Most of us assume that pain in the groin is the result injuries like a groin pull or perhaps a hernia. However 22% of athletes with groin pain suffer from what is know as a labral tear.

The labrum is a fibrocartilagionous structure that outlines the socket of the hip joint. It has many functions including shock absorption, joint lubrication, and pressure distribution and aiding in hip stability.

Labral tears are often the result of trauma (including repetitive strain injuries), capsular laxity/hip instability, degeneration and hip joint impingement. However 74% are not associated with any known specific event or cause, and these are generally insidious in onset, with the underlying cause thought to be repetitive micro trauma.

Athletic activities that involve repetitive pivoting motions and specific activities such as soccer, hockey, golf and ballet have been linked to labral abnormalities because they require frequent external rotation of the hip.  Some tears have also been attributed to running and sprinting.

90% of patients diagnosed with labral tears complain of anterior hip or groin pain. Other common symptoms include clicking, locking, catching, or giving way of the affected hip. The pain is often a constant dull pain with intermittent episodes of sharp pain that worsens with activity.  Walking, pivoting, prolonged sitting, and impact activities, such as running, often aggravate symptoms. 71% of patients also describe night pain as a common symptom.

For a proper diagnosis you should visit your chiropractor. The best method for diagnosing labral tears is with an MRA, Magnetic Resonance Arthrography that would require a referral from a family physician.

How to avoid a labral tear?

There is an associated postural dysfunction that is associated with developing labral tears, called lower crossed syndrome, which involves a pattern of muscular imbalance in the pelvis.

Lower crossed syndrome can develop from too much sitting and slouching with no low back support. The resultant posture is a pelvis that is rotated forward and a low back that is arched or extended too much.  This causes the lower back muscles or erector spinae to continually contract to hold the body’s weight upright while the constantly flexed position shortens the muscle length of the iliopsoas and rectus femoris muscles.  Through continued concentric contraction or in a shortened position, the muscles adapt and shorten in length leading to muscle tightness. However, since the body acts like a series of pulleys and levers, when one muscle gets shortened, it usually means that another muscle gets lengthened.  This phenomenon is known as reciprocal inhibition.

In the case of lower cross syndrome the muscles which are tight or short require stretching and the muscles that are lengthened or weak require strengthening.

Rehabilitation

Muscles requiring stretching include:

• Iliopsoas
• Rectus femoris
• Erector spinae
• Piriformis
• Tensor fascia latae (TFL)
• Leg adductors

Muscles requiring strengthening:

• Abdominal group (transverse abdominus)
• Gluteal group

To learn more about exercises geared towards reducing lower crossed syndrome or to book an appointment with Dr. Remy,  please send an email to drremy@thechiropracticoffice.ca

The Iliotibial band is a muscle which functions to stabilize the knee and hip during flexion of the knee. ITB Syndrome (ITBS) is an overuse injury well recognized as a common cause of knee pain. ITBS is marked by sharp, burning knee pain and may be associated with swelling around the knee. The pain itself is usually felt along the outside of the knee.  ITBS is particularly common in runners and cyclists. Research has reported that ITBS makes up almost 12% of all running-related injuries.

Other Common Symptoms:

• Start running pain free, but develop symptoms after a reproducible time or distance
• Initially, symptoms subside shortly after a run, but return with the next run
• Running downhill and /or with a lengthened stride cause pain

What Is the Iliotibial Band ?

The Iliotibial band is a sheath of thick, fibrous connective tissue which attaches at the top to both the iliac crest (hip bone) and the Tensor Fascia Latae muscle. It then runs down the outside of the thigh and inserts into the outer surface of the Tibia (shin bone). It also has attachments to the gluteus maximus muscle.

Beneath the lower part ITB is a region of adipose (fatty) tissue. This fat pad is located underneath the ITB between the bone of the knee (lateral epicondyle) and the ITB itself. This fatty tissue has a great deal of nerves and arteries surrounding it which makes it very sensitive to pain and pressure.

When we bend or flex the knee the ITB is pulled medially or towards the knee. This compresses the fat pad, which is located just underneath the ITB, into the bone of the knee. Continuous flexion/tension will irritate the fat pad and cause pain and possibly swelling at the knee.

  Common Cause of ITBS

• Downhill running
• Increasing mileage too quickly
• Poor running or cycling mechanics/technique
• Poor footwear
• Anatomical mechanical deficiencies:
  • increased pronation
  • gluteal muscles weakness/inhibition

Role of Gluteal Muscles

According to research, weak hip abductors (lateral gluteal muscles), during eccentric contraction of support phase of running phase, appear to be responsible for ITBS. The muscle most involved is the glute medius. Its job is to steady the pelvis during gait.

Glute medius weakness will trigger compensation by weaker hip abductors including the glute minimus and Tensor Fascia Latae.  Since the ITB is attached to the tensor fascia latae, an increase in tensor fascia latae stress will cause increased tension on the ITB. All together this creates greater compression of the fat pad located underneath the distal ITB and ultimately causes symptoms of ITBS.

Prevention of ITBS= Strengthen the Glute Medius

The gluteus medius is a thick fan-shaped muscle and its posterior part is covered by the gluteus maximus. It originates from the outer surface of ilium. The fibers pass then downward and laterally to get inserted to lateral surface of the greater trochanter (outer hip).

As mentioned previously this muscle is a hip abductor, meaning in lifts the leg away from the body. It also plays a role in internal rotation of the hip. Its most important job is to stabilize the pelvis during gait. For instance, it prevents the pelvis from rotating downwards or sagging when the opposing side is lifted or not supported with the other leg during walking/running.

Glute Medius Exercises

1. Side Leg Lifts

Lie on one side, tighten the thigh muscle of your top leg, and then slowly raise the leg off the floor (at least 30 cm from the ground). Hold the leg up for a 2 count, and lower it on a 4 count. Relax your muscles. Then tighten the thigh and repeat.

2. Hip Hike

Standing on an elevated surface with the weight on one leg, hip sticking out, straighten the weight-bearing leg until it is even with or even hiked up above the elevated leg. Repeat 10-15 times per leg.

 3. Monster Walk

Put your feet inside of the tube and place it right below the bottom of your calf muscle OR hold the band in each hand, step on the middle of it with both feet, and now cross the band by switching the handles and putting them into the other hand.

Start with your feet together and then take a step directly to the side with one foot, slowly. Take a step with the opposite foot in the same direction. Continue slowly one foot at a time.

4. Wallbangers

Stand with your right side about 6 to 12 inches from a wall. Squat and lean your upper body to the left until your right hip touches the wall. Do not pause at the wall, you should recoil off and return to center.

It is important to note that if you are experiencing knee pain, you should consult with your chiropractor prior to starting any of the above exercises.

For more information on the treatment and prevention of Iliotibial Band Syndrome, please contact Mississauga Chiropractor, Dr. Nekessa Remy at 905-820-7746  or to book your complimentary consultation please email drremy@thechiropracticoffice.ca

Patients often ask me whether stretching before or after a workout is better for performance. The answer is, it should be done both before and after a workout.

The better question is what type of stretching should be done before and after a run.

STATIC STRETCHING

Static stretches entails holding a muscle in an elongated, fixed position for a period of time. This is the most common form of stretching done. They are effective in cooling down the muscular system as well as improving mobility and range of motion. This type of stretching should be done after your run, as part of your cool down.

Muscles to focus on:

• Glutes
• Hamstrings
• Quadriceps
• Calves
• ITB (Iliotibial band)

Each stretch should be held for a 20 – 30 seconds to be effective.

DYNAMIC STRETCHING

Studies show that static stretching could hurt performance if done before a workout (save it for after your run). But dynamic stretching, which uses controlled movements to improve range of motion, loosens up muscles and increases heart rate, body temperature, and blood flow to help you run more efficiently. These stretches should be done before you run as part of your warm up.

Dynamic stretching involves moving parts of your body and gradually increasing reach, speed of movement, or both.”  Dynamic stretching consists of controlled leg and arm swings that take you (gently!) to the limits of your range of motion. In dynamic stretches, there are no bounces or “jerky” movements.

Dynamic stretching is most effective when it’s sport-specific. This pre-run routine targets the muscles used for running. Start slowly, focus on form; as the exercises get easier, pick up speed. Use small movements for the first few reps, and increase the range of motion as you go.

Dynamic Stretches for the runner

LEG LIFTS

Swing one leg out to the side, then swing it back across your body in front of your other leg. Ensure your feet are facing forward throughout the stretch. Repeat 10 times on each side. Feel wobbly? Hold onto a steady object.

BUTT-KICKS

While standing tall, walk forward with an exaggerated backswing so that your heels come up to your glutes. When this is easy, try it while jogging. Do 10 reps on each side.

PIKE STRETCH

Get in a “pike” position (hips in the air, palms flat on the ground). Put your right foot behind your left ankle. With your legs straight, press the heel of the left foot down. Release. Repeat 10 times on each side.

HACKY-SACK

Lift your left leg up, bending the knee so it points out. Try to tap the inside of your left foot with your right hand without bending forward. Repeat 10 times on each side.

TOY SOLDIER

Keeping your back and knees straight, walk forward, lifting your legs straight out in front and flexing your toes. Reach your opposite hand to the opposite toes. Advance this by adding a skipping motion. Do 10 reps on each side.

WALKING LUNGES

Step forward using a long stride, keeping the front knee over or just behind your toes. Lower your body by dropping your back knee toward the ground. Maintain an upright posture and keep your abdominal muscles tight. Repeat 10 times on each side.

For a video demonstration of each exercise, click on the link below.

Dynamic Stretches Video Tutorial

For more information on Mississauaga’s The Chirorpactic Office  or to book a complimentary consultation please contact Dr. Remy at 905-820-7746 or email us at drremy@thechiropracticoffice.ca

As golf season nears, it’s time to improve your strength and endurance. Not only will this help your swing it will also help to reduce the chance of injury. How do you minimize injury risk and improve golf swing speed at the same time? There are certain resistance exercises which have been shown to assist with year round conditioning specific to golf. The following program focuses on improving muscle endurance and motor control which will aid in achieving muscular stability for the lumbar spine and shoulder region and ultimately prevent injury while improving mechanics.
Each exercise included is supported by the available biomechanical evidence and cross sectional epidemiological evidence.

Training to Improve Spinal Stability and Prevent Low Back Injuries
Spinal stability is achieved by the coordinating contraction of the trunk muscles in order to prevent the spine from buckling. The ability to stabilize the spine is considered necessary in the prevention of low back injuries. It involves the co-contraction of the flexor, extensor and lateral bending trunk muscles. The aim of these exercises is to improve the endurance and strength of these muscles to facilitate their ability to stabilize the spine and improve their ability to produce force during a golf swing.

Curl Up
Golfer lies on back with one knee bent 90 degrees and the second leg straight. Maintain an abdominal brace throughout the exercise. Hands should be placed under the low back to prevent spinal flexion. Golfer “curls” their shoulders 2 inches off the surface. The neck should stay in a neutral position (keep chin slightly tucked). Strain should be experienced in the abdominal region. The golfer should focus on curling the ribcage toward their pelvis. Hold the position for 3-5 seconds and perform 10-20 repetitions, or until fatigue with inability to perform exercise with correct form

Bird Dog
Golfer starts on hands and knees. Maintain an abdominal brace throughout the exercise. Keep the spine in a neutral position and your head aligned with the rest of your body. Avoid letting your chin poke out toward the floor. From this four point kneeling position the golfer should extend one leg parallel to the floor, hold for 3 seconds and return to the starting position.
Repeat with other leg. Additionally, the opposite arm can also be raised. The golfer must maintain control of the spine and minimize twisting and excessive movement. Hold the position for 3-5 seconds and perform 10-20 repetitions, or until fatigue with inability to perform exercise with correct form.

Side Bridge/Support
Golfer starts in side lying position and raises their torso off the floor. Maintain an abdominal brace throughout the exercise. Their weight should be supported by their knee and their forearm. To increase difficultly support the weight from the forearm and the golfers lateral feet. Hold each position for 3-5 seconds then “roll into the next bridge position, maintaining a neutral spine.

Front Bridge/Support
Rolling from the side support position the golfer maintains a neutral spine and supports their weight on their forearms and the balls of both feet. Keep the spine in a neutral position and your head aligned with the rest of your body.

Training to Improve Shoulder Joint Control and Prevent Shoulder Injury
Adequate control of the scapula (shoulder blade) has been suggested to be necessary in the prevention and treatment of shoulder injuries. The primary stabilizers of the scapular couple correctly to prevent instability of the shoulder complex. Those muscles include: serratus anterior, upper, mid, and lower trapezius, rhomboids and rotator cuff muscles. The aim of the scapular stabilization program is to perform exercises which meet the following criteria:

1. Train the serratus anterior, while minimizing upper trapezius activity. Increasing the strength of the serratus anterior will decrease scapular winging and increase upward rotation and posterior tipping of the scapula. This allows for adequate space for the clearance of the rotator cuff during elevation of the arm.
2. Train the subscapularis muscle (one of 4 rotator cuff muscles) because of its role in positioning the arm in the shoulder socket and its increased activity during the golf swing.
3. Train the scapulothroacic muscles (muscles which attach to the thorax and the shoulder blade; trapezius, levator scapula, rhomboids and serratus anterior) to control shoulder blade movement and provide a stable socket for the humerus.
4. Train external rotators to position the humerus within the fossa (shoulder joint) and be optimally conditioned for the requirements of the golf swing.

Lower Trap Arm Raise
While lying face down the participant lifts their arm to a position 45 degrees lateral to and at the level of their head. The arm should be in line with the lower trapezius fibres. This exercise trains the trapezius, deltoid, external rotator cuff and rhomboids. Perform 10-20 repetitions

External Rotation (teres minor and infraspinatus)
 Using a dumbbell with their arm abducted and elbow flexed, the participant should eccentrically lower the dumbbell (internally rotate) and then raise the dumbbell to the starting position via external shoulder rotation. This exercise trains the external rotator cuff. Golfers should focus on keeping their shoulder blades back and down. Perform 10-20 repetitions

Push Up Plus
The athlete begins in push up position and allows their shoulder blades to “roll together”. The participant, while maintaining a neutral spine, attempts to push themselves up further by pushing the shoulder blades farther apart (Scapular Protraction). This exercise has been shown to maximize serratus anterior & subscapularis activity while minimizing upper trapezius activation. The external rotator cuff is also active. Perform 10-20 repetitions

For more information on how to prepare for golf season please contact Dr. Nekessa Remy at drremy@thechiropracticoffice.ca