Hams/Groin Strains
The best method for treating acute, chronic hamstring and groin strains
Stretching crucial to a quick recovery and return to court
By Dr. John Aronen
| Before you get started … Handball players and stretching—the ideal world and the real world.
In the October issue of Handball magazine, Dan Graetzer wrote a very informative article about proper stretching techniques. In the ideal world, every handball player would carefully read the article and incorporate the information into his or her pregame and postgame warmup and stretching routine. Unfortunately, my 20 years of involvement with the handball community has reinforced what I already knew: Very few handball players have such a routine, other than to arrive barely on time to rush onto the court and then have a cold beer or two after the match. (It appears that the 12-ounce curls have more appeal than postgame stretches.) If that is the case, why feature this article on buddy stretches for the hamstrings and groin muscles? Simply because these buddy stretches are not only the most beneficial exercises a player can do to increase the flexibility of the hamstrings and groin muscles, they are also the treatment for a pulled (strained) hamstring or groin muscle. As many of you are aware, I spent eight years as team physician at the U.S. Naval Academy developing, with the help of Ray Chronister and Kevin Regan, treatment methods for injuries that would result in an injured athlete’s quick yet safe return to full activities. As soon as it was determined that the athlete had strained a hamstring or groin, we started the player on the buddy stretching exercises. The old school, and I mean old, was to rest the injury for 48 hours and then gradually start gently stretching it. All this accomplished was to allow the strained muscle to become tighter and tighter over the 48 hours of unnecessary rest. The key is to start stretching the strained hamstring or groin muscle right away multiple times during the day, using discomfort as the criteria for how aggressively the injured athlete and his buddy perform the buddy stretching. You’ve always got a number of, shall we say, wimps out there, but these stretches have proven to work to expedite the safe return to activities for the injured, motivated athlete. I realize very few of you will read this article unless you’re currently having a hamstring or groin muscle problem. But if it could be the ideal world, each player would:
If you read the article, it tells you the goals of the buddy stretching treatment. How fast you achieve these goals is based solely on how soon you start the buddy stretches and how frequently you do them during the day. Any questions, just call me at 858-485-9488. |
Working at the nationals each year gives the members of the USHA sports medicine team the chance to see friends as well as identify the injuries common among handball players.
Two of the more frequently seen injuries are initial and recurrent strained hamstring and adductor (groin) muscles. We have been able to identify two factors that contribute to the frequency of these recurrent strains:
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Failure of players to emphasize a pre- and post-play stretching regimen for both of those major muscle groups.
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Players’ lack of knowledge about how to treat such strains.
The lack of stretching is consistent with the player’s feeling of invincibility–unless he strains the adductor. Stretching cannot guarantee freedom from muscle strains. But if he knows how to stretch properly, he will be a step ahead in treating the strain.
Though the early treatment of strains is somewhat controversial, those who deal with athletic injuries agree that the goals should include regaining full flexibility and strength of the injured muscle group.
Over the years, the USHA sports medicine team has achieved very satisfactory results and quick returns to the court using the following regimen of treatment.
All patients are started on a pain-free stretching program the day of the injury.
Typically, an acutely strained muscle will go into spasm from which the athlete experiences discomfort.
Frequent pain-free stretching of the acutely strained muscle can control spasms, minimizing discomfort and preserving flexion. Resting an acutely strained muscle in the early stages results in unnecessary discomfort and prolonged delay regarding a safe return to the courts.
Unfortunately, in recognizing the inherent strength of the hamstring and adductor muscles, athletes usually need help to stretch these muscles pain-free. Thus, a buddy contract/relax stretching method is used, allowing the athlete to perform effective pain-free stretching.
The lack of stretching is consistent with the player’s feeling of invincibility–unless he strains the adductor. Stretching cannot guarantee freedom from muscle strains. But if he knows how to stretch properly, he will be a step ahead in treating the strain.
Though the early treatment of strains is somewhat controversial, those who deal with athletic injuries agree that the goals should include regaining full flexibility and strength of the injured muscle group.
Over the years, the USHA sports medicine team has achieved very satisfactory results and quick returns to the court using the following regimen of treatment.
All patients are started on a pain-free stretching program the day of the injury.
Typically, an acutely strained muscle will go into spasm from which the athlete experiences discomfort.
Frequent pain-free stretching of the acutely strained muscle can control spasms, minimizing discomfort and preserving flexion. Resting an acutely strained muscle in the early stages results in unnecessary discomfort and prolonged delay regarding a safe return to the courts.
Unfortunately, in recognizing the inherent strength of the hamstring and adductor muscles, athletes usually need help to stretch these muscles pain-free. Thus, a buddy contract/relax stretching method is used, allowing the athlete to perform effective pain-free stretching.
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| Figure 1: Patient lies on his back on table or floor. Buddy places leg of injured thigh on his shoulder. While keeping injured leg fully extended by clasping his hands on patella, buddy stretches injured hamstring until patient feels tightness. Patient contracts injured hamstring against resistance provided by buddy’s shoulder. Once patient feels he can no longer contract muscle due to fatigue, he relaxes and buddy again stretches muscle to new point of tightness. Contract/relax sequence should be performed three to four times during each stretching session. Goal is to regain strength and flexibility in injured thigh muscles equal to that in non-injured thigh. | Figure 2: Patient lies on his side on table or floor. Buddy places leg of injured thigh on his shoulder. While keeping injured leg fully extended by clasping his hands on patella, buddy stretches injured adductor until patient feels tightness. Patient contracts injured adductor against resistance provided by buddy’s shoulder. Once patient feels he can no longer contract muscle due to fatigue, he relaxes and buddy again stretches muscle to new point of tightness. Contract/relax sequence should be performed three to four times during each stretching session. Goal is to regain strength and flexibility in injured thigh muscles equal to that in non-injured thigh. |
The athlete will:
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Minimize the discomfort normally experienced from spasms associated with acute muscle strains in the early stages.
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Hasten his safe return to the court by preserving and regaining the needed flexibility and strength.
The key limitation in the aggressiveness of the buddy contract/relax stretching method is the pain the athlete experiences.
The injured athlete allows his buddy to stretch the injured muscle only to the extent that it is pain-free, and he contracts the injured muscle only as hard as he can pain-free. Using pain as the guideline, the severity of the injury cannot increase. By following the regimen, the severity of the strain and associated pain will dictate the length of time before a return to full activities.
One can usually gain 10 to 20 degrees of flexibility by repeating these techniques.
If you have questions on how soon to start your rehab, call Dr. John at 858-485-9488.
