Expert Interviews

Neal Reynolds has worked as physiotherapist to Premiership and England International teams. Here he discusses how a full time professional team might approach the treatment of calf strain injuries.


Maria Madge is a Chiropractor specializing in spinal adjustments, who has worked extensively with sports people. Dr Maria Madge has trained in Sacro Occipital Technique (SOT) and other methods.


Susan Findlay teaches sports massage at the North London School of Sports Massage. She explains how massage can aid in the recovery of achilles tendonitis.


David Lloyd Consultant Surgeon specializing in groin surgery. Pioneer of the Lloyd release operation. David Lloyd talks about groin pain, a 'sportsmans hernia' and the Lloyd release surgery.

Initial treatment

In the early stages it is important to consider the mechanism of the injury which gives an indication of exactly what has happened and how severe it may be. Generally with a groin strain it is going to be kicking a ball or the foot slipping on the turf.

Treatment wise, ice and compression are applied immediately. This can be a little more difficult due to the location of the injury. I would still use an ice and compression machine but I don't think it is quite so effective. We would supplement that by just using ice as well. One thing you can do is going into an ice bath. This is a tank filled with very cold water. You will not get the compression factor but you will grantee taking the heat out of the injury.

You can use compression shorts and you can use a compression bandage. The aim of this treatment is to get the injury into the inflammation stage as quickly as possible, and then out the other side again. People think inflammation is a bad thing but it is absolutely vital for the healing process. For the first couple of days I would use tonnes and tonnes of ice. Twenty minutes every hour, over and over again.

Then I start to bring in some of the electrotherapy such as ultrasound, short-wave and laser may then be used up until the first week. Then hot and cold would be used to flush out waste products. Massage wouldn't be used in the very early stages as it is very tender and may still be bleeding. Massage then starts lightly after 4-5 days, with increases in depth and pain allows.

Prevention

Prevention of groin strains is similar to other muscles in that there are things you need to do before and after training, as well as strengthening work inbetween training.

Before training, it is important to warm-up thoroughly, especially for something like football where there is twisting adn turning and kicking balls. Start with jogging, gradually building up to sprinting and then stretching. The aim is to take the muscle from a short, rested, state, to it's full length. Neal uses both static and active or dynamic stretches. Dynamic stretches involve movements like side lunges to stretch and then shorten the muscle, just like it happens in a game. The muscles need to be ready to act like this from the first minute of the match.

If you strengthen a muscle then it is going to get shorter and shorter over a period of time. So stretching is really important to do alongside a strengthening routine. On the reverse of that, if you just do stretching and flexibility, the muscle is very long, but if you don't have the strength this is when it is most vulnerable, so injuries and groin pain are more likely.

Strengthening can be done using resistance bands or cables. Even a groin resistance machine if this is all that is available to you. A lot of sportsmen have very strong abdominals but they don't work on the groin muscles. The abs get so strong and pull very hard on the pelvis and the groin muscles don't have the strength to counteract it.

Sports massage is good for injury prevention, it can be used before and after training to get you ready for training and then to flush away waste products. A warm-down will also help with this.

Massage

Susan explains how groin strains can be either a sudden injury, or a more long term overuse injury. The type of injury will affect the treatment required.

More long-term injuries often contain lots of scar tissue which needs to be worked out. Other techniques such as myofascial release and muscle energy techniques may be used to increase muscle flexibility.

In short term injuries, the treatment may require first aid such ascold therapyand rest. Massage should not be used too early in the treatment process to ensure all bleeding has stopped. This can be up to a week.

Chiropractic treatment

Groin pain can be difficult to isolate as to what is causing the problem as lots of areas can refer pain into the groin.

If you have strained your groin this may be an overuse, overstretch type scenario during running or jumping type activities. This causes local inflammation and maybe a mild tear. The chiropractor would also check the pelvis, the hip, the groin and down as far as the knee to establish what it is that's gone wrong as groin injuries don't tend to occur in isolation. It might be referred from the SI joint, the hip or even the lower back.

Then they establish which muscle groups are tight. There may be the muscles on the inside, outside or in the buttock area. Once these are identified then a combination of stretching and massage will help those muscles. A chiropractor will also check if there is any misalignment or restriction in the joints surrounding the area and if you correct this then the muscles will tend to follow.