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  • Help with likely adductor strain

    Hey Doctors,

    I'm am really hoping you can help me out with this. I keep injuring what I assume is my adductor and it's getting me down.

    Training history: 8 years serious. 1RM's: Squat 185kg, Bench 132.5kg. DL 220kg. Weight: 98kg. 39 yrs old.

    Background: I first injured what I assume to be my adductor 2 years ago, likely with a recovery/intensity mismatch. It took me a good 12 months to regain 90% of my progress with the first 6 moths of that being limited to only squatting roughly 60kg without pain. I reinjured it again (less severely this time) about 3 months ago this time likely due to a recovery/volume mismatch (I did A LOT of squatting at 100kg for a Xmas challenge) or perhaps a technique change (I was starting to widen my stance out again because everything was feeling good and historically I've always squatted better that way). And then, today, I have tweaked it again (immediate sharp pain which dissapated quickly) while doing warmup 5's at a stupidly low RPE of 5 or 6, I stopped straight away, possibly due to paranoia, and feel like I need to re-evaluate everything.

    The most irritating part of this is the lack of warning signs... on all 3 occasions, there was no sign of discomfort or fatigue before the injuries occurred.

    The painful bit: It is located on the inside of the thigh in a muscle that runs from beside the scrotum to the medial side of the knee. The pain itself is about halfway between these points, however the entire structure always feels 'tight' and I am getting a mild snapping sensation from high in the groin (like a tendon is rolling over something) when squatting but also when my leg and torso are at 90 degrees (like a straight leg deadlift).

    Things that make it worse: Fast powerful concentrics (it seems a little better if the squatting/deadlifting is slower and smoother but that could be due to less weight). Wider stance. Pushing forcefully into the floor on a conventional deadlift. Anything that resembles a sumo stance.

    Things that make it better: Squatting narrow takes some stress off the area (however, I have longer femurs and this tends to pitch me forwards a bit more than I would like). Smooth, tempo like work (2 down, 1 pause, 2 up) doesn't seem to hurt as much but is kind of less specific and self limiting. Deadlifting from 3" blocks (ie: no leg drive)

    Questions:

    What is the best way to go about rehabbing this?
    How can I stop it from happening again?
    Are there any specific exercises I can do to strengthen the area?

    Please halp! I would really like to make some progress and not constantly feel like I'm going backwards. The only thing stopping me from going completely insane is the fact that my bench is slowly and steadily increasing.

    P.S: I have seen an MD here in Australia (after the 1st occurance) but got the standard response: stop lifting weights, start stretching and by the way take these opiates for the pain... For the record, I didn't follow any of these recommendations...

    P.P.S: I have been bingeing the podcasts and really liking them. It's nice to see some discussions based on something other than 'beliefs' or anecdotes...
    Last edited by Blocky; 03-22-2019, 05:57 AM.

  • #2
    Update:

    Did a little bit of lower body stuff just to explore what I can and can't get away with.

    I am able to leg press moderate weights (narrower stance) with no discomfort at all.
    No problems with using the 45 degree back extension, but pulling from the floor is not cool.
    Did about 15 sets of 5 squats, starting with 0kg and finished with 3 x 5 at 40kg with no problems (it's only 100kg less than my 5RM... no big deal... sigh). Should I hang out at 40kg and add volume? or should I progress up with a 3 x 5 and add 2.5-5kg per session?

    Cheers,

    Blocky

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    • #3
      I ended up raising weight on the bar a little bit AND adding an extra set... but I didn't respond as well as I wpould have liked so I'm just going to stay at this weight and add volume until the adductor feels vulnerable.

      Comment


      • #4
        Hi Blocky,

        I'm sorry to hear about the adductor issue you've been dealing with. I've been recovering from a similar injury the past few months and I'm almost back to full strength with the help of Dr. Miles and Dr. Ray. Here are some strategies you can try implementing into your training:

        -Reduce loads with the squat and utilize a 3-0-3 tempo (2 weeks of 12s, 2 weeks of 10s, 2 weeks of 8's, 2 weeks of 6's, 2 weeks of 6's with normal tempo for example). The higher reps and tempo will naturally limit the amount of weight on the bar
        -Work up to a top set at RPE 8 or so, limiting the total number of sets to 6 (includes all warmups).
        -Add in a single leg movement (DB split squat, unilateral leg press, etc. - train both sides) as well as an adductor specific exercise (adductor machine if you have access) to help introduce some more specific loading to the area using the same protocol (tempo and higher reps) as above. Limit the number of sets to 3-4 with these (includes all warmups)
        -Gradually work your way back up with tolerable levels of symptoms (meaning they don't increase drastically during the session or 24 hours afterward to the point where you're unable to perform activities of daily living). If they do that's ok. This simply means you weren't able to tolerate the dose of training on that day, and a reduction in load is likely indicated.

        If you don't have access to an adductor machine, you can try implementing the copenhagen adductor exercise depicted below: Click image for larger version

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        The top row is the most challenging; try starting with the bottom row (1A/1B) and progressing as tolerated. You don't necessarily need a partner for these as shown in the image. You can set this up with a box or putting a bar in the squat rack and looping a yoga mat around it. Start out with 1 set of 10 to 15 each side on lower body training days. Once you're able to consistently perform 1-3 sets of 15 each side, progress to the next row.

        Hope that helps!

        If you would like more specific guidance with the issue, you can set up a consultation with Dr. Miles or Dr. Ray here: https://www.barbellmedicine.com/consults-and-contact/
        Attached Files

        Comment


        • #5
          Thanks Charlie,

          Great info... sounds like I'm on the right track.

          I've been squatting twice a week, one day of 5's (total reps around 25-30) and 1 day of 8's (24 reps), just adding a few kilo's each week (I haven't been specifically been keeping track of tempo, but they ARE a lot slower than normal with no bounce in the bottom). Today was the first day that everything felt good but I still limited myself to a small increase. I have also been doing some lunges and single leg pressing. I've also kept up deadlifting from blocks and my e1RM is still around 90% of my best 1RM.

          I did try the copenhagen adduction movement... but the leg feels super vulnerable in that position (literally feels like something is about to rip apart). Unfortunately, I'm in a home gym and don't have an adduction machine. I could probably do the 1A version without too much problem.

          I think the major issue is that the symptoms don't seem to come on gradually during a session... squatting is good, good, good, broken... literally no warning signs on all 3 occurences - just got half way up on the squat and then fell down.

          Thanks for the help though,

          Cheers,
          Blocky

          Comment


          • #6
            Blocky,
            This is actually very common for your complaint of "good, good, good, broken." This is part of the issue with reoccurrence of strains and one of the instances where people feel good before they are physiologically good. I would recommend trying the adductor protocol. If you think about it in terms of daily living versus training you daily living activities are likely WAY subthreshold of what your strength is, this is why it is easy to do things around the house. Once you start training though, you start creeping up on your capacity until you exceed it. We have evidence from hamstring strains that cross sectional area is still 20% less and strength 10% less from side to side at return to sport. The same could likely be said for adductor strains. Trying to run up to 90% of best 1RM would likely put you right at capacity for that 10% deficit. If you're running the adductor exercises, you can use that as a subjective way of assessing strength side to side i.e. if 10 reps is an 8 on the strained leg and and 4 on the other side, chances are you're not quite ready to run 90% 1RM.

            Comment


            • #7
              Thanks Doc,

              My squatting is currently sitting at 5's at 40% of 5RM with gradual weekly increases. My deadlifting is from blocks in a higher hip position which 'seems' to be all hamstring and doesn't bother my leg at all (and the bulk of the work is around 70% for 5's). Leg pressing also 'seems' to be fine with regards to the adductor but I'm using a narrower foot position.

              I'm going to get right on the adductor series. What kind of frequency should I be aiming for? I'm currently training squats and deadlifts twice weekly, but I've got the time to spare if I should be doing the adductor exercises daily or every 2 days.

              Cheers,
              Blocky

              Comment


              • #8
                I would start with 3x/week for the adductor series. Normally I'll have this in programming 2x/week for at least 8 weeks and keep the exercise in as part of a GPP day or supplemental exercise beyond that. If something has been shown to be protective and someone has a history of injury to that area, I'm inclined to keep it around. Especially if it is not a large time consumer and is relatively easy to perform.

                Comment


                • #9
                  Thanks,

                  I figured out a way to do all the copenhagen variations using a dip belt (around the thigh) and some chain in the powe rack. There is a noticeable discrepency between legs BUT both legs feel pretty weak - however the 2A variation was ok and didn't hurt. I will keep chugging along and see how it goes.

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                  • #10
                    Keep us posted. The exercises are actually pretty hard regardless.

                    Comment


                    • #11
                      Originally posted by Derek Miles View Post
                      Keep us posted. The exercises are actually pretty hard regardless.
                      No kidding. At least it gives me something to focus on while I'm not lefting heavy.

                      Update:

                      Back to squatting 5's with 75kg... I've been adding a little bit of weight per session LP style.
                      Deadlifting seems good to go, still working at 70-85% painfree.

                      Questions:

                      I feel like adding weight LP style is going to become problematic soon (and I don't want to push too eagerly back into the injury zone like I have before)... how should I progress further? Should I just try and add volume at 75kg for a while (I'm already doing 5-6 sets of 5)? Maybe just slow down my weight jumps to every 2nd or 3rd session?

                      Cheers,
                      Blocky

                      Comment


                      • #12
                        Yes, moving to a jump every 2-3 sessions is more ideal than every session. I tend to cap people at RPE 8 for a few weeks just to make sure we're leaving some in the tank as things heal up. I would let that be the primary guide.

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