Name My Pain

Chronic Hip and Groin pain Injuries (Inside Leg) Name My Pain
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Adductor tendinopathy
This condition presents as dull to sharp type pain high up on the inner thigh, and is more consistent with excessive overuse of the muscles in that area, such as a footballer of any code that has to run at high speeds and constantly change direction, as well as being very common on the kicking leg of a footballer if they are the goal kicker.
The pain initially can be quite dull, and only appear after activity, as it worsens it can be present more frequently before and after exercise, but in initial stages can actually disappear as the athlete warms up, only to reappear after exercise worse than prior to activity. At its worst it is sore all the time and can increase with activity.

Tendinopathy’s result from overuse of the muscle and the tendon that attaches that muscle to the bone. When the tendon is overused it sustains small microscopic tears. In order for the body to repair these tears it creates inflammation, and that inflammation can cause pain, stiffness and swelling.
These types of injuries typically are ignored at first. As the pain initially decreases with warming up, and then is not present during activity. But the discomfort returns when the athlete cools down. If not addressed this process continues and worsens the condition, so that pain becomes more present during activity, and worsening more after finishing, until ultimately there is constant pain, and limitations to all activity.

Osteitis pubis
This pain presents as dull and in the groin area, increasing with increased activity. Generally as a result of excessive loading to the area through overload of sit ups, or in the athlete that is required to kick a lot in their chosen sport. Very common in the Australian Rules footballer

Ostietis Ostietis

Stress fracture of the pubis ramus
Generally presents as an overuse activity following exercise, where initially the pain only presents after activity but over time the pain increases until it is present with even walking. It can generally be localised to the area of the fracture, so pain with palpation over the pubis area, and can radiate pain in to the buttocks. The pubic area as well as being painful on palpation can also be warm.

Stress fractures are overuse injuries and occur when the body, and that particular bone are placed under an excessive constant load. The body’s defenses to deal with this are to take away old bone (osteoclasts) and lay down new bone (osteoblasts). However under the constant load the body is unable to keep up with the demands and an imbalance forms and ultimately a bone weakness, and hence a stress fracture.
Traditionally stress fractures are only sore after exercise and activity, and noticed generally for the first time after the athlete has cooled down, however if not addressed the fracture can worsen and the pain become more constant during exercise and ultimately limiting activity and performance.

Pubic Rami Pubic Rami

Stress fracture of the neck of the femur
Generally presents as dull poorly localised pain in the beginning with pain increasing with activity. As the fracture worsens so does the amount of time that the person feels pain.

Stress fractures are overuse injuries and occur when the body, and that particular bone are placed under an excessive constant load. The body’s defenses to deal with this are to take away old bone (osteoclasts) and lay down new bone (osteoblasts). However under the constant load the body is unable to keep up with the demands and an imbalance forms and ultimately a bone weakness, and hence a stress fracture.
Traditionally stress fractures are only sore after exercise and activity, and noticed generally for the first time after the athlete has cooled down, however if not addressed the fracture can worsen and the pain become more constant during exercise and ultimately limiting activity and performance.

Fractured Noff Fractured Noff

Snapping hip
This condition is very common in ‘Ballet Dancers’ and is characterised by a snapping noise in the region.
There are two types, the outside (lateral) ‘Snapping’ is common in the young dancer, and presents with no pain, but merely the ‘Snapping’ noise.
The other type is internal ‘Snapping’, with again a ‘snapping’ noise but present with pain, especially with hip flexion.
Hip flexion will reproduce pain to confirm diagnosis. (See below)

Hip&Groin

Flex hip, by bringing knee up towards the ceiling, this will reproduce pain, if ‘Snapping Hip’ is the injury.

Snapping Hip

Illiopsoas (hip flexor) strain
This results from either an acute tear, or a chronic overuse of the muscle, an acute tear results from a high velocity activity where the leg is placed under load at force, sprinting and kicking a ball are the most common. Depending on the severity will dictate the level of pain. A tearing sensation and acute onset of pain in the groin and hip usually results. The extent of the injury will dictate whether the athlete can continue, with the pain generally worsening when they cool down, to a severe tear where the athlete is unable to walk without a limp.
A Chronic overuse tear results from excessive kicking, where the athlete has a poorly localised ache deep in the groin on one side.
To test whether this is the correct diagnosis pain and stiffness with hip flexion stretch, (modified Thomas test) will indicate an Illiopsoas strain.

Pain and stiffness is felt in the groin area, in this picture it would be felt in the left leg.
Hip & Groin

Illiopsoas bursitis
This generally results from an overuse of hip flexion, with walking, sprinting or kicking when a tight hip flexor muscle has caused friction on to the bursa. Generally results in poorly localised ache in the groin, but it does not present with pain on hip flexion stretch. As the Illiopsoas muscle strain does.

Rectus abdominus tendinopathy
This injury can occur either as an acute strain following a sudden forced lift or activity, or as an overuse injury, e.g. excessive sit ups.
Pain is aggravated by sit up activity.
Sit-up will reproduce pain, indicating rectus abdominus tendinopathy.

Tendinopathy’s result from overuse of the muscle and the tendon that attaches that muscle to the bone. When the tendon is overused it sustains small microscopic tears. In order for the body to repair these tears it creates inflammation, and that inflammation can cause pain, stiffness and swelling.
These types of injuries typically are ignored at first. As the pain initially decreases with warming up, and then is not present during activity. But the discomfort returns when the athlete cools down. If not addressed this process continues and worsens the condition, so that pain becomes more present during activity, and worsening more after finishing, until ultimately there is constant pain, and limitations to all activity.

Sit-up will reproduce pain.
Hip & Groin

Inguinal hernia
This can result from a direct or indirect trauma. Symptoms include a dragging sensation to one side of the lower abdomen aggravated by increasing intra abdominal pressure, such as coughing sneezing. There is also occasionally a palpable bulge.

Hernias

Posterior inguinal wall weakness (“sportsman’s hernia”)
This presents with dull poorly localised groin pain that generally has worsened over a period of time, and is aggravated by activity, particularly kicking. Generally a common injury in male football kickers. This pan can be increased with sneezing, coughing and valsalva movement.

Obturator nerve entrapment
This presents as exercise-related groin pain, which originally begins proximally near the groin but as exercise/activity increases the pain radiates down the leg towards the distal medial thigh (inner thigh above knee).
There may also be a general feeling of weakness and an inability to achieve full propulsion of the leg in running.
Pain with resisted adduction (moving the hip closer to the midline) of the hip will indicate an Obturator nerve entrapment. (See below)

Resist taking the leg across the midline, towards the groin, with your arm. This will reproduce pain on the inner thigh above the knee.

Hip & Groin

Perthes’ disease
Present in the young athlete, between 4-12 years. It presents as a low grade limp or ache within the hip, groin or knee. It is usually confined to one side. More common in males.
If this is suspected then an x-ray is recommended for an accurate diagnosis.

Perthes Perthes
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