First FA Medical Society meeting of the season, and a really good start! This evening’s lecture looked at various aspects of Adductor Avulsion injuries, ranging from surgical management to a Physiotherapy case study.
Roald Otten (@roaldotten) began the evening off with a look at the literature surrounding the conservative management of the condition. The focus of Roald’s talk was to look at the criteria-focussed approach to groin injury rehabilitation. There were two “branches” to the rehabilitation with a “branch” and a “running branch”. There was a consistent theme of exercises in the indoor gym based rehabilitation, with the alterations being focussed around the prescription of sets, repetitions and loads performed in the exercises. The idea being to initial work on fatigue-resistance with high repetitions and low load before progressing to more functional high velocity work. The key take home points of this talk for me were;
- “Pain-controlled Repetition Maximum” may be utilised within adductor rehabilitation. Up to 2/10 pain in rehabilitation is acceptable, any more than this and we may have to decrease the load of the exercise
- Within rehabilitation we should be looking to increase tissue capacity, mimic injury mechanisms and address other risk factors such as decreased hip IR ROM
- Compression shorts may help in the complex rehabilitation case
Professor Schilders was the second speaker and he discussed the surgical management of adductor complex injuries. He tried to push us away from looking at purely the adductor longus injury, and also understanding what has happened to the Pyramidalis-anterior pubic ligament- adductor longus complex as a whole. A link to Professor Schilders’ paper discussing the PLAC anatomy can be found here- https://www.ncbi.nlm.nih.gov/pubmed/28866812 . A few bullet points to provide my summary on the talk are;
- Ensure that you are using the correct imaging sequences with sagittal and axial oblique views to be able to identify the relevant anatomy
- Is there an associated Pectineus injury? This may present clinically with difficult to perform a straight leg raise
- History taking is the most important clinical test! Is they hear a pop in a forced abduction mechanism then they need further imaging and review
Following the break Ricky O’Donoghue (@rickyod88) took the time to talk us through the step by step management of an Adductor Avulsion injury at Crystal Palace FC. I think that this was probably my favourite section of the evening with Ricky carefully explaining the process that was taken at CPFC when analysing how to produce the best rehabilitation results following an adductor injury, with a specific focus on their experiences with a surgical repair.I have tried to summarise my key points of his talk below, but this will not do it justice with a great selection of videos used by Ricky to emphasise his points;
- Testing- Are we happy that Isometric mid-range testing is appropriate to analyse whether a player is able to return to training safely? There is no eccentric or outer range component, so can we work with what we have to devise a reliable and specific test?
- Have you analysed and attempted to influence change of direction mechanics? If not then you are ignoring a major component of adductor injuries. Especially given that 60% of these injuries are sustained in closed chain mechanisms
- How are you safely intending to progress the player from planned to unplanned cutting tasks? Have a plan and a structure to your rehabilitation
Finally Dr Zafar Iqbal (@sportsdrzaf) discussed the potential medical complications that can be associated with an adductor avulsion injury. There was reflection on a number of cases of adductor avulsion injuries. The themes of these clinical cases were;
- Conservative management does not appear to provide a smooth rehabilitation process. There is likely to be set backs!
- Is surgery necessary to restore normal anatomy and force production abilities? Understand the pathology that you are working with.
As always a really enjoyable evening with some high-quality speakers. Their twitter handles are included within this article if you want to read more from them. I look forward to the next @FAMS_SE talk in November looking at load management in football.