Groin pain Part 5a: Treatment of Enrique L.-Evaluation and follow up

Groin pain, Neuromuscular therapy / Sunday, August 2nd, 2009

This is a series on groin pain. If you missed the beginning go back to Part 1, the case study of Enrique L.

In the initial Neuromuscular Therapy evaluation at my Boston area clinic, after reviewing Enrique’s medical history, the history of his groin pain complaint and getting a description of his symptoms, I examined and treated what I determined were the major muscles involved.  The tensor fasciae latae (TFL) muscle was very symptomatic. At one spot he said “That’s it!” The iliopsoas was very active with the iliacus portion painful, the psoas portion harboring a Trigger Point, and the iliopsoas tendon sensitive. Deeper into the groin, both the pectineus and the adductor longus muscles were tight and tender, more in the muscle belly than the pelvic attachment.
What was most unusual in my mind was the swollen area I felt over his hip capsule. I postulated that it might be a swollen iliopsoas bursa, a spasm in the lower muscular portion of the iliacus where it crosses the hip capsule, or a tight pectineus pressing the neurovascular structures to the surface.

At the second session he reported that he had felt good for a few hours after the NMT treatment. He felt looser and was able to walk without soreness. Even his abdominals had felt looser but, by the next morning, he was back to where he had been before the treatment. He was having a bad day, hadn’t slept the night before and said the pain would come and go like nausea. He said it feels like when you’re in pain you “think you’re going to die.”
I started the session by treating both hips, using Assisted Active Isolated Stretching on the long and short adductor muscles, the hip flexor tendons and the TFL. Next I used NMT techniques to treat the iliopsoas, hip flexor tendons and short adductors finishing with focus work on the right TFL, adductor magnus and quadriceps.

The iliopsoas was easier to release this time. The adductor longus was painful and he remembered that this muscle had “popped” on the left when the chiropractor had tested the muscles previously. The TFL still had a “hot spot” but the pain felt good this time. The adductor magnus was still very tender.

He was sore when he left the office, so I suggested he use ice to control the pain and take 1000 mg vitamin C to reduce the soreness.

The next post reviews the second section of treatments.

2 Replies to “Groin pain Part 5a: Treatment of Enrique L.-Evaluation and follow up”

  1. Hi Christina ~ The blog is great! I have finally had time to read many of your entries and they’re really good, with lots of clear, practical information. I found the case of Sally S. particularly interesting! 🙂

    1. Thanks Shari,
      Glad to have you as a reader! Your comments are appreciated. i thought you’d find Sally’s case interesting!

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