4+ Month Groin Pain (Hip Flexion and Adduction)

First post here, but I’ve been on the BBM train for over three years now. I worked with Jordan for six months back in 2018 (learned a lot), attended one of your seminars (learned even more), and indulge in essentially all of your content. I leverage your programming, BPS model & pain approach, and overall behavioral change philosophy with my own clients and it serves all of us well.

Anyways, training was going very well through October 2020. I hit a few squat rep PRs (first in a few years) across the competition squat, supplemental squat 1, and supplemental squat 2 (all in one training block), and everything else was trending better than ever. Strength was up, and work capacity was VERY high. I experienced some severe groin pain the day after supplemental squat 1 (wide stance low bar squat w/ flats). I worked up to 6 @ 7, 6 @ 8, 6 @ 9, -6% to -7% x 6 x 3 sets. I track session RPE and duration; the sessions were long and tough, but nothing over sRPE @ 8.

The pain was extreme at first. I could barely get into a full ROM bodyweight squat. The next week, I extensively dropped the intensity and volume on the three squat movements. I started working with high pin squats (anything full ROM was painful) with all sorts of variations - bar position, stance width, tempo, DB goblet. I’ve exhausted all variations with the equipment I have access to. Rep ranges haven’t been less than six. Nothing above RPE 6 since then. I’ve reduced frequency via squat slots and sessions per week (also took a few week long breaks, too). I’ve reduced intensity/volume/frequency on deadlift as well (for several blocks now).

Over four months later, I’m still having issues with limited improvement in symptoms. Particularly pain in the groin during hip flexion and adduction. I notice the pain is worse if I’m lying (on a bench) and try to perform hip adduction. The pain is exceptionally sharp during something like a bodyweight lunge. Mostly pain free with above parallel pin squats at many intensities (haven’t touched a true RPE 7+).

In my most recent rehab block, I’m doing a mixture of full ROM and high pin squats (regular and wide stance), 2ct paused high bar, and swapped conventional deadlift for sumo deadlift. I do a few sets full ROM, then place the pins higher as the pain starts to become noticeable. Again, very little to no pain during above parallel pin squats. Surprisingly, I thought I started to improve with wide stance squat and sumo deadlift, but that was short lived. I’m working with sub RPE 6 loads, and adding weight every session (still sub RPE 6). Volume is 3-4 work sets at 6 reps right now. No real improvement after months of taking the right steps in every modification I can think of.

I found this old thread: Groin Pull, Pain with L Hip Flexion / Adduction. 3+ months of modified activity - Medical Q/A with Drs. Feigenbaum & Baraki - Barbell Medicine Forum

And I can relate to all of the symptoms: "Pain with resisted hip flexion and adduction. Mostly located on top inside-to-front-ish area of my left thigh. " I haven’t seen a doctor yet, but the idea has recently popped into my head as it’s been over four months, and I feel I’m doing all the right things - with very little to no success/improvement. Basically, I’m just training for the sake of training right now - just to keep moving. But I’m putting in very little work (on the squat). Similar to the thread I referenced above, I’ve become very hopeless, too. Barbell training has been a staple of my life for 14 years, and I can see my lower body atrophying with the lack of training stimulus I’m able to give it at this time. General mindset and mood is not great because of this. At times I try to embrace the recovery process, but that only lasts so long. With the limited stimulus I do exert, my body is significantly more fatigued than ever before, with all the aches and pains, and seemingly permanent DOMS.

I appreciate your time.

In strength,
Connor

Hey Connor,
Can you go into a little bit more detail as to what you have been doing for your rehab? It sounds like you had a muscle injury which sometimes needs some specific training. Particular to this injury, we just released a piece going through the hip flexor and adductor portions here. Sometimes you need to check for any residual strength deficits after the injury and put in some specific work there whether with the Copenhagen adductor exercises or reverse Nordics. I do not think those specific exercises are a panacea and you can likely accomplish the adductor work via something like a lateral lunge or adductor machine as well. Hip flexors tend to be a little harder to “isolate” but things like hanging knee raises are a good starting approach.

Thanks for the response, Derek.

Per your remark about receiving a basic dissertation in the Individualized Exercise Prescription in Pain & Rehab podcast, dissertation you will get. I included the week start dates to show that each week, on average, took far longer than 7 days, with reduced frequency.

The RPE for weeks 1-6 were more closely tied to RIR, as I was hoping the reduced volume, intensity, and frequency would significantly reduce the sensitivity where I could pick up where I left off.

Week 1: start 10/29
C-S: High Pin Squat, 8 @ 4-5 x 3 sets
S-S2: Narrow Stance High Pin High Bar Squat, 8 @ 6.5
S-S1: Wide Stance High Pin Squat, 8 @ 6

Week 2: start 11/10
C-S: High Pin Squat, 8 @ 6.5
S-S2: High Bar Squat, 7 @ 6 x 3 sets
S-S1: 3-0-3 Squat, 8 @ 6, -90# x 8

Week 3: start 11/29
C-S: Above Parallel Squat, 8 @ 6, -90# x 8 x 3 sets
S-S2: 3-2-3 High Bar Squat, 7 @ 6
S-S1: High Pin Squat, 8 @ 6

Week 4: start 12/7
C-S: 3-0-0 Squat, 8 @ 6, -95# x 8 x 2 sets
S-S2: 3-2-2 High Bar Squat, 7 @ 6
S-S1: 3-0-0 Squat, 8 @ 6.5, -100# x 8 x 2 sets

Week 5: start 12/15
C-S: 3-0-0 Squat, 8 @ 6, -90# x 8 x 3 sets
S-S2: 3-2-0 High Bar Squat, 7 @ 6.5, 7 @ 7
S-S1: 3-0-0 Squat, 8 @ 7, -235# x 8

Week 6: start 12/30
C-S: Squat, 8 @ 6.5, -100# x 8
S-S2: skip
S-S1: 2ct Paused High Bar Squat: 8 @ 7

Week 7: start 1/9
C-S: High Pin Squat: 8 @ 6
S-S2: DB Goblet Squat, 12 @ 6 x 3 sets
S-S1: High Pin High Bar Squat, 8 @ 6, 8 @ 6.5, 8 @ 7

Week 8: start 1/22
C-S: High Pin Squat, 8 @ 6 x 2 sets
S-S2: skip
S-S1: skip

Week 9: start 2/1
C-S: Squat, 5 @ 9 (stopped due to pain)
S-S2: Leg Extension, 13 @ 8 x 2 sets
S-S1: skip

Week 10: start 2/10
C-S: High Pin Squat, 6 @ 4-5 x 5 sets
S-S2: Narrow Stance DB Goblet Squat, 14 @ 6 x 3 sets
S-S1: Wide Stance Pin Squat, 6 @ 4-5 x 5 sets

Week 11: start 2/22
C-S: High Pin Squat, 6 @ 4-5 x 4 sets
S-S2: 2ct Paused High Bar Squat, 14 @ 6.5
S-S1: Wide Stance Pin Squat, 6 @ 4-5 x 4 sets

Week 12: start 3/5
C-S: High Pin Squat, 6 @ 6 x 3 sets
S-S2: 2ct Paused High Bar Squat, bar x 14 @ 9 (stopped due to pain)
S-S1: Wide Stance Pin Squat, 6 @ 4-5 x 2 sets

Week 13: start 3/14
C-S: 3-2-3 Squat, 8 @ 8
S-S2: 3-2-3 Arnold Squat, bar x 5 (stopped due to pain)
S-S1: 3-2-3 Wide Stance Squat, 8 @ 8

I’m no specialist like Derek but I can relate to your problems.

I think I strained one of my adductors which created pain and restricted mobility in my hip area. It turned into an almighty knot but I couldn’t figure out how to release it. I lived with it for about 2 years.

I eventually managed to successfully release it when I bought the Rogue mobility hand and attached it to my power rack. It gets into nooks and crannies in a way that a lacrosse ball just can’t AND I can get the purchase that I need to really get deep into the tissue. They are not expensive and worth a shot if you think it may have turned into a trigger point.

Hey Khay - glad that situation improved for you. However, we would not recommend generalizing your experience to others. Our general approach is outlined here: Pain in Training: What To Do?

Trigger points are largely unsupported in the research literature and subsequent of that interventions or implements designed to correct them are not well substantiated either.

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