ABSTRACT
BACKGROUND: Evaluation and treatment of groin pain in athletes is challenging. The anatomy is complex, and multiple pathologies often coexist. Different pathologies may cause similar symptoms, and many systems can refer pain to the groin. Many athletes with groin pain have tried prolonged rest and various treatment regimens, and received differing opinions as to the cause of their pain. The rehabilitation specialist is often given a non-specific referral of "groin pain" or "sports hernia." The cause of pain could be as simple as the effects of an adductor strain, or as complex as athletic pubalgia or inguinal disruption. The term "sports hernia" is starting to be replaced with more specific terms that better describe the injury. Inguinal disruption is used to describe the syndromes related to the injury of the inguinal canal soft tissue environs ultimately causing the pain syndrome. The term athletic pubalgia is used to describe the disruption and/or separation of the more medial common aponeurosis from the pubis, usually with some degree of adductor tendon pathology. TREATMENT: Both non-operative and post-operative treatment options share the goal of returning the athlete back to pain free activity. There is little research available to reference for rehabilitation guidelines and creation of a plan of care. Although each surgeon has their own specific set of post-operative guidelines, some common concepts are consistent among most surgeons. Effective rehabilitation of the high level athlete to pain free return to play requires addressing the differences in the biomechanics of the dysfunction when comparing athletic pubalgia and inguinal disruption. CONCLUSION: Proper evaluation and diagnostic skills for identifying and specifying the difference between athletic pubalgia and inguinal disruption allows for an excellent and efficient rehabilitative plan of care. Progression through the rehabilitative stages whether non-operative or post-operative allows for a focused rehabilitative program. As more information is obtained through MRI imaging and the diagnosis and treatment of inguinal disruption and athletic pubalgia becomes increasingly frequent, more research is warranted in this field to better improve the evidence based practice and rehabilitation of patients. LEVELS OF EVIDENCE: 5.
ABSTRACT
BACKGROUND: Codman's pendulum exercises are commonly prescribed after shoulder surgery and injury to provide grade I and II distraction and oscillation resulting in decreased pain, increased flow of nutrients into the joint space, and early joint mobilization. Many shoulder protocols suggest that weight may be added to these pendulum exercises as rehabilitation progresses, however, very few guidelines exist to stipulate how much weight should be added. OBJECTIVES: To determine if added weight affected the subject's ability to relax the shoulder musculature during pendulum exercises. METHODS: Twenty-six participants, ages 20 to 56 years old (mean 32.26, ± 8.51 years) were divided into two groups, nine pathological and 17 non-pathological. The muscle activity (EMG) of four variations of Codman's pendulum exercises 1) wrist suspended 1.5 kg weighted-ball, 2) hand-held 1.5 kg dumbbell, 3) hand-held 1.5 kg weighted-ball, and 4) no weight were recorded in each muscle. RESULTS: When grouped across all patients and all other factors included in the ANOVA, the type of pendulum exercise did not have a significant effect on shoulder EMG activity regardless of patient population or muscle tested. Generally, the supraspinatus/upper trapezius muscle activity was significantly higher than the deltoid and infraspinatus activity - especially in the patients with pathological shoulders CONCLUSION: Performing the exercises with added weight did not result in significant increased shoulder EMG activity for the deltoid and infraspinatus muscles in subjects with and without shoulder pathology. However, patients with shoulder pathology had greater difficulty relaxing their supaspinatus/upper trapezius muscle group during Codman's pendulum exercises than healthy subjects.
