Adductor Tendonopathy Rehabilitation Programme

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1 Adductr Tendnpathy Rehabilitatin Prgramme Updated May 2010 This prgramme has been develped t enable swelling and discmfrt t settle quickly, t prmte rapid healing f the injury while maintaining a gd level f functin All exercises shuld be perfrmed relatively pain-free; if the exercise yu are wrking n is aggravating the prblem, then yu are mst likely ding t much The exercises shuld be perfrmed fllwing the initial pst injury phase is cmplete Yu shuld spend 10 t 15 minutes perfrming strengthening exercises twice a day Perfrm stretching exercises fr 10 minutes; 4 times per day. Perfrm cre stability exercises fr 10 minutes; 4 times per day (it is easier t cmbine these alng with stretching). Begin individual exercises by perfrming abut 5-10 repetitins f each and then prgress t 20, 30 etc. As cmfrt allws start t include sme statinary, lw resistance cycling When yu can perfrm all f the exercises in each sectin withut discmfrt, then yu can mve nt the next stage Mr. Patrick Cartn MD FRCS (Tr & Orth) Cnsultant Orthpaedic Surgen, Specialist in Sprts Surgery f the Hip and Grin

2 What are the Adductrs? The Adductrs are a grup f muscles in yur inner thigh/grin that wrk tgether t prduce flexin, adductin and rtatin f the hip. The mst cmmnly injured f which is the Adductr Lngus. Hw d I injure the Adductrs? Adductr injuries mst frequently ccur in sprts/activities that invlve twisting/turning/kicking and sudden changes in directin. These can prduce t much strain fr the strength f the tendn r muscle which can result in small tears r in sme cases cmplete rupture f the tendn. Mst Adductr injuries settle in respnse t cnservative management using rest frm aggravating activities, stretching and strengthening exercises, cre stability exercises and nn-weight-bearing training. Hwever, in the case f recurrent grin strains r cmplete rupture f the tendn, surgery is likely t be required. Stage 1 Pst Injury Phase Day 0-5 Cmplete rest frm activity is required; prtect the limb frm the discmfrt f full weight bearing with the use f crutches fr as lng as necessary Gradually increase weight bearing as cmfrt imprves Ice packs shuld be applied fr minutes at least fur times a day fr the first five days fllwing injury Avid any mvements which aggravate the discmfrt at this stage The use f anti-inflammatry medicatin is helpful in reducing pain and inflammatin (always seek the advice f a medical prfessinal befre taking prescriptin medicatins). Stage 2 Early Exercise Phase Day 5 10 Perfrm the fllwing exercises lying n a bed r flr: Static adductin 1 Place a ftball between yur feet while lying n yur back, and squeeze it between yur feet. Hld fr 30 secnds and repeat 5-10 times Static adductin 2 Place a ftball between yur knees while lying n yur back with yur knees bent and yur feet n the bed. Squeeze fr 30 secnds and repeat 5-10times Cre Stability exercise 1 (Transversus abdminus) Tighten yur tummy and draw yur belly buttn in twards spine withut mving yur pelvis/spine Hld while taking 5 breaths and repeat 5-10 times. (Zip and Hllw)

3 Cre Stability exercise 2 (Scissrs) Start in lying psitin with hips and knees bent and with bth feet n the bed/flr. Tighten yur tummy and lift ne ft ff the flr straightening yur leg and hld fr ten secnds. Repeat with the ppsite leg. Perfrm 3-5 sets. Cre Stability exercise 3 (Abdminal sit-up) Tighten tummy and d a small sit-up by lifting shulders ff the bed/flr. Perfrm 3-5 sets f 10 sit-ups Cre Stability exercise 4 (Cmbined Abdminal sit-up) Place ftball between yur knees and squeeze gently. As yu sit-up lift yur feet ff the bed t draw yur knees and chest twards each ther Cre Stability exercise 5 (Abdminal) Frm the lying psitin with legs ut straight tighten yur tummy and lift bth feet ne inch abve the bed/flr; hld this psitin fr 10 secnds; slwly bring yur feet widely apart and hld fr 5 secnds; bring feet back tgether and relax. Repeat 5 sets. The fllwing exercises can be perfrmed standing e.g. by sink/wrktp Balance exercise 1 Standing n ne leg while brushing yur teeth. Spend 1minute n each leg. Perfrm 2 sets. Balance exercise 2 Standing n ne leg while bending and straightening yur ther knee. Perfrm 3 sets f 10 Balance exercise 3 Stand n ne leg and allw the ther leg t swing gently frwards and back like a pendulum. Repeat 2 sets f 30 secnds, and then repeat with ther leg Active hip abductin/adductin (Ft-slides) While wearing a sck n a lw frictin surface e.g. wden flr, allw a little pressure nt yur ft and while maintaining this pressure slide yur ft away frm yu ut t the side and then pull back in. Repeat this fr 1 minute cntinuusly 5 times and alternate with perfrming it with yur ft pinted 90 degrees frm the ther (ut t the side) Thrughut the day the Transversus Abdminus (tightening yur tummy) exercise can be dne as ften as yu remember. Hld fr abut 10 secnds each time x5/10. Yu can als d the static adductin exercises in sitting by squeezing yur fists between yur knees, and yu can perfrm the balance exercises any time yu are up standing/waiting Begin using an exercise bicycle fr minutes f lw resistance mvements A rwing machine can be used with lw resistance fr gentle hip flexin/extensin Swimming pl gentle exercises can begin in the pl after five days (see belw)

4 Hydrtherapy / Swimming Day 10 - nwards Attend the swimming pl every day Frward and backward walking Hip strengthening exercises in standing Briskly swing yur leg frwards and backwards like a pendulum. Carefully bring yur affected leg ut t the side and back t the start psitin, dn t lean t the side. Mve yur leg briskly thrugh the water as this increases the resistance prvided by the water. Straight leg kick Walking n yur heels/tes/walking n the spt Calf Raises Stretching Backstrke Aqua-jgging Breaststrke when cmfrtable Stage 3 Intermediate Exercise Stage Weeks 2-4 Bed/Flr Hip abductin and adductin Lie n yur unaffected side. Lift yur affected leg ut t the side, up twards the ceiling, and return t start psitin. Perfrm 3-5 sets f 10 reps Stand hlding n t a supprt; bring yur affected leg ut t the side as far as pssible, hld as lng as yu can and return slwly t start psitin. D nt lean t the side. Lw-Back extensin Lay n yur frnt with shulders a little ff the end f the bed. Tighten yur tummy and extend yur back and raise yur shulders up twards the ceiling. Perfrm 3-5 sets f 10 repetitins Cntinue abdminal sit-ups Clsed chain bridging Begin this in lying with hips and knees bent s that yur feet r flat n the bed/flr. Tighten in yur tummy muscles, squeeze yur bttm and raise yur bttm and then spine ff the bed. Try t keep yur pelvis level and aim t get yur shulders, pelvis and knees level. Perfrm 3-5 sets f 10 repetitins Adductr stretch Flexin - a very imprtant exercise; place the ft n tp f the ppsite thigh crating a figure f 4 shape; gently push the knee dwn twards the bed/flr and hld fr 5 secnds at the limit f stretch; yu will have t wrk thrugh mild stretching discmfrt t prgress. Repeat 10 times fr each leg. Perfrm at least five sets each day.

5 Extensin this stretching exercise requires a secnd persn t perfrm crrectly; the secnd persn hlds ne ft and brings the straight leg gently ut t the side t its limit; gently the leg is stretched and held thrugh mild discmfrt fr 5 secnds. Repeat 10 times fr each leg. Perfrm at least three times a day when pssible. Standing Hip flexr stretch Stand in a lunge psitin with affected leg behind. Tighten in yur tummy and lean frwards s that yu get a stretch at the frnt f yur hip. Hld fr secnds and repeat 3 times Ft slides with increasing weight thrugh affected leg Active hip abductin/flexin/extensin with ankle weight Crss cuntry skiing n ne leg Stand n unaffected leg and swing affected leg frward and back while swinging arms in the same rhythm. Perfrm 3-5 sets fr 1minute and repeat with weight n ther leg Adductr stretch Extensin this stretching exercise requires a raised surface such as a desk, bed r chair; stand sideways placing yur affected ft n the raised surface; widen bth yur legs as far as they will g (feeling a stretch in bth adductr regins); push the affected leg ut a little further feeling increased tightness; hlding this psitin and keeping facing straight ahead, turn the affected ft upwards t pint t the ceiling, hld fr ten secnds and relax. Repeat 5 times fr each leg. Perfrm at least three times a day when pssible. Stage 3 Advanced Exercise Stage Weeks 4-6 Thrughut this stage many f the mre challenging exercises and stretches shuld cntinue with increased effrt and time. Begin light jgging (remember t warm up and perfrm stretching prir t and fllwing jgging); initially jgging shuld be perfrmed fr minutes in a straight line n a firm surface (grass); as cnfidence increases increase pace and time, then begin t jg in large figure f eights reducing in size gradually. Slalm, twisting and side t side actins during the running phase shuld cme later and as cmfrt allws.

6 Begin t prgress thrugh sme f these exercises if available: Stepper Elliptical trainer (if applicable) Walking/buncing/Jgging n mini-trampline Standing n varius surfaces e/g carpet/cushin/flded twel Side-stepping Lw impact aerbics Multi-directinal jumping and hpping Landing frm a height nt 2 feet then nt 1 ft Skipping Sprt specific training can begin at 5 6 weeks prviding the rehabilitatin prgramme has been cmpleted with n discmfrt. Cntact Details: Jacinta O Sullivan (Secretary t Mr. Cartn) Telephne: Fax: Shane Walsh (Physitherapist) Telephne: Orthpaedic Ward (Out f Hurs): Telephne: Fr mre details n all aspects f care and rehabilitatin please refer t the website: Mr. Patrick Cartn MD FRCS (Tr & Orth) Cnsultant Orthpaedic Surgen, Specialist in Sprts Surgery f the Hip and Grin Hip and Grin Clinic, Suite 5 Whitfield Clinic, Crk Rad, Waterfrd

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