Physical therapy plays key role in recovery from a Grade 2+ groin strain
Aug. 14, 2015
By Greg Peters
Whether you're a weekend warrior coming up lame after legging out a ground ball in a softball game or a highly skilled professional athlete such as the Kansas City Royals' Alex Gordon, who was injured on July 8 chasing down a fly ball, injuries are all too common in the sports world, and quite often physical therapists are called upon to get players back in the game.
Physical therapists - like those educated in the Department of Physical Therapy and Rehabilitation Science (PTRS) at the University of Kansas Medical Center - are trained to help athletes and non-athletes recover when their bodies break down. While the prognosis for Gordon is to be out of action at least eight weeks, part of his recovery calls for therapy performed by the Royals' physical therapist and athletic trainers under the watchful eye of The University of Kansas Hospital's Sports Medicine staff.
"Physical therapy students learn several best practices guidelines to treatment these types of injuries, but each treatment plan depends on the patient's specific injury." said Neena Sharma, PT, Ph.D., CMPT, an assistant professor in the medical center's physical therapy department. "By doing a thorough history and examination, physical therapists can create a rehabilitation plan that is appropriate for each patient and condition."
What is a Grade 2+ groin strain?
Sharma said a groin strain is described as a pain felt when a patient is touched on the muscle that pulls the legs together (adductor), the associated tendons or the insertion point on the pubic bone. The pain can be reproduced by contracting or stretching the muscle. Only about 10 percent of all reported strain injuries are adductor muscle/groin strains, and ice hockey (43 percent) and soccer (13 percent) players are among the most likely to suffer groin strains.
Experts classify groin strains in three grades: Grade I - muscular fibers are overstretched and torn without serious rupture and minimal pain and movement restriction are noted; Grade 2 - muscle fibers are partially ruptured with significant pain and swelling and a reduced range of motion in the joint; there can also be small bruising and a loss of muscle strength; and Grade 3 - severe pain, large bruising and a loss of movement and muscle function associated with a complete rupture of the muscle fibers.
So what sorts of physical therapy treatments can a person - professional or regular Jane or Joe - with a Grade 2+ groin sprain expect? Sharma and her fellow physical therapy faculty member, assistant professor Marcio Santos, PT, Ph.D., offered insights into the typical milestones and therapies commonly associated with this type of injury, while keeping in mind that each person's recovery is unique based on their age, fitness, overall health and other factors.
Road to recovery
The road to recovery from a Grade 2+ groin strain normally travels through three stages on the way to getting a person back into the game: acute, subacute and recovery.
First is the acute phase, which can last for as little as three days and up to a week or 10 days. Sharma said the most important thing in the acute stage is to get the pain under control. By the end of this phase, a patient might be able to perform concentric contraction of the muscle against gravity without pain. For example, a patient might lie on his side and raise his leg toward the ceiling.
During this phase, the physical therapist employs a variety of treatment modalities depending on the patient's pain level. A typical prescription would include PRICE (protect, ice, compress and elevate). Assistive devices, such as crutches and ace wraps, are used to protect the strain and to keep weight off the injury. Therapy might also include ultrasound, low-voltage nerve stimulation and light massage.
Exercises are based on whether the patient can contract his leg muscles without pain. Activities include exercises where the muscles are shortened (concentric) without the pull of gravity and also non-weight bearing exercises. A typical concentric exercise without gravity would be sliding a leg toward and away from the body while the patient lies on his back.
The subacute phase can run from 10 days to six weeks, depending on the patient. At the end of this phase, the patient is able to perform hip range of movement exercises on the injured side similar to the uninjured side. Adductor muscle strength should be at least 75 percent of the strength of the uninjured side.
In this phase, a physical therapist might stimulate the muscle with electrical currents to build strength, and then progress to isotonic and functional exercises such as moderate stationary cycling and walking on a treadmill. The patient should start weight-bearing exercises and moderate stretching.
The recovery phase can last from six weeks to six months, and by the end of this phase, the patient's adductor muscle strength should be at least 90 percent of the non-affected side. During this final stage, the patient is allowed to increase the exercise load, including intensity and speed. At this point, an athlete can return to sport-specific activities. The therapist will also help the individual with stretching and flexibility exercises to help them regain a full range of motion.
"Athletes usually are more motivated to physical therapy and exercises and devote adequate time, so their recovery is faster," Santos said. "However, to return to the same level of high-demand physical activity, they require more fitness, which can take a longer recovery time."
Media reports say Gordon, who is tireless in his conditioning, is beginning to do baseball-related activities such as running and throwing, so he appears to be on course for a return after missing about eight weeks. For the average weekend warrior, that time will vary, but one thing is for certain, physical therapy is part of the process regardless of what level you play.