• Groin and Low back Pain Caused by the Iliopsoas Muscle

  By Juliette Woodruff, Registered Massage Therapist

  The term iliopsoas refers to a group of muscles which have a primary function of bending the hip. Although referred to with one name, iliopsoas is actually comprised of three muscles: the psoas major, psoas minor, and iliacus. These muscles attach to both the spine and thigh bone and work in opposition to the gluteal (buttock) muscles. In balance they provide the basic strength required for hip movement activities like walking, as well as playing a significant role in maintaining upright posture. Any tightness or shortening of iliopsoas disturbs the balance resulting in low back and groin pain, as well as creating a series of other symptoms.

  What causes iliopsoas pain?

  • An overactive iliopsoas muscle: When your spine and legs are continuously in a flexed position (e.g., sitting at a desk or in a vehicle for prolonged periods of time or from repeatedly lifting heavy objects, etc.) the iliopsoas muscle may shorten and the gluteal muscles at the back of the hip may stretch. Pain is caused from the over-activity in the iliopsoas muscle and the alterations to the body’s movement patterns
  • Iliacus Tunnel Syndrome: This may occur after surgery to the pelvis (e.g. hernias, etc.) causes a shortening of the muscles (contracture) and a build up of scar tissue in the iliopsoas muscle. Sometimes this scar tissue can trap the femoral nerve and cause iliacus tunnel syndrome resulting in a reduction in sensation extending from the inner thigh down to the foot. If may also become difficult to straighten the knee due to a lack of strength in the thigh muscles.
  • Meralgia Paresthetica: is a condition that irritates a sensory nerve called the Lateral Cutaneous. Tight clothing, direct trauma (e.g. seat belt trauma), abdominal surgery, obesity, or deep bruising are all common causes which can lead to a shortening of the iliopsoas muscle (contracture) and tension on this nerve. This condition can result in a reduction in sensation or a burning located along the outer aspect of the thigh. Over the long term compression of this nerve can cause skin changes as well as a loss of hair on the affected leg.

What are symptoms of an over active iliopsoas muscle?

• Pain in your groin area when executing activities that place high demands on the thigh (e.g., walking, hockey, soccer, running, gymnastics, ballet, etc.)
• Pain across your back or down the front of your leg
• A feeling of heaviness in your legs
• Clicking or pain in your groin
• Difficulty straightening your leg
• Pain after sitting for long periods of time

How should iliopsoas pain be treated?

Physiotherapy and massage treatment are both beneficial to rehabilitate the gluteal muscles and to reduce the reoccurrence of tight psoas muscle. Strengthening the muscles that are weak is an essential part of recovery. Exercises should be directed at building the abdominal muscles to stabilize the spine. Other specific structures which should be addressed depend on the condition and the strength of the muscles. A qualified physiotherapist can determine which muscles should be targeted.

Massage can aid in a quicker recovery from injury as well as help to decrease the pain. It enhances the circulation, assists in the healing process, increases the range of motion, decreases the pain and reduces the formation of adhesions in the injured tissue. Massage can be used to assist you in participating in your exercise program by reducing the discomfort and enabling you to move better by improving your range of motion through lengthening of the tissue. Massage therapy can also allow the muscle to gain power by reducing the trigger points in the muscle (irritable area within a muscle).

Many athletes as well as other clients may suffer from the psychological effect of their injuries. Post-injury reactive depression will have a negative impact on the healing process. Massage therapy treatments can aid in reducing stress.

Treatment of a tight Iliopsoas can also benefit other conditions (e.g., degenerative disc disease, lordosis, scoliosis, faulty posture, etc.). The lengthening of this muscle helps to re-align the spine, allowing the hip to extend more fully and to reduce faulty posture.

Juliette Woodruff is a registered massage therapist at the Orthopaedic Therapy Clinic. She has over 6 years of experience in providing treatment for back pain and muscle tightness.

• Olympic Gold Medalist Overcomes Multiple ACL Injuries

  By: Mark Duggan Registered Physiotherapist

  Olympic snowboarding gold medalist Maelle Ricker has travelled a long road from 8 knee operations, including multiple ACL ruptures, becoming an Olympic Champion. She is one example of an alarming statistic showing that young female athletes are 4-6 times more likely to sustain a sports related ACL injury of the knee as compared to males in similar sports. This heightened risk for females has led the International Olympic Committee to release a position statement on the current causes and treatment and future areas for research related to ACL injuries in young females. An ACL injury is a devastating injury requiring up to a year of rehabilitation, before a return to normal physical activity. There is also a very high risk of developing knee osteoarthritis 10-15 years following this type of injury. The good news is there is scientific proof that a specifically designed exercise program and preseason assessment by a physiotherapist can help reduce the risk of an ACL injury and its life changing consequences. As in Maelle Ricker’s case with the proper rehab you may be even able to continue to compete at a high level of physical activity.

  What is the ACL?

  The ACL is a ligament in the knee which runs from the shin bone (tibia) to the thigh bone (femur). Its job is to help stabilize the knee and to prevent excessive forward movement of the shin bone away from the thigh bone. Injuries range from minor overstretching to tearing or a complete rupture of the ligament. These injuries should be evaluated by a physiotherapist or an orthopaedic specialist to determine the severity and appropriate treatment. Depending on the severity, the knee can be more unstable and prone to repetitive trauma after these injuries.

  Why are females more at risk than males for an ACL injury?

  At this time the reasons why females are more at risk for theses injuries are not fully understood and are likely quite complex. However, factors such as bone size, bone shape and hormone differences have all been proposed to add to this risk. Research has also shown that females use different muscles and body positions when jumping and moving and these altered movement patterns may be what increases the risk of an ACL injury.

  How can ACL injuries be reduced?

  Risk factors such as bone size and hormone levels cannot be changed but how someone jumps and moves can be corrected and improved by a knowledgeable physiotherapist. Prevention is best achieved through learning how to land a jump properly and how to move quickly in ways which reduce the stress on the ACL. Incorporating exercises that focus on strengthening of the trunk and legs, balance training and agility drills are also beneficial. These programs can easily be incorporated into practices, training sessions or warm ups.

  Who should participate in a prevention program?

  The risk of ACL injury is particularly high for adolescent females, ages of 14-19 who are involved in sports with quick stopping and cutting movements such as soccer, basketball, downhill skiing, and snowboarding. These are the young female athletes who should be targeted to participate in an appropriately designed prevention program. It is also recommended that a physiotherapist performs a preseason screening examination to help identify risk factors such as poor muscle strength and flexibility which also can lead to injury. The bottom line is that with the proper evaluation and instruction young girls can reduce their risk of an ACL injury in sports and the devastating long term effects on their physical health.

  For further information about ACL injuries, injury prevention programs or preseason screening evaluation please contact physiotherapist Mark Duggan, who has over nine years experience in orthopaedic and sports injury rehabilitation.

• Announcement – New Kinesiology, Personal Training, Relaxation Services through our Certified Exercise Physiologist @ The Orthopaedic Therapy Clinic

  At the Orthopaedic Therapy Clinic we have found that the three pillars for the successful resolution of your injury include:

  1. direct treatment for your injury,
  2. exercises and movement re-patterning to resolve post-injury weaknesses and restrictions
  3. restoration &/or retention of fitness.

  In our continuing effort to improve services and further integrate our approach to rehabilitation, we are pleased to announce that Nami Osakabe Certified Kinesiologist (C.K., CSEP-CEP, M.Sc.Kin., B.Sc.Kin., Hons) P has joined our team and we are now offering in-house Kinesiology services.

  Nami is a graduate of York University and holds a Masters degree in Kinesiology. She also holds a certification as an Exercise Physiologist and Relaxation Instructor. Her graduate studies included training for people with diabetes, asthma, weight loss and back pain. She has provided fitness testing to the entry draft combines and the NHL Toronto Maple Leaf Hockey Players. She was a personal trainer with the Human Performance and Research Lab at York University. Her article on high intensity training has recently been accepted for publication in the Canadian Health and Fitness Journal.

  We are excited by the background and skills that Nami brings to our clinic. This addition to our team will enhance our expertise in providing exercise physiology and physical training in the presence of injuries, as well as providing training where other health conditions are an issue. Having Nami onsite will facilitate The Orthopaedic Therapy Clinic’s team approach by ensuring that your need for fitness is balanced with a view to injury prevention.

  When should you use Kinesiology training services?

  when you have an injury and have not been able to maintain fitness without re-injuring
  when you are returning to training after injury or illness.

  Days and location of the Kinesiology training service:

  These services are available on Monday Wednesday and Friday, onsite at the Orthopaedic Therapy Clinic. As our team approach integrates, this availability will be increased and the service may also be extended into your home.

  Nami can design independent fitness programs or work with you on a regular basis in our clinic to achieve your fitness goals.

  Appointments can be booked through our front desk or by calling 416-925-4687

  Initial sessions last one hour and include fitness quantification testing as well as program design. Follow-up appointments may be booked for either 30 minutes or one hour depending on your specific goals.