Sports-related groin pain is a common condition in athletes. It results from chronic, repetitive trauma or stress to the muscle and tendon portions of the groin or from overuse of the lower abdominal musculature and muscles of the upper thigh. The groin pain usually develops gradually. It can be associated with virtually any sport but most often is encountered in hockey, soccer, rugby and football – sports that require frequent bending or leaning forward.
A hamstring strain, often called a pulled hamstring, is a common injury to one or more of the hamstring muscles, during which muscle or tendon fibers are stretched, or partially or completely torn. These injuries are graded according to severity, with Grade 1 being mild, Grade 2 being moderate, and Grade 3 being severe, with a complete rupture.
The hamstring muscle group consists of three muscles: the semitendinosus, semimembranosus, and the biceps femoris. These muscles originate from the lower edge of the pelvis at a part called the ischial tuberosity. They travel down the back of the thigh, across the knee and attach to the tibia and fibula, the bones of the lower leg. At each end of the muscles are tendons, strong cords of connective tissue. Tendon fibers begin within the muscle fibers and extend to the bones where they have their attachments. A hamstring injury can happen at any point along the muscle: at the origin; where the tendon and muscle fibers join; in the belly of the muscle; or where the muscle inserts into bone.
The function of the hamstrings is to allow you to extend your leg straight back, and also to help you bend your knee.
Hamstring strains are almost always caused as a result of overloading. This means stretching the muscle while at the same time loading it with weight and force necessary for motion. An example of loading the hamstrings is an athlete sprinting: the rear leg is straight and the toes push against the ground. In this situation the hamstrings are stretched (to allow the straight leg) and loaded with body weight and the force needed to propel the body forward.
Overloading the muscle, or subjecting it to too much force, can cause a hamstring strain. For this reason, athletes are particularly prone to this injury. Adolescent athletes are also at risk, due to the fact that muscles and bones do not develop at the same rate. If the bone has grown faster, the hamstring will be tight and therefore vulnerable.
Poorly conditioned, tired, or tight hamstring muscles are more likely to be injured. Often, a person’s quadriceps muscles, in the front of the thigh, are stronger than their hamstrings, so the hamstrings will tire faster, increasing the risk of injury.
Symptoms of a hamstring strain will depend somewhat on the severity of the injury, but may include the following:
- Sudden, severe pain in the back of the thigh, causing you to stop immediately. You may hop or fall down, unwilling to put weight on the injured leg.
- Possible popping or snapping sensation at moment of injury.
- Swelling, the extent of which will depend on your injury.
- Bruising on the back of the leg, below the knee.
- Tenderness over the injured area.
- Weak hamstring muscles.
Your doctor will ask you about your medical history, including any previous injuries to your leg. He or she will also ask you about the circumstances of your current injury and the type and severity of your symptoms. You will have a physical examination, during which the doctor will palpate (touch) your leg to assess areas of tenderness. Depending on your particular injury, you may be asked to lie on your front and bend your knee against resistance. This may cause pain.
An X-ray may be taken to see if the hamstring injury has torn away a small piece of bone. This can sometimes happen with a severe strain, and is known as a tendon avulsion. These normally occur at the upper (proximal) end of the muscle rather than the lower (distal).
Magnetic resonance imaging (MRI) scans may be taken as these are better than X-rays at showing soft tissues such as muscles and tendons. MRIs are therefore often used to evaluate the extent of the injury and aid decisions regarding treatment.
Early treatment for a hamstring strain has been shown to provide the quickest and best recovery. It is extremely important to follow medical advice and allow yourself time to heal otherwise you will be at risk of recurrent hamstring injuries.
Most hamstring strains heal with conservative (non-surgical) treatment, resulting in a full recovery and a return to normal, pre-injury levels of activity. A mild Grade 1 strain will heal swiftly, whereas a Grade 3 injury, which may require surgical repair, might take 3 to 6 months to heal properly.
During the acute stage of the injury, that is, the first one to five days, the strain can be treated with the following methods:
Rest: Avoid any activity that either caused the injury or makes your symptoms worse. You may wish to use crutches temporarily, to keep weight off your injured leg. Your doctor may recommend that you wear a knee splint for a while. This would prevent your leg fully straightening, thereby avoiding any further strain on the hamstrings.
Ice: Ice, crushed in a bag and wrapped in a towel, can be applied to the back of the thigh for as long as is comfortable, several times a day. This will help to reduce swelling and pain.
Compression: Wearing a compression bandage on your leg will prevent excessive swelling and minimize bruising.
Elevation: Raising your leg above the level of your heart will help reduce swelling. This will be most easily achieved at night, when you can rest your leg on a pile of pillows while you sleep.
NSAIDs: Over-the-counter non-steroidal anti-inflammatory medications will help relieve pain and swelling.
Physical therapy: When advised by your doctor, a graduated program of exercises can be initiated, beginning with gentle stretching and gradually including strengthening exercises. Always follow medical advice as to when it is safe to begin exercising, and when you can return to sporting activities. Physical therapy might include massage to align muscle and tendon fibers so that they heal in the correct position. This also minimizes the formation of scar tissue.
A Grade 3 strain may require surgical repair. If the injury is a tendon avulsion, where the tendon has pulled away a piece of bone as it ruptured, surgery will always be required. Your surgeon would reposition any bone fragment or tendon or muscle fibers, and hold them in place with surgical stitches or staples. After surgery you would need to avoid putting weight on the leg. You may have to wear a brace and use crutches to help you get around until the injury has fully healed.
Hip Flexor Strain
Hip flexors are a group of muscles in frontal part of the hip; they include the rectus femoris and iliopsoas, which originate at the hip and run down to the femur bone. They are used primarily during walking and running. When the hip flexors contract, tension is placed through the hip flexor muscle fibers. Too much tension may cause muscle fibers to tear, resulting in hip flexor strain.
hip is one of the most anatomically stable joints, but it is susceptible to
injury when it is in the flexed position. Thus, hip sprains are uncommon sports
injuries, accounting for less than 4% of all sprains. These injuries usually
occur as a result of severe twisting or traumatic impact to the hip, such as
what may occur during a fall or with direct and forceful contact. Hip sprains
can also result from overuse and overstretching of the hip, especially among
individuals who do not warm up sufficiently before activity.
hip joint has a capsule that is comprised of multiple circular and longitudinal
ligaments, including the transverse ligament, the iliofemoral ligament, the
pubocapsular ligament, and the ischiocapsular ligament. A ligament is a band of
tissue that connects bones together. Because the bones of the hip anchor
muscles that travel down the leg, across the abdomen, and into the buttocks, a
sprain in the hip area may radiate pain to any of these sites.
that is felt directly over the injured ligament and that increases with
and bruising (in severe cases)
and muscle spasm
partial or full loss of joint flexibility
or pain with walking
physician will examine the affected area and apply pressure to the areas of
suspected injury to identify points of maximum tenderness. Patients may be
asked to perform certain movements to determine the range of motion, the
stability of the joint, and muscle strength. Radiographs should be taken to
rule out fracture, dislocation, and subluxation. Magnetic resonance imaging is
used to look for labral tears, which can be confused with joint sprain.
the injured area
relative rest and use crutches with no or partial weight bearing until walking
is no longer painful.
to rehabilitation of the muscles, range-of-motion exercises, and proprioception
activities around the joint. Progressive chiropractic adjustments may address
concomitant joint dysfunction.
prognosis for this condition depends on the severity of the strain. With
conservative treatment, mild to moderate sprains will usually heal on their own
within a few weeks to a couple of months. Severe injuries may require surgery
followed by a physical therapy rehabilitation program. It is important to allow
the injury to heal completely before resuming physical activity to avoid the
risk of reinjury. Special medical athletic wear (e.g., Bio Skin compression
shorts) helps to increase proprioception and control muscle movements to
improve recovery time after injury.
Lymphedema is an abnormal accumulation of protein-rich fluid
in the interstitial space. This not only can cause swelling, but can also
result in changes to the skin, infection, and decreased wound healing where
wounds are present.
A thigh bruise, medically known as a quadriceps contusion and commonly called a dead leg or charley horse, is an injury to the quadriceps muscles that causes damage to the muscle fibers and bleeding within the thigh.
The quadriceps muscle group consists of four large and powerful muscles that run down the front and sides of the thigh: the vastus medialis, vastus intermedius, vastus lateralis, and the rectus femoris. At each end of the muscles are tendons, strong cords of connective tissue. Tendon fibers begin within the muscle fibers and extend to the bones where they have their attachments. The quadriceps originate at the ilium (located at the upper edge of the pelvis) and the femur (thighbone). At their lower ends their respective tendons join together into one quadriceps tendon that surrounds the patella (kneecap). The tendon then becomes known as the patellar tendon, which inserts into the tibia (shinbone). The quadriceps are responsible for flexing (bending) the hip, straightening the leg at the knee, and are used in nearly every movement of the legs.
Damage to the quadriceps can cause bleeding, the severity of which depends on the force of the injury. Bleeding can be either intramuscular, which means that the bleeding is contained within the muscle compartment, or intermuscular, where the blood escapes from the fascia (sheath of tissue) that surrounds the muscle and flows downward within the leg, between the muscle compartments. Intermuscular bleeding is less severe. Intramuscular bleeding can be serious as the blood, trapped within the fascia, increases pressure within the muscle compartment. This can lead to the development of compartment syndrome, which causes muscle and nerve damage and impaired blood flow that can result in the death of leg tissue in the injured area.
An external blow to the front of the leg is the normal cause of a thigh bruise. The impact crushes the muscle against the femur. These injuries often occur during sporting activity, such as playing football, basketball, soccer or rugby, when a player receives a kick to the thigh, or is hit with a piece of sporting equipment, such as a bat.
The severity of the symptoms will depend on the force behind the blow, but will likely include the following:
- Sudden pain, which may be severe, at the moment of injury
- Bruising, which may travel down the leg
- Inability to fully bend or straighten the knee
- Inability to place full weight on the leg
- Stiffness, made worse if the athlete continues to play after injury
The doctor will ask about the circumstances of the injury, and physically examine the thigh. If it is an older injury and ossification is suspected, X-rays might be taken.
It is extremely important to treat a thigh bruise properly as, without such treatment, blood can form pools in the damaged muscle that calcifies, or hardens, with time, resulting in stiffness and lumps within the muscle. This condition, known as osteomyositis ossificans, sometimes needs remedial surgery.
Regardless of whether bleeding from a quadriceps contusion is intra- or intermuscular, initial treatment should be the same. An ice pack should be placed on the thigh immediately. If no ice pack is available, one can be made by placing ice in a bag and crushing it. The bag should be wrapped in a towel before placing it against the skin.
The knee should be fully flexed (bent) when the leg is iced. If the knee is straight when the leg is first iced, stiffness in the leg the following day will be markedly worse. If the knee is flexed, the quadriceps will remain much more flexible. Icing can be repeated for as long as is comfortable, every two hours for the first two days following injury. Between each icing the leg should be kept wrapped in a compression bandage.
Crutches can be used to aid mobility. To minimize swelling, the patient should keep the leg elevated above the level of the heart, as often as possible. This is best achieved by lying on the back with the leg resting on a pile of pillows.
NSAIDs (non-steroidal anti-inflammatory drugs) such as ibuprofen (Advil), naproxen (Aleve), or aspirin can be taken, according to direction, to reduce pain and alleviate inflammation.
Physical therapy might include instruction on proper rehabilitation techniques, ultrasound, and electrical stimulation to promote healing.
After the acute stage of the injury, which is the first two or three days, gentle rehabilitation of the quadriceps can begin. It is important not to cause any pain when exercising. If pain is felt, the patient is doing too much and recovery time will be lengthened. Damaged muscle fibers need to be allowed to heal properly.
Sitting on the floor with the injured leg straight out in front and the unaffected leg bent with the foot on the floor, contract the thigh muscles of the injured leg (the quadriceps) by pressing the knee towards the floor. Hold the position for 5-10 seconds then relax. Repeat 10 times, 3 times a day.
Lying on your back, bend the injured knee and keep the foot on the floor. Slide the heel towards the buttocks as far as you can without pain. Repeat 10-20 times.
Straight leg raise:
Lying with the back on the floor, bend the unaffected knee and rest the foot on the floor. Keeping the knee of the injured leg straight, contract the thigh muscles and lift the leg up until the heel is about 6 inches off the ground. Hold for 5-10 seconds then relax. Repeat 10 times, 3 times a day.
Quad stretch 1:
Lie on the floor on the stomach, with the injured leg on a pillow. Slowly bend the knee until a gentle stretch is felt. Hold the stretch 30-60 seconds. Repeat 10 times, 3 times a day.
Quad stretch 2:
Using a wall for support, hold the right foot with the right hand and gently pull the foot up and behind, towards the buttocks, stopping when you feel a gentle stretch. Keep the knees together and the pelvis neutral (neither tilted forwards nor backwards). Hold the stretch for 10 seconds then relax. Switch legs and repeat exercise.
As a thigh bruise is an accidental injury, there is little to be done to prevent it occurring. However, if the patient is returning to contact sports, padding can be worn over the thigh to protect the quadriceps muscles.
A bursa is a small fluid-filled sac that sits near a bone.
It cushions and protects nearby tissues when they rub against or slide over
bones. Bursitis happens when a bursa gets irritated and swollen. In the case of
trochanteric bursitis, bursitis occurs due to an exaggerated movement of the
gluteus medius tendon over the outer femur.
Inflammation of trochanteric bursa is one of the most common
causes of hip pain. The normally paper-thin bursal wall thickens and loses its lubrication,
resulting in outer thigh pain. Most of the cases of trochanteric bursitis are
caused by an abnormal gait due to various conditions, such as knee arthritis,
ankle sprains, leg length discrepancy, back pain and others.
Venous disease, affecting the venous system, is one of the
most common maladies to affect the legs of people and to negatively impact
their quality of life. Mild forms present cosmetic concerns with the more
severe forms resulting in serious symptoms significantly reducing the quality
of life, mobility and productivity. The recently published Bonn study reported
just over 90% of the population has some level of venous disease with 17%
experiencing the more severe levels.