Very strange one

[Coxy]

I've had a lower abdominal problem that's flared up consistently over the past 8-10 weeks. I play Oztag and basically the first time during a warm up or game that I get up to a full sprint I get a rather intense pain in my lower abdomen.

It generally goes away and I can play the rest of the game without much discomfort, but the following morning it's always very stiff and sore and makes getting out of bed difficult.

This week was worse. I was fine during the game until I made a run where I changed direction and felt something "go" in my lower left abdomen.

The pain was pretty bad if I went at anything much above a walk at that point.

The following morning I could barely walk. Every step caused a real pain in my lower left/centre abdomen.

It improved today, but I went to see my physiotherapist and even he's confused.

He thinks a hip flexor strain is the most likely scenario but says the symptoms conflict a bit with that. We're going to treat it as such and watch how it progresses.

Basically:
- no pain when flexing my abs
- very little pain when doing a small crunch
- very little pain when lifting one leg or the other while lying down
- intense pain when I try lifting both at the same time
- intense pain when I roll over in bed

He's concerned it may be a weakness of the abdominal wall, but he's saying not to think about that until we've ruled out the hip flexor.

Weird one. Any ideas?

[dlifson]

Groins are a bugger............ALWAYS.

You mentioned that the problem has been there for a while, any mechanism of injury.........change in shoes, training or anything like that......might help a bit.
The fact that it was made worse with changing direction could mean groin, SIJ or lumbar..........lots of forces go through the body with a corkscrew motion.

The general rule for me to be convinced of a muscle strain is that the pain should be reproduced on contraction, stretch and palpation (generally). So the fact that the condition is improved with activity and worse when it cools down does not only mean muslce........it could be an inflammatory condition.

Thinking of a possible abdominal injury/hernia/sortsman's groin you can try the following and if yes, then consider it.
Is there any pain with coughing or sneezing? :(
Is there any pain if you sit on a bed and lift yourself up using only your arms? :(
What happens when you squeze your knees together :confused:

Otherwise with the pain lifting both legs and turning at night...think of SIJ or lumbar spine. Try the movement again with your back in neutral and your stomach braced and see if there is a difference.

Last but not least, do not forget something visceral. Although your problem is brought on by something mechanical, it cannot be ignored.

Best of luck

Darryn (Physio)

[Coxy]

Groins are a bugger............ALWAYS.

You mentioned that the problem has been there for a while, any mechanism of injury.........change in shoes, training or anything like that......might help a bit.
The fact that it was made worse with changing direction could mean groin, SIJ or lumbar..........lots of forces go through the body with a corkscrew motion.

The general rule for me to be convinced of a muscle strain is that the pain should be reproduced on contraction, stretch and palpation (generally). So the fact that the condition is improved with activity and worse when it cools down does not only mean muslce........it could be an inflammatory condition.

Thinking of a possible abdominal injury/hernia/sortsman's groin you can try the following and if yes, then consider it.
Is there any pain with coughing or sneezing? :(
Is there any pain if you sit on a bed and lift yourself up using only your arms? :(
What happens when you squeze your knees together :confused:

Otherwise with the pain lifting both legs and turning at night...think of SIJ or lumbar spine. Try the movement again with your back in neutral and your stomach braced and see if there is a difference.

Last but not least, do not forget something visceral. Although your problem is brought on by something mechanical, it cannot be ignored.

Best of luck

Darryn (Physio)

No particular change in equipment or training regime happened, other than the start of the new Oztag season. I had found myself able to run a shade faster and was probably pushing myself a bit harder in the games.

At the physio today he did some contraction tests (I lay down on my back, knees bent, abs contracted and slowly lowered each leg at the hip...very little pain was caused).

Similarly, I was able to raise one or the other leg without any significant pain, but lifting both caused immediate quite intense pain.

As I said, I also did a "small crunch" (lying flat I lifted my shoulder blades a few inches off the ground just by tensing my abs) without any significant pain, but there was some pain at the base of my abs (rectus abdominus?).

Pain with coughing and sneezing: yes, after this most recent, most acute bout so far.

Pain sitting on bed and lift only with arms: yes

Squeeze knees together: no pain.

Hop on either leg: no pain.

Other thing that's interesting. If I stand up straight with hands on hips and move my hips left or right there's quite a bit of pain across the lower midriff, a few inches below my navel, almost centred.

Likewise if I take a similar stance with feet just wider than shoulder width and lunge one way or the other slowly, the same kind of pain.

He found no obvious lumps or bumps that might indicate a hernia or muscle scar tissue. Though he did find some areas on the sides of the rectus abdominus that were firmer than others. He didn't conclude much from that.

Sorry for such a long post, I'm just concerned. Thanks for the feedback, it's appreciated.

[Unregistered]

may be osteitis pubis- examination & MRI with correct sequences for bone stress will confirm or exclude

TJ

[Coxy]

Saw a sports physician today. He suspects it's a strain of the conjoint tendon. He's sent me for an ultrasound to rule out hernia.

He said osteitis pubis is a possibility but the squeeze test was negative, and apparently that makes it unlikely.

[Coxy]

Saw a sports physician today. He suspects it's a strain of the conjoint tendon. He's sent me for an ultrasound to rule out hernia.

He said osteitis pubis is a possibility but the squeeze test was negative, and apparently that makes it unlikely.

Ultrasound came back negative for inguinal or femoral hernia.

Conjoint tendon looked good.

So it sounds like it's muscular.

[Coxy]

Well a few weeks on and I've been told I can return to playing Oztag in the next week or two.

Ultrasound returned negative for hernia, and the doctor doesn't think osteitis pubis is likely.

Symptoms improved dramatically in the second and third week since injury - with only occasional over the counter pain relief (nurofen) - and have since stagnated a little, but the rehab work I'm doing on improving core strength around my groin/back/sides is helping greatly.

I can now run at about 3 quarter pace with no pain and am back to a full, normal weights regime 2 or 3 times a week.

Next step is a bit more straight line acceleration/deceleration and then see how I go running angles/stepping etc.

[injuryupdate]

Groin is an area in which functional outcome is much more important in most cases than anatomical diagnosis.

[Coxy]

Yeah, that seems pretty true.

Well I took advantage of the Brisbane public holiday and went for a long walk and threw in a few jogs/sprints in the process.

Got up to about full pace and really had to back off. Pain was fairly sharp, almost completely medial (around the symphysis I think the doctor referred to the area as). I could feel my running action getting really sloppy and my pelvic stability...well, what stability. hehe

Once I stopped running and returned to a brisk walk it was fine. I iced it when I returned home and it's fine now.

I guess I just have to slow down a bit and give it a few more days before trying something like that again :P

[Coxy]

Might as well post in my "history". First training run for the new Oztag season today and I coped OK. Still got a bit of pain over the pubic symphysis when I stretch out to a sprint or uncontrolled sideways/bending type movements.

Also got quite a few twinges in my right adductor longus. I've been trying to strengthen it during my time off, which I think has helped but still felt a bit ordinary today.

Almost a "snapping" sound as I take off on some movements, but it just feels uncomfortable rather than painful. Afterwards there was some slight pain right up in the groin itself, where I imagine the tendon joins onto the bone.

I've read a bit about adductor tendinopathy recently and it sounds a bit like that to me.

I'm wondering, since I have far less discomfort moving my leg when I put some light pressure on my adductor fairly high up, would compression shorts be worth considering while playing?

[injuryupdate]

Compression shorts can sometimes take pressure off the adductors, so may be worth a try.