Groin Pain with Iyad Salloum

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in Burnaby, British Columbia, and we're gonna talk about groin pain. How you doing Iyad? 

Iyad: Good, Mark. How are you doing? 

Mark: I'm all right. It's a new year. The snow is falling. It's cold. Welcome to BC. So, groin pain? What's the deal with groin pain? 

Iyad: So this is such a big injury, or let's say, call it complaint, because it could be caused by so many different things. And the remarkable part about it is that whatever your age group, you can have a different cause or contributor of groin pain. So, for example, we see this in some pediatric groups when they're playing too many sports or sometimes after a trauma.

Like, we're talking like really young kids in the age of like 8 to 12 sometimes. And then we could see it also in our very, very elderly population due to changes in the joint. And then everything in between. You could see it, for example, in athletics and sports. Pretty common to have groin pain in hockey and soccer.

And I think it's really important to identify what type of injury potentially you're dealing with or what type of mechanism is causing that groin pain and then kind of devise the proper treatment because of that. Because if I had somebody who's, for example, between 8 and 12 and unable to weight bear because of their hip pain and groin pain, I'd wanna get that looked at to make sure we're not dealing with any injury to the growth plate or injury to the femoral neck, which can be pretty serious. So we would definitely like, wanna rule that out first. 

And then if it's somebody who's, let's say a little older, playing a lot of sports, we can just look at lots of things from volume of activity to quality of movement to potential, like how much can their tissues actually handle and how much are they actually using them? And then kind of work our way up. And in cases where we're dealing with, let's say, an advanced arthritis case of the hip, we can still do quite a bit with exercise. However, sometimes we also have to kind of work closely with our medical colleagues or even consider surgical options. If it's, let's say a bit too developed and a bit too advanced. 

Mark: So I guess the first question is, can I just solve all this issue with stretching? 

Iyad: That's a really good question. And the answer is no. Rarely do we see actually stretching be the only thing you would use. Most of the time, it gets really funny. Depends on the type of groin pain. Like, so sometimes it could be helpful and it could be a useful tool to get out of symptoms, but also to kind of re-expose the, let's say the affected area to a bit of stress.

Cause the stretching is not considered necessarily like a really high load through those musculature, through the joint. But in some cases, for example, if I have somebody that could get provoked with stretching, you know, that's where we usually see clients who've had this for a few months and then they're like, okay, that's it. I can't cope with this anymore. And they try some DIY versions of stretches that they find online. And those stretches could be helpful if you were dealing with just the musculature, for example. That's just a bit maybe not exposed to different lengths, and then you're like, oh, it feels really good when I stretch.

However, in those cases when they do this, like, yeah, I actually notice that sometimes stretching can make it a bit more sore. And that's where I can just say a blanket yes, the stretching is probably a no-go in this case. 

Mark: What about hernias? 

Iyad: Yeah, so that's actually one of the things we would wanna look at because there's a lot happening in the front of your hip and thigh and kind of lower abdomen. So you know, you can have a hernia potentially. That could be a reason. There are some tests that we would use to just kind of, even if we're suspecting that, we would then refer on to our medical colleagues for some confirmation.

 And then like the treatment for a hernia is gonna be a lot different than if we have, for example one of our hip flexors in the front of the thigh tendinopathy there, where we'd wanna load it a bit more gradually, you know what I mean? Meanwhile, the hernia, we would wanna maybe modify some of the exercises so that we don't exacerbate their conditions.

This is why I thought would be useful for us to talk about it because I feel like there's just a lot of unknowns when it comes to groin pain and we're learning more and more about it every day. I've seen a few resources online saying, oh, if you have groin pain, do this. And I feel like that's where we're probably missing the mark a bit because groin pain is a symptom. It's not an injury specifically. And we have multiple things. We call them like these diagnostic entities. So we have like a hip flexor related issue, a hip joint related issue. You have, for example, an inguinal region, which would be usually associated with the hernia related issue. And then you have the adductors, which are your inner thigh muscles. It could be related to that too. 

So there's like, these are the big four major entities. And then we look at also potentially, does this person have a low back condition that's referring to the front of the hip. Any of those things. So that's where it's good to have a set of eyes on it and just kind of get the right idea of what you're dealing with so you can actually intervene with it appropriately. Because sometimes it could be felt of the hip, but not caused by the hip, if it's the low back, for example.

Mark: So how often is it an issue of over-training or not proper warming up or whatever that issue is that, like you've alluded to versus mm-hmm. an imbalance, which we see often in other parts of pain issues that people have. 

Iyad: So generally speaking, I'd say the over-training could be, let's call it actually training errors, like more than over training specifically, cuz sometimes under training and then the return to normal could be just as bad as a contributor.

So in certain age groups, I'd say if you're not looking at non-traumatic causes like somebody didn't get, you know, a big fall that landed on the hip or like a big impact in like a collision sport or anything like that. You could see a big proportion of those being caused by that.

And then in some cases it could be like a prolonged slow buildup. Like in the case of, let's say hip arthritis, that's just kind of developed a bit over years and years and years. So in that case, it's hard for us to just pinpoint and say it's over training alone. Cuz there's a lot of factors that go into it, like your metabolic health, your body weight, inflammation in the body could also contribute to this.

If you had small, repetitive, old injuries and they didn't get a chance to heal properly, that could also potentially predispose you, along with this overtraining. That could be, for example, what made you feel it. But it's highly unlikely to say that, oh, you ran once and that's why your hip has become arthritic. Because that doesn't hold up. You know, running isn't necessarily bad for you. It's actually quite good. But as if anything, you do too much of something all at once, it might make you a bit more likely to be sore and maybe need to come into one of our offices to see what we could do about it.

Mark: So when you're prescribing, once you've diagnosed exactly what the root cause is of the pain, mm-hmm, or it could be multiple issues, I'm sure. Yes. Then what's the typical course of treatment look like? 

Iyad: So a great question. Again, it depends on what are you trying to get back to. If you are just like, Hey, I just need to be able to walk around the block and be able to run my chores, do my errands, that kinda thing. And that's gonna be a very different thing than if you're, let's say, div one soccer player that needs to be able to sprint at high speeds repeatedly, cut and change direction. You know, so the demands will be very different. 

The other thing that really determines this is also like, you know, what level are you coming in with? For example, if you have these goals that you wanna be able to get to and you're let's say under loaded and rested too long, then the buildup time's gonna have to be a bit longer, obviously, than somebody who has tried to stay active with the injury. That's typically what we would try to do. Our first approach would be activity modification to try to keep up as much of your load tolerance and your capacity as possible. And then we can kind of add more sequentially or gradually on that. 

And then sometimes we would also need to maybe talk about changing certain habits. So we could do some gateway training, for example. Play with that, which we talked about previously, like the gateway training could just be like changing the mechanic of it, which it might not fix all of it, but it can definitely make you get more mileage out of what you currently have. And then kind of continue training instead of having to completely stop.

And that's usually the biggest issue is we stop too long, we lose capacity. And then we try to go back into it and then, you know, we're like, oh my God, it's flared up now with a lot less. Even though when we stop, it feels good when it settles down and you're feeling normal. But then the second you go back at it again, you're like, oh wow, it's sore again.

So we think we reaggravated it, but in reality, your tolerance was here, you rested. So it dropped a bit. And then you try to go up again. Well, now your tolerance has been lower because you've just been doing nothing. And then that's kind of a vicious cycle where we rest and spike up too much.

Mark: Timeframe to heal?

Iyad: Very good question too. It really depends what we're dealing with and it really depends what we're working towards. So I'd say anywhere from four weeks to eight, six months to a year, it really depends. I think we're looking at different things. 

So for example, if we're dealing with something with, it depends on something called irritability. Like, you know, that's a really good thing to kind of look at. It's like, well, how long into your activity does it get bothered in? So if you're the kind of person who I feel at a 10 K of running, you know, that outcome's gonna be so different. And if somebody else is I feel it in my first three steps. So that sensitivity level really matters. 

And then also healing and in that sense is the very different in these injuries cuz it's all about how much tolerance can we build up to get you to your goal. So giving a blanket term doesn't make sense. Most tendons, for example, that we're dealing around the groin, will take about 12 weeks of a good loading program to kind of be able to handle that strain and stress. So that's probably like as specific as I could be with you in the absence of all the important pieces that we could use to frame this.

Mark: Of course. Well, if you've got a lot of pain in your hip, the guys to see in Burnaby, North Burnaby are Insync physio. You can book online at insyncphysio.com. You can call the office to book (604) 298-4878. You better call and book if you've got pain. They'll get you feeling better as quickly as possible because they will diagnose the root cause of what's going on. Thanks, Iyad. 

Iyad: Thank you.