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1. The groin dramatically influences the rest of the body and the rest of the body dramatically influences the groin

2. Description of an ACL injury mechanism with the fault or cause in the front butt

3. Understanding the loading of the front butt requires a comprehensive strategicanalysis

4. If the groin can be properly lengthened, stimulated, proprioceptively enhanced and strengthened, it can significantly contribute to the success of all forms of function

5. Determine what facilitates the pain in the groin injury and determine where there are functional successes relative to the groin

6 Discussion of stride stance tweaks in the sagittal, frontal and transverse plane

7. Three dimensional front butt function analyzed with the Functional 3D Testing SystemTM

8. Description of manual resistance and manual reaction with arms with balance activities

9. Discussion of down leg tweaks in all three planes in the TrueStretchTM

10. Ultimately we need to build upon success and gain functional capabilities of the groin and the rest of the body

11. Functional rehabilitation is functional training and functional training is functional rehabilitation

12. The front butt and back butt work together to provide the power for the golf swing through the feet

13. The study of hockey injuries reveals a significant amount of groin injuries occurring during the pre-season

14. Training to prevent the groin injury in hockey has proven effective

v2.12 THE GROINThe Front Butt

By: Gary Gray, PT

OBJECTIVES FOR THE GROIN FFUUNNCCTTIIOONNAALLGGUUIIDDEE

To assimilate up-to-date information and knowledge about the groin. To learn how to apply effectivefunctional techniques when testing and training for the groin.

To understand and appreciate the tri-plane CChhaaiinnRReeaaccttiioonn principles as they apply to the groin.

HOW TO USE THIS FFUUNNCCTTIIOONNAALL GGUUIIDDEE

This functional guide can be used as a convenientsummary of the program’s contents to take with youafter viewing. You can also use this guide as a notebook; space has been provided so that you canmake notes on relevant tracts as you watch them.

STRATEGY 1

Strategically understanding the structural and functional differences betweenthe “back butt” and the “front butt”.

STRATEGY 2

Strategically appreciating the three dimensional CChhaaiinn RReeaaccttiioonn function of thegroin in all forms of function.

STRATEGY 3

Strategically determining contributing factors throughout the body that influencethe groin.

STRATEGY 4

Strategically assessing the function of the groin and it’s Chain Reactionthroughout the body for various forms of function.

STRATEGY 5

Strategically implementing a preventative stretching and strengthening programthat is function specific with respect to the groin.

STRATEGY 6

Strategically rehabilitating the groin through the exploitation of drivers in orderto create the appropriate CChhaaiinn RReeaaccttiioonn response.

STRATEGY 7

Strategically training the groin through a logical and progressive conditioning program.

STRATEGY 8

Strategically transforming our understanding of the groin with respect to the golfswing and to the ability to rehabilitate, train and condition the groin for all forms offunction.

STRATEGY 9

Strategically taking advantage of effective research in order to develop enhancedstrategies for the rehabilitation, training and conditioning of the groin and the entirebody.

A Biomechanical Understanding of the Groin

The groin is a tough area to understand functionally

The groin is functionally and fondly known as the “front butt”. There is a significantdifference in the muscle mass between the front butt and the back butt

•The groin dramatically influences the rest of the body and the rest of the body dramatically influences the groin

•The groin requires motion and stability throughout the entire CChhaaiinn RReeaaccttiioonn

•The groin is made up of the adductors, the abdominals, the iliopsoas, the sartorius,the rectus femoris, the gracilis, and the pectineus.

•The difficulty in differentiating groin injuries and hernias

• We therefore need to know the function of all the groin muscles

•The powerful adductors . . . they are predominantly sagittal and transverse plane muscles. They are traditionally known as frontal plane muscles.

In gait, the adductors decelerate hip flexion and internal rotation during the loading of the front leg, and decelerate hip extension and internal rotation of the loading of the back leg while externally rotating the back leg itself. In most function gravity adducts the hip with the adductors playing a primary role in sagittal and transverse plane function.

•The sartorius . . . has obvious tri-plane capabilities, with eccentric loading through knee flexion, hip extension, hip adduction, knee abduction, and hip and knee internal rotation.

•The rectus femoris . . . has significant sagittal as well as transverse plane capabilities with complimentary frontal plane capabilities with eccentric loading in all forms of function.

•The iliopsoas . . . understanding it’s transverse plane bias anatomically

Decelerates internal rotation of the femur with significant transverse plane loading in the front loading leg in gait, as well as the back loading leg in gait with significant sagittal plane and frontal plane loading mechanisms

•The abdominal muscles . . . provide motion and stability in all forms of function of the pelvis for all the muscles that insert into the pelvis

Get loaded eccentrically in all three planes of motion through relative motion between the pelvis and the rib cage

• Description of an ACL injury mechanism with the fault or cause in the front butt

•The biomechanical perspective from the ACL and the back

•Understanding the loading of the front butt requires a comprehensive strategic analysis

•The front butt gets turned on by the feet and hand drivers

• If the groin can be properly lengthened, stimulated, proprioceptively enhanced and strengthened, it can significantly contribute to the success of all forms of function

CASE PRESENTATION - A special thanks to Keith Bozyk

Discussion of the function of the groin

Not knowing what to take a look at because of our ignorance of what the groin does in function

Differentiating the various structures of the groin

Ruling out a hernia

Looking at contributing factors that directly influence the groin

•Biomechanical analysis of feet•Modified gait analysis•Thoracic spine and trunk analysis•Leg length analysis•Biomechanical analysis of the legs•Comprehensive hip assessment

Determine what facilitates the pain in the groin injury and determine where there arefunctional successes relative to the groin

•Right stride stance with bilateral overhead arm drives in the sagittal, frontal and transverseplane

•Left stride stance with bilateral overhead arm drives in the sagittal, frontal and transverseplane

Discussion of stride stance tweaks in the sagittal, frontal and transverse plane

•Left and right stride stance toe out with bilateral overhead arm drives in the sagittal, frontal and transverse plane

•Left leg balance, right leg anterior and posterior reaches•Right leg balance, left leg anterior and posterior reaches•Left leg balance, right leg medial reaches•Right leg balance, left leg medial reaches•Left leg balance, right leg right and left rotational reaches•Right leg balance, left leg right and left rotational reaches

Tweak with pre-positioning of arms in the sagittal, frontal and transverse planes

Repeat of balance reach tests with concurrent arm drivers

Three dimensional front butt function analyzed with the Functional 3D Testing SystemTM

Description of manual resistance and manual reaction with arms with balance activities

TrueStretchTM functional analysis of groin

•Hip extension with foot eversion, with leg internal rotation, with bilateral arm drivers, with overhead posterior reaches, overhead lateral and medial reaches, and right and left rotational reaches.•Left hip extension with right leg hip flexion•Left hip extension with right leg hip flexion, with bilateral arm overhead posterior reaches•Left hip extension with right leg hip flexion, with bilateral arm overhead medial and lateralreaches

•Left hip extension with right leg hip flexion, with bilateral arm right and left rotational reaches at shoulder height

•Left hip extension with right leg hip flexion, with right arm overhead posterior reaches and left arm left rotational reaches

•Left hip extension with right leg hip flexion, with right leg toed in with bilateral arm right rotational reaches at shoulder height

The “back butt” feeding the “front butt” bad things

Discussion of down leg tweaks in all three planes in the TrueStretchTM

Strategy of preventative stretching

Double check of three dimensional function of hamstrings

Functional relationship between the hamstrings and the groin

Understanding “back butt kyphosis”

Double check hip rotational capabilities functionally

Tweak with rotation of the up leg in the TrueStretchTM

Ultimately we need to build upon success and gain functional capabilities of the groinand the rest of the body

Functional stretching requires functional strengthening

•Stride stance, with shoulder to overhead 3D lifting matrix with dumbbell load•Stride stance toed in, with shoulder to overhead 3D lifting matrix with dumbbell load •Stride stance toed out, with shoulder to overhead 3D lifting matrix with dumbbell load•Stride stance toed in with increased width of stance, with shoulder to overhead 3D lifting,with posterior reach tweak with dumbbell load

Discussion of the three dimensional lunge matrix with shoulder to overhead lifts

Gradually creating instability to enhance functionability•Right leg balance, with right arm stabilized, with left leg posterior bungee driver•Right leg balance, with right arm stabilized, with left leg posterior bungee driver, with left arm overhead posterior reach

•Right leg balance, with right arm stabilized, with left leg posterior bungee driver, with left arm frontal plane overhead drives and rotational drivers

•Right leg balance, with left arm stabilized, with right arm drivers in all three planes•Right leg balance, with left leg posterior bungee driver •Right leg balance, with left leg posterior bungee driver, with bilateral arm overhead posterior reach

•Right leg balance, with left leg posterior bungee driver, with bilateral arm overhead posterior lateral reach

•Right leg balance, with left leg posterior bungee driver, with bilateral arm overhead posterior medial reach

Discussion of frontal plane tweaks with bungee drivers

Discussion of progressing to bungee loading the right leg

•Right foot BAPSTM, with right arm stabilized, with left leg posterior bungee driver, left arm overhead posterior reach

•Right foot BAPSTM, with right arm stabilized, with left leg posterior bungee driver, left arm overhead posterior bungee driver

To fully rehab, to fully train and condition, to fully prevent, we need to take oneclinically beyond where they need to go functionally

Discussion of using the right hand, the left hand, the right foot, and the left foot as theultimate drivers for the groin•Understanding the strategies of “where to go”

Functional rehabilitation is functional training and functional training is functional rehabilitation

Function is a constant reassessment

Debrief with Bob Wiersma, Executive Director, Accelerated FunctionalRehabilitation Network•Importance of leg length differences•It could be a functional leg length discrepancy•The stress on the struts . . . the groin•Relationship of the groin to the back•95% of back pain doesn’t have it’s primary cause in the back•The inability to turn on the front butt•The multiple “X factors” in the body•The X factor in PNF•In function everything is synergistic•Discussion of overuse and fatigue injuries•The adductors ability to over-stabilize, splint and bail out•Top-down and bottom-up strategies to get to the front butt•The excitement of the front butt

GARY’S OPPORTUNITY TO TRAIN AND CONDITION WITH KEITHAdvanced training and conditioning for the groinTurning the groin on . . . providing a fun and functional groin workoutWarm-up on the TrueStretchTM and with 3D Stretch Matrix stretches

Smart HurdlesTM

•Anterior step-over•Posterior step-over •Anterior step over with overhead reach•Right lateral and left lateral step-over•Left lateral and right lateral step-under•Right rotational and left rotational step-under•Left lateral and right lateral step-under in back•Right lateral and left lateral step-under and step-over

Slide BoardLateral slideLateral slide with overhead reachesAnterior and posterior slideRight rotational and left rotational slideRight rotational and left rotational slide with forward pivot and back pivotLateral slide with leg rotationsLateral slide with Body BladeTM sagittal planeLateral slide with Body BladeTM frontal planeLateral slide with Body BladeTM transverse planeLateral slide with medicine ball catch and throwLateral slide with bungee cord anterior pullsLateral slide with bungee cord posterior pullsLateral slide with bungee cord punches

Discussion of the strategy of the groin workout

With a special thanks to Keith

The groin in golf . . . golf requires accuracy and power

The groin is a tremendous power source if we can recruit it in the golf swing

Groin dysfunction can cause CChhaaiinn RReeaaccttiioonn injuries throughout the body withthe golf swing

Eccentric loading of the groin in the golf swing

The front butt and back butt work together to provide the power for the golfswing through the feet

Creating distal instability takes away the friend of the front butt, ie; the backbutt.

Use of the slide board to facilitate enhanced function of the groin with the golfswing

Slide Board and the winged golf club •Foot reaction with sagittal plane arm driver•Foot reaction with frontal plane arm driver•Foot reaction with transverse plane arm driver•Lateral slide with frontal plane arm driver•Lateral slide with transverse plane arm driver•Lateral slide with sagittal plane arm driver•Sagittal plane foot drives with sagittal plane arm driver•Sagittal plane foot drives with frontal plane arm driver•Sagittal plane foot drives with transverse plane arm driver•Frontal plane foot drives with transverse plane arm driver•Frontal plane foot drives with sagittal plane arm driver•Frontal plane foot drives with frontal plane arm driver

The skill of transformation is understanding the biomechanics of humanmotion, taking advantage of how the body works, and then transformingthat knowledge into a specific function in order to use the science oftweakology in order to design an effective training program for a specific purpose

RESEARCH ROUNDTABLE WITH DR. DAVID TIBERIO

Studies referred to: Leaf JR, Keating JL, Kolt GS. Injury in the Australian sport of calisthenics:a prospective study. Aust J Physiother. 2003; 49(2): 123-130.

Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. MedSci Sports Exerc. 2001; 33(9): 1423-1433.

Tyler FT, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effec-tiveness of a preseason exercise program to prevent adductor musclestrains in professional ice hockey players. Am J Sports Med. 2002; 30(5):680-683.

The Australian calisthenics study identified 32% of the injuries involving the low back and 25% of the injuries involving the groin.

Asking the participants of the study which motion they thought caused theirinjuries revealed the perception of back extension as the primary causativemotion

Discussion of the inability to transform extension with calisthenics exercises

The study of hockey injuries reveals a significant amount of groin injuries occurring during the pre-season

The strategy of preparing the groin for the game

The isometric test of strength, (adducting the hip), of the adductors, does not correlate to the incidence of injury.

Discussion of isometrically and/or isokinetically testing a muscle (doing what itdoes not do) in function and trying to correlate it to function.

Training to prevent the groin injury in hockey has proven effective

Balancing the instability of the function of hockey with proper tweaks for training

We must have multiple strategies

The pelvis is looking for “someone” to decelerate it

Screening for the potential risk of groin injuries involves individualized attention,taking the athlete through a training and conditioning program, and evaluatingtheir response.

Using tweakology to create the required CChhaaiinn RReeaaccttiioonn to provide training andconditioning specifically for the groin and it’s CChhaaiinn RReeaaccttiioonn throughout thebody

Going from the complex to the simple side of the complexity

Understanding a logical progression of providing enough stability so that themobility is successful . . . and then gradually, through tweakology, taking awaymore stability while guaranteeing success with functional mobility.

A parting comment regarding making sure that we are understanding, andtherefore rehabilitating, training and conditioning problems such as insertionalabdominal injuries, with function

A special thanks to Dr. David Tiberio for sharing such relevant researcharticles.