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90 m a s s a g e & b o d y w o r k m a r c h / a p r i l 2 0 1 5 technique CLINICAL APPS Michael is experiencing mild pain in his right groin region. He is 28 years old and has a desk job that keeps him sedentary for most of his day. He played hockey in college and started playing again about a year ago. The pain in his groin started about four to six weeks ago, and he associates it with his hockey playing. He has continued to play through the pain, trying to be conscious of stretching and other preventive measures, but the pain persists. A week ago, he went downhill skiing and had a bad fall. He felt immediate pain in his hip and groin, but was able to continue skiing for the rest of the day. His hip and groin pain has continued to be a problem for the last week and is painful with certain movements, as well as when he gets up after sitting for long periods. He also notes that it seems like the pain in the area has grown or now includes something else he can't quite identify. The fi rst place to start in any evaluation is to gather as much detail as possible about the mechanics of the injury. Michael experienced a mild level of pain prior to the ski accident. However, the accident exacerbated the injury and pain. Determining the biomechanical forces his body was subjected to at the time of the accident helps identify the specifi c tissues most likely involved. Michael described the injury in which his body was moving downhill, not at a great speed due to the terrain, and his right ski became caught by a branch. His leg was forcefully pulled into extension and abduction. Because his body was moving forward while his leg was pulled back and away from him, there would be a high eccentric load on the hip adductors and hip fl exors. Groin pain is very common in hockey players and is often associated with injury/dysfunction in one of the adductor muscles. Michael's history indicates further injury to this region from the accident. PHYSICAL EXAM/EVALUATION Michael says his primary pain is in the upper medial thigh region. He can press on this region and reproduce the pain, so a local tissue dysfunction is most likely. A brief review of the key structures in this region reveals that most of the adductor muscles have attachment sites in the upper medial thigh region. Image 1 shows the location of the deepest group of adductor muscles. The adductor longus is the muscle most commonly strained, especially in many sporting activities like hockey, and this strain is usually referred to as a groin pull. Each of the adductor muscles also has a musculotendinous junction in the area. Michael indicated pain here. The musculotendinous junction is the most common location for strain and musculotendinous injury. Groin Pulls Adductor Longus Strain and the Iliopsoas By Whitney Lowe Thigh adductor muscles. Image is from 3D4Medical's Essential Anatomy 5 application. 1 Adductor longus

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