Kinesio Tape Groin Area? The 48 Correct Answer

A groin strain injury can happen to anyone, but it’s most common in athletes, especially soccer, football, or hockey players.1 The injury occurs when the muscles in the groin area contract too suddenly, causing a painful stretch or tear in the groin Muscle tissue.2 How do you know if you have a groin strain?

You will feel pain on the inner thigh and depending on the severity of the injury, you may also experience the following symptoms2:

Loss of strength in the affected muscles

loss of freedom of movement

Tenderness from swelling in inner thigh

Difficulty raising the knee or bringing the knees together

Before self-diagnosing, especially if you’ve never had a groin strain, see a doctor. A few simple home care tips can help speed recovery and reduce the risk of long-term pain.3

Speeding up recovery after groin strains

The faster you recover, the less time you spend in pain. Faster recovery also means you can get back to your normal activities faster. So it pays to educate yourself about groin strain recovery. Talk to your doctor before starting treatment and make sure you don’t have any other related injuries that should also be treated. Some of the ways you can speed up your recovery are3:

Some of the ways you can speed up your recovery are:

Rest No athlete wants to be told they need to rest, especially in the middle of the season. However, as with any injury, if your damaged tissues aren’t given a chance to properly heal, the recovery process can take longer and you risk making the injury worse. Resting doesn’t always mean you have to be bedridden. Staying active while resting injured muscles can actually keep you fit, potentially allowing you to return to activity even faster once the recovery process is complete. Instead, rest is about avoiding unnecessary strain on the groin, so avoid kicking, high-intensity exercise like running, and heavy lifting. If the pain is severe, avoid walking or physical activity for a day or two after the injury.3 Cryotherapy Cryotherapy, or cold therapy, is a proven method of reducing pain and inflammation in soft tissues. Cold reduces inflammation, which can help with pain and promote faster recovery.4 The faster you can apply cold to the injured area, the faster your groin strain can heal. Many athletes make the mistake of icing an injury just days after their injury. However, the therapeutic use of cold works throughout the recovery process. Try applying cold several times a day. Not only does cryotherapy relieve pain and reduce swelling, but it also helps slow down cellular metabolism, allowing for faster healing.5 Compression Applying a compression bandage to the groin area can also help minimize swelling, which can help with pain and mobility. Be sure the dressing is applied so that there is enough compression to have an effect, but not so much that it impairs circulation. If the legs or hips become numb or tingly, or if the skin near the compression bandage becomes discolored, it could be a sign of poor circulation and compression that is too tight.3 Anti-inflammatory drugs Your doctor may recommend temporary use of nonsteroidal antioxidant anti-inflammatory drugs (NSAIDs) to reduce inflammation, especially in the first few days after injury. Make sure you understand all possible side effects and follow your doctor’s dosage recommendations. Physical Therapy Strengthening and stretching the injured muscles is an important part of the groin strain recovery process, but it’s important not to overdo it too soon. A qualified physical therapist or trainer can recommend appropriate exercises and tell you how often you should perform them.3 If you want to simplify cryotherapy and the compression components of the groin strain recovery process, you should consider using them

game ready

. The system combines cold therapy and active compression into a single, easy-to-use unit that supports your recovery so you can get back into the game faster. Ask your trainer or physical therapist if they have access to Game Ready, or

find a provider

near you today.

references

What is a groin strain?

A groin strain — also known as a groin strain — occurs when one of the muscles of the inner thigh becomes stretched, injured, or torn. A groin strain can be mild or severe.

With rest and proper treatment, most groin strains heal completely and do not cause lasting problems.

What are the signs and symptoms of a groin strain?

All groin strains cause inner thigh pain. Other signs and symptoms may include:

Swelling and bruising in the groin area

muscle cramps

weakness in the leg

problems walking

What causes a groin strain?

There are five muscles in the groin. A groin strain occurs when any of these muscles:

is stretched too far

works too hard and gets hurt

becomes stressed when not ready (e.g. without proper warm-up)

is directly injured by a blow to the area

Who can get groin strains?

Anyone can get a groin strain. Things that increase the likelihood of an occurrence include:

Sports that involve sprints, bursts of speed, or sudden changes in direction. These include athletics (particularly the hurdles and long jump events), basketball, soccer, football, rugby, hockey and skiing.

don’t warm up. Muscles that aren’t properly warmed up and stretched are more likely to get injured. This is especially true in cold weather.

being tired or exercising more than usual. Tired or weak muscles are more likely to get injured.

extreme stretching, such as in ballet, gymnastics, and martial arts

Returning to activities too quickly after a groin strain

How are groin strains diagnosed?

Doctors diagnose a groin strain as follows:

ask questions about the injury

ask about symptoms

to take an exam

How are groin strains treated?

With rest and proper treatment, most groin strains will heal on their own in about 4-8 weeks. More severe groin strains may last longer. It is very important to allow the strain to fully heal and get the doctor’s OK before returning to activity. People with groin strains who return to activity too soon are at risk of re-injuring the groin.

To help with symptoms while the groin strain heals:

Rest the area and avoid activities that cause pain.

For the first day or two, place an ice pack on the affected area for 15 minutes three to four times a day. Place a towel between the ice and the skin to protect it from the cold.

Use an elastic bandage to support the groin and keep swelling down.

Raise the groin by lying down and placing pillows under your hips to lift your hips and thighs.

Take pain relievers such as ibuprofen (Advil, Motrin, or store brand) or acetaminophen (Tylenol or store brand). Follow the instructions that come with the medicine to know how much to take and how often.

If the doctor says it’s okay, people with a groin strain can strengthen and lengthen the muscles through physical therapy (PT) or an exercise program at home.

Can groin strains be prevented?

Anyone who has a groin strain should wait until it has fully healed before resuming activities. To prevent a groin strain:

Surgical Considerations

The groin region is remarkable for the spectrum of diseases that occur at this anatomical site. Surgical implications arise from many different approaches to these clinical entities.

Radical orchiectomy

Testicular cancer is emerging as one of the most curable types of cancer, due in part to advances in chemotherapy drugs and surgical techniques. Patients with testicular cancer need to have their testicles removed for definitive healing. The testicle is removed in a procedure known as radical inguinal orchiectomy with high ligation of the spermatic cord. [6]

In this procedure, the testicle is removed via an incision above and parallel to the inguinal canal. Once this incision has been made and deepened through the Camper and Scarpa fascia, the external oblique aponeurosis is incised sharply inferomedially through the outer ring. The ilioinguinal nerve lies above the spermatic cord. This is gently pulled back and the spermatic cord is then severed all around and completely exposed. A Penrose drain is used as a tourniquet to prevent the possible spread of cancer by compressing vessels and lymphatics. The testicle is then inserted through the inguinal canal and freed of its gubernacular appendages. The spermatic cord is then divided by double clamps and ligated with sutures, tied and excised. The external oblique aponeurosis is then closed with sutures to prevent hernia.

A scrotal approach for radical orchiectomy is not recommended due to the marked lymphovascular drainage of the testicular and scrotal wall and layers to avoid spreading the cancer.

Tumors of the groin region

Tumors of the spermatic cord or groin are quite rare. The clinical distinction between inguinal hernias, which are very common in this region, and tumors, a rare entity, is even more difficult when based on history and physical examination.

Tumors of the spermatic cord are usually benign (70 to 80%) and most are simple lipomas, which are also found in most inguinal hernias. Sarcomas are the most common form of malignant tumors of the spermatic cord. Rhabdomyosarcoma is the most aggressive type and is the predominant type in children. The other histological sarcoma types, namely liposarcoma, leiomyosarcoma and fibrosarcoma, are most commonly found in the adult population. Of all liposarcomas in the body, only 12% are found in the groin region and more specifically in the spermatic cord, making them relatively rare in the clinical setting.

Treatment is usually an orchiectomy with a large local excision to ensure negative resection margins as these tumors can recur. [7]

cryptorchidism

Cryptorchidism refers to a testicle that has not fully descended and is therefore not found in the scrotum. Before birth, the testicles are in the abdomen of the fetus. The testicle then begins to migrate towards the inner inguinal ring. Between 28 and 40 weeks of gestation, the testicles begin transinguinal migration that eventually leads to placement in the scrotum. In patients with cryptorchidism, it is recommended to place the testicle in the scrotum if it has not migrated on its own within 6 months.

The undescended testicles are mostly located along the inguinal canal and are called cryptorchids. With the surgical exploration and orchiopexy of the testicle in the scrotum, the patient has a better chance of fertility and can perform testicular self-examination to check for cancer. It is important for the patient to be able to examine themselves, as patients with cryptorchidism have a significantly increased risk of testicular cancer. [8th]

lymph nodes

Lymph nodes in the groin region receive drainage from the penis, scrotum, and vulva. Patients with cancer or sexually transmitted diseases can develop lymphadenopathy in this region.

penile cancer

Penile cancer is a rare but serious disease that occurs in certain parts of Africa and South America. This is one of the types of cancer in which primary metastasis occurs through the lymphatic system. The first place of spread of penile cancer is the superficial inguinal lymph nodes. It is very important to identify these nodules as they are important in the staging and treatment of penile cancer patients. Inguinal lymph node dissections are performed by urologists without evidence of lymph node spread or metastasis to allow for more accurate staging. This helps with further treatment to achieve a cure in some patients. [9]

testicular cancer

Patients with testicular cancer do not primarily have inguinal lymphadenopathy. Testicular cancer typically spreads to the lumbar lymph nodes, particularly the pre-aortic and lateral aortic nodes. However, testicular cancer can metastasize to the superficial inguinal nodes when there is excessive retroperitoneal involvement, scrotal invasion, or when scrotal orchiectomy is performed. [10]

The image below shows the template for superficial inguinal lymph node dissection in a patient with penile cancer.

The presentation of the inguinal lymph node dissection for a patient with penile cancer. View media gallery

Inguinal hernia repair: laparoscopic versus open repair

Symptomatic inguinal hernias require surgical repair. The main indication for repair is to prevent imprisonment. This occurs when the bowel becomes pinched and pinched in the hernia defect, stopping blood flow to the bowel segment. This can lead to intestinal necrosis if not reduced within 6 hours when the occlusion is complete.

Hernias can be repaired using either an open technique or a laparoscopic technique. In both procedures, the goal is to remove the hernial sac and repair the inguinal canal. The repair can be performed by reapproximating the patient’s own tissue to minimize and close the defect. If the defect is severe enough or the abdominal muscle wall is very weak, a heterogeneous material such as polypropylene mesh is used for reinforcement.

In laparoscopic repair, the 2 techniques used are the total extraperitoneal repair and the transabdominal preperitoneal patch.

Many studies have compared the use of mesh, which is highly recommended for laparoscopic repair of inguinal hernias; other studies compared the use of glue and other alternatives such as staples or sutures for mesh fixation. Postoperative pain is better with glue, with similar results. [11] Amid discussions about the rising cost of inguinal hernia repair procedures, the newly introduced robotic approach comes to add even more cost to an increasingly expensive surgery.

The advantages of open versus laparoscopic procedures have been discussed. Laparoscopic procedures have the advantage of a less invasive approach with reduced morbidity, reduced pain, and faster recovery. However, compared to open procedures, laparoscopic repair also poses other potential risks, including bowel obstruction, bladder damage, and potential neurovascular damage. [12]

Overview Runners, baseball players, and hockey players beware: you can strain a groin muscle if you don’t warm up or stretch first. Stretching can be especially valuable if you’re not naturally flexible. Most researchers agree that a combination of static and dynamic stretching is useful because it helps loosen muscle fibers and increase blood flow, allowing your body to respond appropriately to exercise stress. A static stretch is the kind that keeps you still for an extended period of time. On the contrary, a dynamic stretch is similar to a warm-up but more targeted. It prepares your body by mimicking the movement of your planned activity. Dynamic stretching is important to prevent groin injuries.

What muscles are the groin muscles? There are six groin muscles: the large adductor, the brevise adductor, the long adductor, the gracilis, and the pectineus. They all connect from the pubic bone to the top of the thigh and the inside of the knee. “Basically, these are the muscles that pull your leg back to its center when it deviates sideways, for example,” says Dr. Julie Ann Aueron, physical therapist and yoga teacher from New York. The adductors are the largest muscle group and the most prone to injury. One of the most common injuries is a muscle group strain/tear.

Dynamic stretching exercises Dr. Aueron recommends dynamic stretching exercises before training to avoid injuries such as tears. Dynamic stretches raise body temperature and cause connective tissue to move a little, she says. Here are a few she recommends: Leg Swing Stand with your legs apart and lift one foot off the floor. Keep your weight on the heel of the stand. Start slow, swinging your leg forward, back, and behind you in one motion. As you begin to loosen up, start picking up the pace and increasing your reach

Movement. Perform 20 reps on each leg. Goal Stretches Stand on your left leg while lifting your right leg. Lift your right knee to hip level, rotate it outward, and open it away from your body. You will feel the stretch in your groin. This is referred to as “opening the gate”. Bring your knee back in front of your body, then lower your leg. You have just “closed the gate”. Repeat steps 1-3 with your right leg. Crossover Stretch Step to the left with your left foot. Swing your right foot around in front of your left leg. Take a step to the left again with your left foot. Repeat in the other direction. Tip: This stretch is similar to the Grapevine dance move, but a little faster. Get a good rhythm going by moving your hips!

Static Stretches Static stretches are great for cooling down after a workout. Static stretching without warming up is less effective, some research has shown, and in some studies it’s even harmful. Lunge Stand with your feet wide and turned out about 45 degrees. Bend the left knee and lunge to the left to lengthen the inner hamstrings of the straightened and straightened right leg. Go back to the standing position and repeat on the other side. Repeat 3 times. Tip: It is important not to bounce. Approach the stretch carefully and hold it for at least 30 seconds. Butterfly Stretch Sit straight on the floor with your knees bent and feet together so your legs are in the “butterfly position.” Put your hands around your ankles. Keeping your spine straight and your buttocks pressed into the floor, slowly bend forward at the waist and gently push your knees apart with your elbows. Don’t round your back when leaning forward. If this pose doesn’t work for you, try this alternative: Lie on your back with your legs perpendicular to the floor and your buttocks pressed against the wall. Slide your legs apart into a wide “V” until you feel a slight stretch on your inner thighs. Make sure your lower back stays pressed to the floor as you move your legs. hold for 30 seconds.

What is a pulled or tight groin? A groin strain is an injury or tear to one of the adductors of the thigh. These are the muscles on the inner thigh. Sudden movements usually trigger an acute groin strain, such as B. Kicking, turning to change direction while running, or jumping. Athletes are most at risk from this injury. Groin strains are not usually serious, although a severe strain can take a long time to recover.

Treatment Immediately after an injury, the goal of treating a groin strain is to reduce pain and swelling. The first few days of treatment follow the protocol for each muscle injury: Rest

Ice

compression

elevation

nonsteroidal anti-inflammatory drugs Depending on the severity of your condition, you may need additional treatments to speed healing. These could include: Physical therapy

message therapy

warmth and stretch

Electrotherapy If you have a grade 3 strain, you may need surgery to repair the torn fibers, especially if the tendon is involved.

Recovery time The recovery time for a groin strain injury depends on the severity of the injury. In general, you can gauge the degree of your recovery based on your pain level. When your adductor muscle recovers, avoid activities that involve pain. Resume activities gradually. This allows your muscle to heal fully and prevents you from developing a recurrent groin strain injury. The time it takes you to recover also depends on your pre-injury fitness level. There is no definitive time frame as it is different for everyone. However, as a general guide, you can expect to rest for several weeks before becoming fully active again after a groin strain. Depending on your level of exposure, here are the estimated recovery times: Level 1: 2 to 3 weeks

2 to 3 weeks Grade 2: 2 to 3 months

2 to 3 months Grade 3: 4 months or more

Diagnosis To diagnose if you have a groin strain, your doctor will first want to know how your injury occurred and whether the circumstances suggest a groin strain. They will ask you about the activity you were doing when the injury happened, your symptoms, and if you have had a similar injury in the past. Next, your doctor will do a physical exam. This could include stretching your adductor muscles to see if the stretch is painful, as well as testing your leg’s range of motion. Any pain you feel during the exam will help your doctor determine where your injury is. In addition to identifying the location of the strain, your doctor will also assess how serious your injury is. There are three degrees of groin strains: Grade 1 A grade 1 groin strain occurs when the muscle is overstretched or torn and up to 5 percent of the muscle fibers are damaged. You may be able to walk without pain, but running, jumping, kicking, or stretching can be painful. Grade 2 A grade 2 groin strain is a tear that damages a significant percentage of muscle fibers. Walking can be difficult, and bringing your thighs together can also be painful. Grade 3 A grade 3 groin strain is a tear through most or all of the muscles or tendons. This usually causes sudden, severe pain at the time it occurs. Using the injured muscle will be painful. There is usually significant swelling and bruising. You may be able to feel a gap in the muscle when you touch the injury. Could it be something else? A groin strain can be confused with other problems. You may experience similar symptoms if you have: a stress fracture (a hairline fracture in the pubic bone or thighbone)

Hip bursitis (inflammation of the fluid sac in the hip joint)

a hip strain (inflammation or injury to the tendons or muscles of the hip) Your doctor will often start with an X-ray and then do an MRI to confirm the diagnosis and rule out other injuries.

Symptoms Symptoms of a groin strain can range from mild to severe, depending on the severity of the injury. These may include: pain (usually felt on the inner thigh but felt anywhere from the hip to the knee)

decreased thigh strength

swelling

bruises

Difficulty walking or running without pain

Cracking sound at the moment of injury

Causes and risk factors A groin strain is the most common in both professional and recreational athletes. It is often caused by overexertion of the adductor muscle when kicking, so it is more common in the athlete’s dominant leg. It can also be caused by spinning quickly while running, skating, or jumping. Movements that require your muscle to stretch and contract at the same time usually cause a groin strain. This puts stress on your muscle and can overstretch or tear it. Although exercise is the most common cause, a groin strain can also result from: Falls

lift heavy objects

other types of exercise, such as B. Resistance Training Any overuse of a muscle can result in long-term strain. The main risk factor for a groin strain is a sport that involves kicking, turning suddenly while running, and jumping. Frequent changes of direction are also a risk factor. The most common athletes to get a groin strain are soccer players and ice hockey players. However, athletes in many sports can be at risk. These include basketball, soccer, rugby, skating, tennis and martial arts. For athletes who play these sports, an additional risk factor is how much they train off-season. Athletes who stop training during the off-season are more likely to lose muscle strength and flexibility when not playing. This increases the risk of injury if they start exercising without first building muscle strength and flexibility. A previous groin strain is another risk factor, as the muscle is weakened from a previous injury.

Exercise It’s important to stop the activity or exercise that caused the groin strain immediately, but there are other exercises that can help heal it. It is best to do these exercises after the pain subsides. Four exercises that can help heal your groin and build strength are the hip adductor stretch, the hamstring wall stretch, the straight leg raise, and the resistance hip flexion. Learn step by step how to perform these exercises.

Groin strain or hernia? A hernia occurs when an organ pushes through a weak spot in the muscle or tissue around it. A hernia occurs near the groin. It can be confused with a groin strain and vice versa. Pain in the groin area can be an indication of a groin strain or hernia. The main sign that you have a hernia, not a groin strain, is a lump or bumps on the side of the groin. You will be able to feel the bump, although at some angles it may disappear, e.g. B. when you lie down. If you suspect you have a hernia, see your doctor. Hernias can cause serious complications, and the only way to treat a hernia is with surgery.

Prevention The best way to prevent a groin strain is to avoid using the adductor muscle without proper training and preparation. Stretch and strengthen your adductor muscles regularly, especially if you’re playing an activity that’s likely to strain the groin area. If possible, exercise year-round. When you take a break from training, gradually work your way back to your previous activity level to avoid muscle strain.

By Action PT • June 24, 2020 •

Chronic pain is a condition that occurs when the brain, based on the many signals it receives from the body, concludes that there is a threat to a person’s well-being. This condition can and often does occur unrelated to actual body tissue damage (due to injury or disease) and beyond the normal healing time of the tissue. It is estimated that 116 million Americans suffer from chronic pain each year. The cost in the United States ranges from $560 billion to $635 billion annually in medical treatment, lost work time, and lost wages. The causes of chronic pain are very different. While any condition can lead to chronic pain, there are certain medical conditions that are more likely to cause chronic pain. These include: Trauma/injury Diabetes mellitus Fibromyalgia Limb amputation Reflex sympathetic dystrophy Some diseases, such as cancer and arthritis, cause persistent pain. However, in chronic pain, pain is generated in the nervous system even after the physical tissues have healed. Chronic pain affects everyone differently. In some cases, chronic pain can lead to reduced activity levels, job loss or financial difficulties, as well as anxiety, depression and disability. Physical therapists work with chronic pain sufferers to relieve their pain and bring their activity back to the highest possible level. With treatment, the side effects of chronic pain can be reduced. For more resources on pain and the use of opioids to manage pain, visit our Pain Health Center and our Opioid Pain Management Health Center. The American Physical Therapy Association launched a national campaign to raise awareness of the risks of opioids and the safe alternative of physical therapy for long-term pain management. Learn more on our Safe Pain Management page. What is chronic pain? Pain is an uncomfortable feeling that we usually associate with injury or tissue damage, but it can also occur without tissue damage. Pain can be acute or chronic. Acute pain lasts only a short time – up to 12 weeks. It is a warning that tissue damage has occurred or may occur, or to help us avoid injury or illness. For example, when we touch a hot stove, the body sends a danger message to the brain that tissue is at risk to prevent further injury. A sore foot may indicate that you need to change your shoes. In some cases, the danger messages can be due to a disease process, and your brain can interpret these messages as pain. This can lead you to see a doctor — diagnosis and treatment — for a potentially serious condition. Signaling pain in this way is how the body protects us, and it’s a good thing. Chronic pain is any discomfort or uncomfortable feeling that lasts longer than three months – or beyond an expected normal healing time. Often, those suffering from chronic pain believe they have an ongoing illness or that their body is not healed, when this may not be the case. Chronic pain probably doesn’t warn you of possible injury or danger; Instead, the pain centers in the brain can cause pain even though no new sources of pain arise in the body. Anyone at any age can develop chronic pain. The brain changes in chronic pain: when you are injured or develop a painful illness, nerves send information from the problem area to the brain. The brain analyzes this information coming from the body to determine if there is a threat to the body and if action needs to be taken to prevent damage. When the pain is constant or chronic, the brain and nervous system go on “high alert” and become more sensitive. Cells that conduct sensations in the nervous system can also become more sensitive when on high alert, making it easier for the brain to interpret those sensations as a threat and thus cause more pain. These changes in the brain and central nervous system induce and maintain chronic pain symptoms. For chronic pain: pain sensations are activated in the brain; The brain continues to interpret all sensations from the problem areas as danger, even if there is no more tissue damage. This allows the pain centers in the brain to be activated more easily; Pain messages come from many different areas of the brain—areas that can control fight or fear responses, movement, emotions, problem solving, and learning. Almost every system in the body can be affected by chronic pain. The brain and nervous system continue to respond by causing you to continue feeling pain. This process increases sensations, emotions, or thoughts about the problem area. At this point, any sensory input can activate the pain centers. Just thinking about it or reading the word pain can trigger painful sensations. The pain is in the brain: To protect you, your brain decides to raise the alert level for sensations you’re feeling. How does it feel? How chronic pain feels varies from person to person; it’s very personal. How often it occurs, how severe it is, or how long it lasts is not predictable from one person to another. Common complaints associated with chronic pain include: It seems like “everything hurts everywhere.” Sudden stabbing pain may occur. It may seem like pain “has a mind of its own.” You feel symptoms even if you don’t do anything to cause them. It feels worse when you think about it. It feels worse when you experience stressful circumstances in your life. You may feel more anxious and depressed. You can feel your symptoms spreading from one area to another. You may feel tired and afraid to go about your normal activities. These symptoms often occur with chronic pain. However, this does not necessarily mean that your physical condition is deteriorating; it can only mean that your system has become more sensitive. Signs and Symptoms Research has shown that the following signs may be associated with chronic pain syndrome: Anxiety. It’s easy to fear increased pain when you suffer from chronic pain. As a result, you may start avoiding activities. You may find that you rely more on family members to help you with daily tasks. Body stiffness when trying to be more active. Stiffness can make you feel like your body is less able to perform daily activities. deconditioning. Not moving your body leads to less tolerance when you want to get more active. If you are inactive for a long time, the muscles weaken and shrink because they are not used. This can also increase your risk of falling. Decreased circulation. Lack of activity decreases the circulation of much-needed blood to your cells. Tissues in your body may not be getting as much oxygen as they need. As a result, they may not be as healthy as they can be. This can make you feel tired and lack energy. Weight gain and/or worsening of other medical conditions. Decreased activity can lead to unwanted weight gain. Extra pounds and inactivity can worsen symptoms of other conditions, such as diabetes and high blood pressure. Chronic pain conditions are also often associated with feelings of anxiety or depression. Increased use of medication. Chronic pain sufferers may tend to increase their medication over time in order to seek relief. Individual behaviors may include: Seeing a variety of doctors or health care providers and facilities to find relief. difficulties in job performance. Some people with chronic pain even seek disability. Avoidance of social situations or family members. If the pain persists, you may find that you experience bitterness, frustration, or depression. Some people report having suicidal thoughts. If you have these feelings, let your doctor know. This is important so that you can get appropriate medication to help you feel better. How is it diagnosed? Your physical therapist will conduct a thorough examination. He or she will: Ask specific questions about your past and present medical conditions and medications you are taking. Ask about your symptoms: location, intensity, how and when the pain occurs, and other questions to get a clear picture of your unique situation. Ask to fill out pain and function questionnaires to understand how the pain affects your daily life. Do tests and moves with you. The tests help identify problems with posture, flexibility, muscle strength, joint mobility, and movement. Special tests help rule out serious health problems, such as pressure on a nerve or an underlying condition. Observe how you use your body at home, at work, and in social/leisure activities. This information will help your therapist prescribe a program that improves your quality of life and keeps you in peak condition. Imaging tests such as X-rays, computed tomography (CT) and magnetic resonance imaging (MRI) are often not helpful in diagnosing the cause of chronic pain. However, if your physical therapist suspects that your pain might be caused by a serious underlying condition, they will refer you to your doctor for evaluation. Your physical therapist will work with your doctor to provide the best diagnosis and treatment for your chronic pain. How can a physical therapist help? Your physical therapist will work with you to educate you about chronic pain, find solutions to improve your quality of life, and get you moving again! He or she will help you improve your movement, teach you strategies for managing pain, and in many cases, relieve your pain. Not all chronic pain is the same. Your therapist evaluates your clinical examination and test results and creates an individual treatment plan that suits you best. Physiotherapy treatments can include: Education to improve your knowledge and understanding of chronic pain – how it occurs and what you can do about it. Your therapist will teach you how to manage your pain and help you get back to your normal daily activities. Strength and flexibility exercises to help you move more efficiently and with less discomfort. Your therapist will design a program of graded exercises for you—movements that gradually increase according to your ability. Graduated exercises will help you improve your coordination and movement, reduce the stress and strain on your body, and relieve your pain. Carefully instituting a graded exercise program will help your brain sense the problem area in your body without amplifying its danger messages. Manual therapy, which consists of specific, gentle, manual techniques that can be used to manipulate or mobilize tight joint structures and soft tissues. Manual therapy is used to increase range of motion, improve tissue quality and reduce pain. Posture awareness and body mechanics guidance to improve your posture and movement. This workout allows you to use your body more efficiently during activity and even at rest. Your therapist will help you adjust your movements at work or while doing chores or leisure activities to relieve your pain and improve your ability to function. The use of ice, heat, or electrical stimulation has not been shown to help with chronic pain. However, your physical therapist will determine if any of these treatments could benefit your unique condition. www.choosept.com, the official consumer website of the American Physical Therapy Association,© 2017

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Surgical Considerations

The groin region is remarkable for the spectrum of diseases that occur at this anatomical site. Surgical implications arise from many different approaches to these clinical entities.

Radical orchiectomy

Testicular cancer is emerging as one of the most curable types of cancer, due in part to advances in chemotherapy drugs and surgical techniques. Patients with testicular cancer need to have their testicles removed for definitive healing. The testicle is removed in a procedure known as radical inguinal orchiectomy with high ligation of the spermatic cord. [6]

In this procedure, the testicle is removed via an incision above and parallel to the inguinal canal. Once this incision has been made and deepened through the Camper and Scarpa fascia, the external oblique aponeurosis is incised sharply inferomedially through the outer ring. The ilioinguinal nerve lies above the spermatic cord. This is gently pulled back and the spermatic cord is then severed all around and completely exposed. A Penrose drain is used as a tourniquet to prevent the possible spread of cancer by compressing vessels and lymphatics. The testicle is then inserted through the inguinal canal and freed of its gubernacular appendages. The spermatic cord is then divided by double clamps and ligated with sutures, tied and excised. The external oblique aponeurosis is then closed with sutures to prevent hernia.

A scrotal approach for radical orchiectomy is not recommended due to the marked lymphovascular drainage of the testicular and scrotal wall and layers to avoid spreading the cancer.

Tumors of the groin region

Tumors of the spermatic cord or groin are quite rare. The clinical distinction between inguinal hernias, which are very common in this region, and tumors, a rare entity, is even more difficult when based on history and physical examination.

Tumors of the spermatic cord are usually benign (70 to 80%) and most are simple lipomas, which are also found in most inguinal hernias. Sarcomas are the most common form of malignant tumors of the spermatic cord. Rhabdomyosarcoma is the most aggressive type and is the predominant type in children. The other histological sarcoma types, namely liposarcoma, leiomyosarcoma and fibrosarcoma, are most commonly found in the adult population. Of all liposarcomas in the body, only 12% are found in the groin region and more specifically in the spermatic cord, making them relatively rare in the clinical setting.

Treatment is usually an orchiectomy with a large local excision to ensure negative resection margins as these tumors can recur. [7]

cryptorchidism

Cryptorchidism refers to a testicle that has not fully descended and is therefore not found in the scrotum. Before birth, the testicles are in the abdomen of the fetus. The testicle then begins to migrate towards the inner inguinal ring. Between 28 and 40 weeks of gestation, the testicles begin transinguinal migration that eventually leads to placement in the scrotum. In patients with cryptorchidism, it is recommended to place the testicle in the scrotum if it has not migrated on its own within 6 months.

The undescended testicles are mostly located along the inguinal canal and are called cryptorchids. With the surgical exploration and orchiopexy of the testicle in the scrotum, the patient has a better chance of fertility and can perform testicular self-examination to check for cancer. It is important for the patient to be able to examine themselves, as patients with cryptorchidism have a significantly increased risk of testicular cancer. [8th]

lymph nodes

Lymph nodes in the groin region receive drainage from the penis, scrotum, and vulva. Patients with cancer or sexually transmitted diseases can develop lymphadenopathy in this region.

penile cancer

Penile cancer is a rare but serious disease that occurs in certain parts of Africa and South America. This is one of the types of cancer in which primary metastasis occurs through the lymphatic system. The first place of spread of penile cancer is the superficial inguinal lymph nodes. It is very important to identify these nodules as they are important in the staging and treatment of penile cancer patients. Inguinal lymph node dissections are performed by urologists without evidence of lymph node spread or metastasis to allow for more accurate staging. This helps with further treatment to achieve a cure in some patients. [9]

testicular cancer

Patients with testicular cancer do not primarily have inguinal lymphadenopathy. Testicular cancer typically spreads to the lumbar lymph nodes, particularly the pre-aortic and lateral aortic nodes. However, testicular cancer can metastasize to the superficial inguinal nodes when there is excessive retroperitoneal involvement, scrotal invasion, or when scrotal orchiectomy is performed. [10]

The image below shows the template for superficial inguinal lymph node dissection in a patient with penile cancer.

The presentation of the inguinal lymph node dissection for a patient with penile cancer. View media gallery

Inguinal hernia repair: laparoscopic versus open repair

Symptomatic inguinal hernias require surgical repair. The main indication for repair is to prevent imprisonment. This occurs when the bowel becomes pinched and pinched in the hernia defect, stopping blood flow to the bowel segment. This can lead to intestinal necrosis if not reduced within 6 hours when the occlusion is complete.

Hernias can be repaired using either an open technique or a laparoscopic technique. In both procedures, the goal is to remove the hernial sac and repair the inguinal canal. The repair can be performed by reapproximating the patient’s own tissue to minimize and close the defect. If the defect is severe enough or the abdominal muscle wall is very weak, a heterogeneous material such as polypropylene mesh is used for reinforcement.

In laparoscopic repair, the 2 techniques used are the total extraperitoneal repair and the transabdominal preperitoneal patch.

Many studies have compared the use of mesh, which is highly recommended for laparoscopic repair of inguinal hernias; other studies compared the use of glue and other alternatives such as staples or sutures for mesh fixation. Postoperative pain is better with glue, with similar results. [11] Amid discussions about the rising cost of inguinal hernia repair procedures, the newly introduced robotic approach comes to add even more cost to an increasingly expensive surgery.

The advantages of open versus laparoscopic procedures have been discussed. Laparoscopic procedures have the advantage of a less invasive approach with reduced morbidity, reduced pain, and faster recovery. However, compared to open procedures, laparoscopic repair also poses other potential risks, including bowel obstruction, bladder damage, and potential neurovascular damage. [12]

Your physical therapist will design a treatment program for your specific needs to speed up your recovery. This program includes exercises and treatments you can do at home to help you return to your normal lifestyle and activities.

The first 24 to 48 hours

Your physiotherapist can advise you:

Rest the area. This may include avoiding walking or activities that cause pain. They may recommend crutches to reduce further muscle strain when walking.

Apply ice packs to the area for 15 to 20 minutes every 2 hours.

Compress the area with an elastic bandage.

Contact another healthcare provider for additional services, such as medication or diagnostic tests.

Your physical therapist will create a customized treatment plan for you based on your unique condition and goals. Your plan may include treatments for:

reduce pain. Your physical therapist can use a variety of treatments and technologies to help control and relieve your pain. This may include ice, heat, ultrasound, electrical stimulation, taping, exercise, and hands-on therapies such as massage. These treatments can reduce the need for pain medications, including opioids.

improve movement. Your physical therapist will select specific activities and treatments to help restore normal movement in the leg and hip. These can begin with “passive” movements that the therapist performs for you to gently move your leg and hip joint. They will help you to do active exercises and stretches that you do yourself.

improve strength. Certain exercises promote healing at every stage of recovery. Your physiotherapist will teach you the appropriate exercises to steadily restore your strength and mobility. This may include using cuff weights, elastic bands, weight lifting machines, and cardio exercise equipment such as treadmills or stationary bikes.

Accelerate recovery time. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you heal. They can help you get back to your normal lifestyle and reach your goals faster than you probably would on your own.

Promote a safe return to activities. Your physical therapist will work with you to set your recovery goals, including returning to work or sports. You will design your treatment program to achieve these goals as safely, quickly, and effectively as possible. Your physical therapist will use hands-on therapies, such as massage, and teach you exercises and retraining activities. Your therapist can also teach you sport-specific techniques and exercises to help you achieve sport-specific goals.

Prevent future re-injury. Your physical therapist can recommend a home exercise program to strengthen and stretch the muscles around your hips, thighs, and abdomen. Performing these prescribed exercises can help prevent future re-injury to your groin. This can include strength and flexibility exercises for the leg, hip, and core muscles.

If an operation is necessary

Surgery is rarely required for a groin strain. When a groin muscle tears completely and requires surgical repair, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities safely and as quickly as possible after surgery.

to blog

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