Exercise and Rehabilitation
Phase I
A. Ice massage with hip abducted and externally rotated as far as possible. Perform before and after exercise and as often as possible between exercise sessions.
B. Mild hip spica compression wrap for initial 48 - 72 hours.
C. Mild muscle relaxant medication as prescribed by physician.
D. Static groin stretching exercises as tolerated 4 - 5 times daily. Each stretch should be held for 15 - 30 seconds. DO NOT BOUNCE.
E. Stationary Bicycle riding with seat as low as possible at a low to moderate intensity.
Supine Groin Stretch: While lying on back with knees bend
and soles of feet together, relax and allow gravity to stretch
groin area.
Sitting Groin Stretch: Sitting on floor, put soles of feet together with hand and pull heels towards body. Gently pull upper body forward until a stretch is felt in the groin area. You may also push down on the knees with elbows to intensify stretch.
Wall Stretch: Start with legs elevated and close together against a wall. Slowly separate legs with heels in contact with the wall until an easy stretch is felt. Slowly squeeze legs together . Repeat.
Sit and Reach: Sit on floor with legs straight and spread shoulder width apart or greater. With a flat back reach across body with leg hand to right foot to feel a comfortable stretch. Alternate and repeat to left side.
Lunge Stretch: Kneel on left knee with foot turned to inside. The right knee should be bent to 90° angle. Put hand on floor to inside of upper body. Move hips downward to stretch inside of right groin. Alternate and repeat.
Advanced Groin Stretch: Place one leg on edge of a table with opposite leg spread as far as possible and on ground. Slowly lean upper body to side of the leg on the ground. Hold and repeat to other side.
Quad Stretch: While standing, grasp top of right foot with left hand and gently pull heel with left hand toward buttocks. Hold and repeat with other leg.
PNF (Facilitated stretching): A partner will help by gently pressing the knees outward. Be careful to not overstretch.
PHASE II
A. Begin moist heat application before exercise after danger of internal bleeding has passed (2 – 4 days).
B. Begin physician prescribed ultrasound with or without electrical muscle stimulation before exercise when danger of internal bleeding has passed.
C. Continue stretching.
E. Begin Groin Strengthening Exercises:
1) Straight Leg Raises:
a) Adduction
b) Abduction
c) Supine
d) Prone
2) Hip Flexion:
Sit on edge of table with feet resting on floor. Lift involved leg towards chest. Hold and slowly lower to beginning position. Repeat 30 times, increasing repetitions as strength improves.
3) Hip Internal/External Rotation:
Sit on edge of firm surface with feet suspended above floor. Rotate thigh
about the axis of the hip, turning lower leg slowly inside as far as possible
then turn to outside slowly. Repeat 30 times, increasing repetitions as
strength improves.
4) Ball Squeeze:
Sit on edge of chair, place 8” - 10” ball between knees. Slowly contract groin muscles, squeezing ball as tightly as possible and hld for 5 - 10 seconds. Relax and repeat 30 times.
5) Front Step-Ups:
Stand directly behind a 4” - 6” box or step. Step up on box with involved leg followed by uninvolved leg. Step down with involved leg followed by uninvolved leg. Repeat. Progress by increasing repetitions then step height.
F. Begin interval work on stationary bicycle.
G. Begin light jogging on smooth, straight surface.
H. Begin stair climbing exercises, increasing step height as tolerated.
I. Ice massage after exercises.
J. Progress to Phase III when Phase II can be completed with little or no discomfort.
Note: During all exertional activities a hip spica compression wrap should be worn.
Progression for weighted activities (# 1 - 3 above)
Phase III
A. Continue all activities from Phase II
B. Progress strengthening exercises as tolerated.
C. Begin functional activities to tolerance:
1) Carioca,
2) High Knee Running,
3) Backward Running,
4) Bounding Drills,
5) Vertical leaps progressing to horizontal jumping, and
6) Sprinting with running starts and coast-through stops.
D. Return to full activities as tolerated when Phase III can be completed with little or no discomfort and bilateral groin strength is equal.