help generate strength and stability in the muscles that surround the pelvic area and lower back. A physical therapist can help decide which exercises are recommended for the specific condition.
Return-to-Work and Physical Activities
Once individuals have gained an improved lumbar range of motion, hip, and core strength, their doctor and therapist may recommend working on specific activities to help them return to their previous level of work and recreation. Depending on job occupation, individuals may need to:
Work on proper lifting techniques.
Require an ergonomic evaluation if they spend time sitting at a desk or workstation.
Some surgeons may have restrictions on how much an individual can bend, lift, and twist from two to six weeks after surgery.
Low-back surgery can be difficult to rehab properly. Working with a healthcare provider and physical therapist, individuals can be sure to improve their range of motion, strength, and functional mobility to return to their previous level of function quickly and safely.
Ellis, R. F., Hing, W. A., & McNair, P. J. (2012). Comparison of longitudinal sciatic nerve movement with different mobilization exercises: an in vivo study utilizing ultrasound imaging. The Journal of orthopaedic and sports physical therapy, 42(8), 667–675. https://doi.org/10.2519/jospt.2012.3854
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