Print Page

Corrective Strategies to Assist in the Prevention of Adductor Strains in Defensive Lineman

By: Tyler Williams

St. Louis Rams

Assistant Athletic Trainer

Background

            Athletic trainers in the NFL provide medical care for an entire team consisting of 53 active players and 8 practice squad players.  Although we regularly examine and treat individual injuries, it is also important to periodically evaluate the trends for sustained injuries at specific positions.  Each position on the football field requires unique and specific movement patterns that can often be unidirectional.  Repetitive movements in one direction can create asymmetries in the body that place an athlete at risk for future injury.  It is important to continually examine the player’s movement patterns and provide corrective exercises for restablishing symmetry along the kinetic chain.  The defensive line is a unique position due to the speed and power occurring in the sagittal plane in combination with extreme rotational forces while performing a rush technique.

            The defensive line position in football encompasses a high level of power and speed in attempt to beat their opponent and get to the quarterback.  A typical rush entails a split second decision for a lineman to get vertically up the field while trying to decide when to plant and change direction as he leverages the opposing lineman in either direction, creating a resisting transverse force on the body.  The entire movement has to be examined to fully comprehend which parts of the body are receiving the majority of the force.  For example, change of direction during a rush places force on the planting leg as well as the contra lateral hip. These numerous repetitive movements throughout the course of an offseason and season can create abnormal length tension relationships in the lower extremities.  In general, a majority of lifts and movements performed by a defensive lineman creates a shortening of the external rotators and abductors of the hip, resulting in compensations at other parts of the body. 

Mechanism     

            When changing direction, the planted leg’s external rotators contract, creating pelvic on femoral rotation which accelerates the anterior side of the hip.3  This quick change of direction causes contralateral pelvic rotation which is eccentrically decelerated by the adductor longus and brevis.3 In general, the TFL, glute Med/Max/Min (glutes), and hip external rotators get overactive; creating lengthened and inactive adductors which respond from repetitive over stretching with protective muscle tightness.  This tightness does not allow the muscle to activate properly in order to apply and dissipate force.  This results in the body dragging the adductors throughout movement, thus creating adductor soreness which presents itself like a chronic overused muscle.  In actuality, the muscle is not being utilized at all due to its inability to activate.  This process can be a significant contributing factor in increasing the risk of an adductor strain, due to the muscle imbalance between the adductor and abductor muscle groups.

           There are a few other factors that can contribute to the adductors becoming weak and inactive.  The strength ratio between the adductor and abductors has been examined in recent years to help identify risk factors for groin strains.  A study on preseason exercise programs found hip adductor weakness to be a strong risk factor for strains where exercise intervention decreased future strains.5 Another study examined the strength ratio between adductors and abductors, concluding that an equal ratio is desired to decrease the risk for chronic strains.4The other factor that can come into play is the stabilization of the core musculature and its ability to stabilize lateral movements as well as rotational forces.2The anterior oblique subsystem and lateral subsystem entails groups of muscles that provide dynamic stabilization for the lumbo-pelvic hip complex.1This highlights the incorporation of the secondary stabilizers such as the external obliques and quadratus lumborum.  All of these factors play a significant role in creating adductor soreness and weakness.  The complications of the muscle being tight and sore is a sign that a movement analysis and corrective strategy needs to be implemented before a muscular strain occurs.

Plan

            The kinetic chain needs to be reestablished and activated so the adductors can properly lengthen and shorten to provide stability, force, and eccentrically decelerate hip movements.  We first manually test the muscle through movements to establish any restrictions or altered subsystems.  The lineman’s position and side needs to be considered to determine which leg is planting and which leg is eccentrically swinging during change of direction.  Once established, mobility is the first goal, followed by establishing stability, and then progressing to reeducating the strength of the movement pattern.   Additionaly, we look at the tightness of the psoas in relation to the activation ability of the glutes. There is a common occurrence of overactive anterior hip flexors which can create inactive glutes. This needs to be taken into consideration so the glute max and med can adequately perform hip extension and stabilization.  The core musculature can also be weak from an anterior pelvic tilt which decreases its ability to stabilize the hips.

            Mobility can be achieved by lengthening the glutes, TFL, and external rotators through modalities and corrective movements. This is performed by use of a deep muscle stimulator, vibe plate, and stretching techniques.  The deep muscle stimulator is used on the TFL and external rotators in a side lying position with the top leg in hip/knee flexion.  A bolster is placed under the upper third of the femur to create a lever to apply manual tension through the stretch while using the deep muscle stimulator.  The glute med and TFL are then manually stretched.  Movements are performed in the sagittal, frontal, and transverse plane from a ½ kneeling position on a vibration plate to open the hips.  A manual psoas release is performed to open the anterior side of the hips so full hip extension can be achieved.   There are also corrective movements which emphasize hip internal rotation to combat the exuberant amount of external rotation they perform throughout activity. 

            Exercises are then performed to activate the glutes, progressing to movements of activating the adductors in conjunction with the glutes.  These exercises include: a glute bridge with physioball squeeze at the top of movment trying to achieve full hip extension at the same time; closed chained star drill with a lateral band pull; standing hip flexion with a lateral band pull to mimic the open chain phase of the running motion; and a single leg glute bridge with a lateral band pull.  Placing a band around the knee and pulling laterally is utilized to activate the adductor complex and shut off the abductors through the movement.  The adductors are then activated by themselves to increase isolated adductor strength. The athlete will then perform a couple of exercises to activate the core musculature to increase hip stabilization and essentially lock everything in that was just corrected.

Conclusion

            Soft tissue injuries can present themselves in multiple different ways, such as tightness, soreness, pain, weakness, and/or strains.  Instead of just treating the muscle symptoms, a more comprehensive approach should be utilized to ensure the root of the problem is corrected.  Looking at the demand of a specific position and its movement patterns can help the clinician correct the kinetic chain imbalance.  It is important to find treatments that assist the healing process of these injuries, but also prevent them from initially occurring or reoccurring.  The comprehensive approach of assessing, correcting (through mobility and stability), and strengthening can help our athletes return from and prevent future injuries in order to enhance performance on the field.

References

1. Clark, M. & Lucett, S. NASM Essentials of Sports Performance Training. Baltimore (MD): Lippincott Williams & Wilkins: 2010.

2. Maffey, L. & Emery, C. What are the Risk Factors for Groin Strain Injury in Sport? A Systematic Review of the Literature. Sports Medicine. 2007. 881-894.

3. Neumann, D. Kinesiology of the Musculoskeletal System. 2ndEd. St. Louis (MO): Mosby Elsevier: 2010.

4. Tyler, T., Nicholas, S., Campbell, R., Donellan, S., & McHugh, M. The Effectiveness of a Preseason Exercises Program to Prevent Adductor Muscle Strains in Professional Ice Hockey Players. Sep-Oct 2002. 680-683. American Journal of Sports Medicine.

5. Tyler, T., Nicholas, S., Campbell, R., & McHugh, M. The Association of Hip Strength and Flexibility with the Incidence of Adductor Muscle Strains in Professional Ice Hockey Players. Mar-Apr 2001. 124-128. American Journal of Sports Medicine.

 

Back

 
 

PFATS Partners

close (X)