Tag Archives: FAI ebook

Foam rolling the adductors

Lots of people foam roll, but I’ve noticed not many seem to roll their adductors (groin). It’s too bad, because I notice that when I show this to my clients at Custom Strength, that it is very clear many of them need it. Ideally, these people would also be getting manual therapy on their adductors as well, but let’s start with the easier solution, and show you a video about how to roll the adductors. It’s one of the 40+ exercise videos that  is included in my upcoming Training Around Injuries: Home Exercises for Femoro Acetabular Impingement (FAI) ebook.

The reason I’m sharing this exercise now is that a friend of mine mentioned this evening that she is having some adductor pain, that started with a pull in a game (ultimate) a couple of weeks ago. She noted it had been better but then was acting up again. I suggested seeing her massage therapist (although manual therapist – which would include physio, athletic therapist, and chiropractor would have been a better suggestion). I also suggested rest and stretching may be good options, and then went on to talk about the “why”. Just a quick note: I’m not by any means qualified to give advice about how to fix a groin strain: that’s what manual therapists and sports medicine doctors do. But I do have opinions (one of which is to see a manual therapist), and so I shared them (including the ‘go see a manual therapist’ part). Note how many times I mention ‘ see a manual therapist’ in this paragraph? By all means please do read on and do watch the foam rolling the groin video, but what’s the real best option to do when you have some unknown groin injury? Hint: go see a manual therapist or sports medicine doctor.

Health care recommendations aside, I am an exercise nerd, so of course, I also talked about why this may have happened. Now I don’t haven any idea how she moves (other than being a great ultimate player), so it really could be anything. But it made me think of a great blog article by Michael Boyle called “Understanding Sports Hernia May Mean Understanding Adduction“. You really should read it, because it’s a fantastic article, especially if you’re in the strength and conditioning or physio realm.

  • Coach Boyle notes that two of the five adductor muscles (pectineus and adductor brevis) have secondary roles  as hip flexors, although they are not strong hip flexors.
  • In the chat with my friend, I used the analogy of the spare tire on your car – it gets you there, but it’s not as good as a full tire (unless your spare is a full tire, but you know I’m referring to cars with the mini spare tire). Same deal with muscles in the body – when a muscle is doing it’s secondary job, it tends to not be as good at it. If you continue driving on the spare tire, it’s going to either seriously limit your speed, or it’s going to blow. Same goes for when a muscle is consistently asked to do it’s secondary function in addition to it’s main function.
  • Coach Boyle is talking about hockey and soccer athletes, where the skating stride and kicking motion both involve adduction and hip flexion, thus potentially pectineus and/or adductor brevis are being asked to work overtime.
  • Ultimate doesn’t have exactly the same thing, but I don’t think anyone will dispute that the cutting and pivoting we do will involve both hip flexion and adduction. So perhaps the same story.
  • One very interesting point Coach Boyle notes: that the two cases of sports hernias he refers to both seemed to have also involved soft tissue restrictions in the pectineus. Which is what lead to Coach Boyle coming up with that theory.
  • He goes on to describe what the physical therapist he was working with described as “benign neglect”, where the symptoms of an injury go away and thus the assumption is that the problem is gone. Apparently not!

Which brings us back to my point above: go see a manual therapist when you get a groin pull. But also try foam rolling it, like so:

Make sure you check out part 2 of Coach Boyle’s Understanding Sports Hernia article, where he talks about prevention and shares a tonne of knowledge including many, many amazing exercises.

This is also serving as a reminder that I’ve been meaning to bring in more weighted lateral squat variations for my clients who play ultimate. It’s funny how sometimes several things remind you of the same thing within a few days, even though you hadn’t considered it in a while. In addition to this discussion (and my re-reading these articles), I also saw the following excellent Eric Cressey video the other day that made me think “why aren’t we doing that at Custom Strength?” Those clients of mine who are reading this, if you’re an ultimate player, and if your hips tolerate lateral squats, you’ll be seeing these soon!

 

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer at Custom Strength in Ottawa, Canada. 

For more on my upcoming hip training ebook, head over to this post titled, My experience with hip injuries and FAI.

My experience with hip injuries and FAI

I’m not sure how many of my friends and readers are aware that I spent many, many years enduring pretty bad hip pain. I don’t want to know how much I spent in the 90s and 2000s on physio, chiro, athletic therapy, massage, acupuncture…, but let’s say it’s most likely a 5 figure number. There was also the slow transition from irregular drug use, to regular Advil (those of you who just said ‘Vitamin I‘ in your head know what I’m talking about), and then to Celebrex.

Through that time, I continued to play lots of sports and just suck up the pain. I think that’s why I get a little smirk on my face when one of my clients tells me that their (hip, knee, back, shoulder…) hurts but no they haven’t stopped playing. It’s not smart, but I get it.

It wasn’t until the mid 2000s, that I figured out how to work out properly. That’s also when I figured out that some of the exercises I had been doing, (like 350 pound partial squats) was most likely contributing to my hip problems.

That was also about the time that I got a diagnosis of femoro acetabular impingement (FAI) and a labral tear. Up until then my doctors had just called them groin strains, with no explanation for why I kept getting them.

As I learned more about how to work out properly, and got great treatments from a couple of fantastic local manual therapists, my hip bothered me much, much less.  But when I played my favourite sports (skiing and ultimate), or took long car or plane rides, it felt pretty awful. Eventually I stopped doing both sports, and opted to have surgery. What a great decision that was, as I’m now 5 years out from surgery and have returned to skiing and ultimate without pain.

I’m not one to take a great outcome for granted: I worked my butt off to rehab after surgery, and I still train 2-4 times per week and include a series of “corrective exercises” for my hip. I also avoid movements that my hip doesn’t like – squats for instance. Maybe my hip would still be fine without this training, but I keep thinking back to some research that Gray Cook (creator of the Functional Movement Screen) noted about how once you’ve had an injury you’re more than 9 times more likely to have a re-injury, and to the outcome studies I had read that showed surgery for FAI had very poor results after 2 years if there was arthritis present at the time of surgery (I had “full thickness cartilage loss” in part of my joint). I would like to continue skiing into at least my 80s, which means I need to keep my hip working well.

As you can imagine, a geek like me who is also a trainer and has personal experience with a hip injury, probably has accumulated (and retained) a lot of knowledge about training around hip injuries. Indeed I have! In fact I get many client referrals for this very reason. In a few cases, I’ve helped clients avoid surgery for FAI, while in others I’ve helped get them strong before surgery and helped them return to activity post-surgery. I also train a lot of clients post-hip replacement, as the “what to do” and “what not to do” is very similar.

About 5 years ago I also started writing an ebook on the subject. I went around in circles for quite a while – at one point it got so big it was going to be the FAI bible. But then I cut out most of that because I realized simplicity is almost always better. Figure out what I have to offer that’s special, and offer it. And so I have. And I’m excited to say that “Training Around Injuries: Home Exercises for Femoro Acetabular Impingement” is written and available here. Not only is it written – it’s also filmed! There are links from the ebook to video playlists showing each of the exercises in the ebook.

Home Exercises for FAI

With that, I’ll also be posting more blog posts about FAI, including some of the content that I cut from the ebook, but that I think you’ll still find interesting: Things like statistics about the prevalence of FAI, and theories about contributors to FAI. It’s a pretty interesting area. The only reason I cut it from the book is that it’s still something of an unknown, which means this is theoretical, and to a certain extent controversial.  In my mind, it was important that the book was not controversial, but rather simply: helpful.

Elsbeth Vaino, B.Sc., CSCS, is a personal trainer in Ottawa with both personal and professional experience with hip disorders.

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Other posts that may be of interest
Why do you have FAI?
My personal experience with FAI
6 Exercises for low back pain
Foam rolling the adductors