Adductor Case Study Update

Progress on NHL athlete.

Source.

Quick Context

The adductor case is ongoing, and we want to share the latest developments with our subscribers. To provide context, the athlete, a hockey player, initially suffered a grade one adductor longus tear. The initial strategy involved a combination of manual therapy and eccentrics in the Copenhagen position, alongside cardiovascular training on the Keiser bike. However, a follow-up MRI revealed a worsening of the adductor longus tear at the four-week mark of employing these interventions. At this point, we took over the management of the athlete for return to performance.

For more specific context on this case, watch the discussion below:

Current Physical State

Hip Joint at Point B

The physical assessment of the hip joint using standardized positions (IR/ER) as demonstrated in FRA, as well as sport-specific positions in the skating stance, revealed no signs of an early capsular barrier or neurological tightness of the deep tissues. Both the ranges of motion and the length-to-tension ratio, which reflects connective tissue behavior, are within normal parameters. This objective information indicates that the hip is within a state of function and can otherwise be considered as an efficient contributor to overall system function. In Absolute nomenclature, this means the hip joint is at Point B.

Neurological Tightness in the Adductor Group

One of the valuable applications of Controlled Articular Rotations (CARs) is the ability to do them passively to gain a sense of where any rotational or linear discrepancies may exist within the workspace. During the passive on-table CARs assessment of the hip joint, neurological tightness was present within the muscular compartment of the adductor group revealing a linear limitation of the femur in abduction, obviously a necessary requirement of a hockey athlete. Specifically, when the hip was passively moved from bent knee hip flexion into the zone of abduction, the neurological tightness becomes visually evident, palpable to the assessing practitioner, and acknowledged by the athlete. While the presence of neurological tightness in the adductor group represents a significant improvement compared to the tightness at the joint level, it was anticipated considering the nature of the injury.

Epimysial Space Build-up

Palpation and subsequent tissue assessment of the adductor group revealed a lack of relative translation between the epimysial spaces of the adductor group at the attachment of the pelvis. Furthermore, the athlete complained of that area - specifically, that attachment proximal point of the adductor groups at the pelvis feeling "abnormal." The athlete stated there is abnormal tension in that area which creates apprehension in force generation and rate of force output scenarios.

Specific palpatory contacts during tissue assessment of the epimysial spaces (see images below) showed a lack of relative tissue motion of the adductor group during the passive lengthening, characterized by an increase in tension of the tissue (felt as increased resistance). From the evidence and the history of the management of this injury to date, it can be surmised that this increase in tissue resistance is most likely a "build-up of disorganized connective and adipose tissue."

Management for this finding included manual directed loading, as well as Progressive Angular Isometric Loading (PAILs) in the adductor group with the intent to stimulate the development of connective tissue architecture. Concurrent with the linear neurological tightness finding, the isometric inputs oscillated between sub-maximal force inputs for longer durations (at minimum 30 secs) as well as higher force holds for shorter durations (at maximum 12-15 secs) as the scale of force inputs was directed specifically at each finding.

At this point in time, this lack of translation in the adductor group seems to be the main limiting constraint to training, as it is the abnormal tension in this specific area that elicits apprehension in force generation and rate of force output training scenarios.

Anterior lateral adductor longus epimysial space.

Anterior medial adductor longus epimysial space.

Current Treatment and Training Strategy

The current strategy is multifaceted and sequenced in a manner that elicits cumulative multifaceted training effects - meaning: it is conjugate.