Summary of Anthony Hogan’s Groin Rehabilitation

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The first of our Advanced Lower Limb Rehabilitation in Sport course was recently held in Perth, Western Australia with a huge success.

Experienced Sports Physiotherapists Anthony Hogan, Greg Mullings & Emidio Pacecca delivered a thorough evidence based and practical two day course at the home of Rugby WA. Excellent feedback by received by all thirty plus attendees which, included representatives from the West Coast Eagles, Fremante Dockers, Essendon Bombers (AFL), Western Force, Brisbane Broncos (Rugby), and the Western Warriors (Cricket WA).

Anthony Hogan delivered a full day on Groin Injury Rehabilitation. I will provide a brief summary of Anthony’s model here however; keep a look out for our future Groin Rehabilitation courses coming to Melbourne and Adelaide in 2015 & 2016 respectively here

Anthony groin assessment

Anthony groin assessment

Session one from Anthony included a summary of the recent World Groin Injury Conference held at the Aspetar Sports Medicine Centre in Qatar. Anthony then gave a detailed look at patho-anatomy and the clinical entities of groin pain. This went much more than general anatomy. We explored the rectus abdominas- adductor longus (RA-AL) aponeurosis, nerve innervation and tracks, inguinal canal & superficial inguinal ring just to name a few.

 

 This lead Anthony to describe his own Groin Rehab Model in which is used to guide his assessment & clinical decision-making.

There are four key entities in which Anthony broke down in a simple and easy to follow method.
1) Hip (joint) related
2) Hip Flexor Related

3) Abdominal/ Inguinal Related
4) Pubic Related

4a) Adductor related
i.     Enthesis
ii.     Pubic Plate/ RA-AL aponeurosis

4b) Rectus related
i.     Enthesis

Palpation masterclass

Palpation masterclass

ii.     RA tendon- Ligament
iii.     Distal rectus Sheath

4c) Symphyseal related
i.     Isolated
ii.     Rectus- Symphyseal
iii.     Adductor Symphyseal

Anthony focused on assessment in session two. Key points to come from his assessment included:

1)   Establish likelihood of hip joint as a source of pain

2)   Establish likelihood of hip flexor as a source of groin pain

3)   Establish likelihood of inguinal as source of groin pain

4)   If squeeze at 0, 45 & 90 are pain free but complain for pain on ADL= unlikely to be pubic related

If these three entities have been ruled out, the clinician must decipher the source of the pubic related groin pain. This differential, in Anthony’s model, can be explored by a number of groin pain provocation tests. This is a systematic approach in which can also provide insight into impairments. These impairments often fall in to one of the following categories.

1)   Increased muscle tone

2)   Decreased muscle performance

3)   ROM impairments

4)   Stability impairments

Session 3 three took place in the treatment rooms on the plinths. Anthony took participants through a measured & professional approach to accurate palpation of the pubic and adductor region. This followed with the opportunity to practice the pain provocation tests from the assessment module under Anthony’s supervision. Participants found this very helpful in order consolidate what they had learned from the morning sessions.

 

Anthony demonstrating palpation

Anthony demonstrating palpation

 

Session three concluded with an open discussion on three different case studies and the role of imaging in athletic groin pain. This was great time to explore how imaging does not always match the clinical presentation and a look at when & why we would use imaging in athletic groin pain.

 

 

 Session four was solely dedicated to rehabilitation from groin pain, which was broken into six different phases with practical demonstrations of exercises and programs for each stage provided:

1)   No Running

2)   Straight Line Running

3)   Multi Directional Running

4)   Controlled Running

5)   Uncontrolled Running

6)   Return to Play

Anthony explored and discussed the following therapy options including when and when not to utilize as well as positives and negatives of each:

–       NSAIDS
–       Electrotherapy
–       ICE
–       Nutrition
–       Dry Needling
–       Manual therapy
–       Injections- CSI, PRP, prolotherapy

Throughout the rehabilitation of groin pain, it is imperative to have key re assessment tests in order to monitor the athlete’s response to loading. Anthony advocates the use of the following tests:

1)   Squeeze test to Pain or percentage of max

2)   Pubic stress test (in modified Thomas test position) OR the side bridge

3)   Hip muscle tone (Bent knee fall out)

See our recommended reading section here  for an article from Anthony on readiness to run when returning for groin injury.

The day was a comprehensive look at the ever-challenging facet of groin pain, rehabilitation and return to play. Anthony explores the intricate details required when dealing with complex longstanding groin pain making him the premier clinician of this topic in Australia. Don’t miss out on the next opportunity to learn from Anthony Hogan. See our event page for upcoming courses.

Thankfully the day concluded with a couple of relaxed beers and wine for the attendees and presenters to network and just enjoy each other’s company.

 

Nick Kane

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