I have a client who has suffered from a groin injury through hockey. Could you please suggest the most affective strength/stretch exercises I could maybe give him? Thank you!
It would be wise to refer you client to the appropriate medical professional prior to dealing out your own rehab program. Receiving "clearance" to begin training establishes and maintains your professional integrity, with your client AND his physician. Learning the specifics and degree of injury suffered may help you as the fitness/performance professional learn how/why the trauma occurred, and where to begin when medical clearance is granted. For the sake of your question, I will assume that we're dealing with a mild groin strain or, adductor muscle(s), and your client has been "cleared."
In hockey the most frequent position visited (hip flexed), combined with the dominant plane of repetitive motion (frontal), can have a tendency to create specific muscular imbalances which may ultimately lead to injury, in this case: a groin strain.
In a hip flexed position neural drive is increased to the Psoas, which becomes shortened and overactive. Neural drive to the Glute Max is then decreased as that muscle is reciprocally inhibited and lengthened. Once the Glute Max is inhibited from performing its primary tasks (i.e. deceleration of hip flexion, internal rotation, and adduction, as well as hip extension), a situation of pronation can occur (i.e. excessive hip flexion, internal rotation, and adduction) due to a predictable systematic tightening of the TFL and ADDUCTORS along with the Psoas.
When abducting in this hip flexed position (skating), it is also important to keep in mind that the Glute Med (primary abductor and frontal plane stabilizer), does not have the correct fiber alignment to perform abduction. Therefore, the TFL takes over. The problem with repetitively increasing the neural drive of the TFL to excessive amounts (such as in hockey), is that this muscle also functions as an internal rotator/hip flexor, and is attached to the IT Band which in turn can become tight and restricted. All of this once again, adds up to increased pronation to the lower extremity.
When altered arthrokinematics (joint movement) occur, such as those above, the CORE loses some of its ability to function, and needs to be trained/retrained as well. Remember, its the CORE's job is to dynamically stabilize the LPHC (lumbo-pelvic hip complex), during function/sport. If there is an injury, such as a GROIN STRAIN, it is vital NOT to look at the injury as an isolated incident, but rather as a holistic break down of the body as a unit (assuming it was not a blunt trauma).
Sports cause repetitive stress. When this repetitive stress goes unchecked and un-addressed, muscular imbalances can/will occur. These muscular imbalances weaken the core, and eventually lead to faulty movement patterns. These faulty movement patterns over time can expose themselves as injury and pain (in this case a groin strain).
It is very difficult to make recommendations without having done an Integrated Kinetic Chain Assessment, so I will offer you a BASE LEVEL of progressions to start with.
- SMFR (Self Myofascial Release on foam roll): IT Band, TFL, Adductors,
- Static Stretching: Psoas, Rectus Femoris, Adductors, TFL, Bicep Femoris, Gastroc/Soleus
- Dynamic Stretching: Walking Lunge, Tubing Side Step
- Core Stability: (2 sets, 12-15 reps, SLOW TEMPO, perform in circuit with minimal rest intervals)
- Quadruped opposite arm/leg raise
- Prone iso abs with hip triple extension
- Bridging progressions - (2 leg on floor, on ball, single leg on floor,etc.)
- Neuromuscular Stability (balance): (2 sets, 12-15 reps, SLOW TEMPO, 30-60 second rest intervals)
- Single leg balance and reach - MP (multi-planar)
- Single leg squat - (to balance threshold only)
- Reactive Training (power): (2 sets, 6 reps per leg, controlled tempo, 30-60 second rest intervals)
- Single leg hops with STABILITY - (start with sagital plane, proceed to frontal, transverse)
- Total Body Strength Training: (3 sets, 12 reps, SLOW TEMPO, 90 second rest intervals)
- Squat to two arm dumbbell press (if appropriate)
Please refer to the PTN Exercise Library for visual demonstrations on how to properly perform the above stretches and exercises.