Ankle sprain and sprained ankle is in the news at the moment especially if you follow tennis and the fortunes of my fellow Scot Andy Murray. Andy sprained his ankle at the French Open Championships during his third round match with Berrer which Andy won in straight sets despite suffering his ankle sprain in the second set.

In a column he wrote for the BBC he said “The moment it happened I was definitely worried my tournament was over there and then, but we’ll just have to see how the ankle reacts over the next 48 hours.”

“I guess most injuries are unexpected and this one definitely was. I was sliding out to the right to chase down a drop shot, like I have dozens of times this week, and all I was thinking about was hitting the ball.”
“Then reality hit and I just thought, ‘Is it bad? How’s it going to be when I stand up?’ Straight away it felt very sore and the trainer told me to take an anti-inflammatory before taping the ankle very tight to protect the ligament.”

Look at this French video of another severe ankle strain way back in 1995 suffered by Michael Stich playing Todd Woodbridge – it’s not for the faint-hearted be warned!!

Click here to view the embedded video.

When you get a sprained ankle it is the ligaments and tendons on the outside or lateral side of your ankle that get damaged. The damage can be a slight strain of the ligament – Grade 1 progressing in severity all the way through to a complete rupture of the ligaments – Grade 3 strain.

Ankle Sprain Treatment

The best thing that you can do for a sprained ankle is to stop it from swelling.
This involves the classic PRICE regime

PRICE

P – Protection
R – Rest
I – Ice
C – Compression
E – Elevation

In other words get off it as soon as possible get some Ice on it and lie down with your foot up. Ideally apply some form of compression with and after applying the ice. If you are Andy Murray and have an expert physio close at hand to make a functional diagnosis of the sprain and that can apply an expert strapping then and only then should you delay starting the PRICE regime. However, believe me when I say that even an elite athlete like Andy will have done all of this immediately he left the court!

For the rest of us mere mortals it is important to stop the ankle from swelling and applying a strapping is a great way to do this. I will cover how to do this in a later article.

For up-to-date information about Andy check out his website at www.andymurray.com

Check out Ankle Joint

Tennis Elbow Exercises

There are numerous programs and videos on YouTube that show you how to do Tennis Elbow Exercises.
The biggest problem I have with them is that it follows the “one size fits all” type of exercise prescription.
My questions for you would be:

• are you doing the correct tennis elbow exercises for your problem?
• do you even have Tennis Elbow?
• are these tennis elbow exercises of the correct intensity for your problem?
• is there a problem with your neck that needs to fixed before doing these exercises?
• is there an elbow joint problem you need to fix first?

These are just a few very important questions that need to be answered before you start paying money and doing “any old exercises” as part of your tennis elbow treatment programme.

Just stop and think for a moment………

If you paid to see a physiotherapist / physical therapist / osteopath / chiropractor would you expect them to prescribe Tennis Elbow Exercises without examining you??
I don’t think so!
You would not be impressed in the slightest would you?

Well don’t do it on the internet either.

Take my FREE Interactive Forearm Pain Video Assessment and find out what kind of problem you have. Sign up below…

TENNIS ELBOW

PROFESSIONAL

 VIDEO 

 ASSESSMENT

In less than 10 minutes from now!

You will know:

• if you really have Tennis Elbow 
• how severe is your Tennis Elbow
• if other conditions are affecting your elbow delaying recovery
• how to access an exercise program for your specific type of problem

 

Just enter the usual details below and click the ‘Sign Up’ button to get started…

Name:

Email:

We respect your email privacy

If you want some simple yet effective Tennis Elbow Exercises as part of your Tennis Elbow Treatment then click on the video below.

Forearm Pain

If your forearm pain is towards the outer elbow then these Tennis Elbow Exercises are designed to fit in with the early to middle stages of your Tennis Elbow Treatment.
The tennis elbow exercises on the video are:

1. resisted wrist extension in a flexed position
2. resisted wrist flexion from an extended position
3. static resisted supination
4. static resisted pronation
5. stretch for the forearm extensors
6. stretch for the forearm flexors

Remember these are general exercises for early to mid stage Tennis Elbow.
If you want a more accurate assessment of your Forearm Pain as it currently is then

We respect your email privacy

BBC Sport report the final retirement of Tennis legend Justine Henin.

The report states:

“Former world number one Justine Henin has been forced to retire from tennis for the second time because of a recurring elbow injury.
The 28-year-old Belgian announced the news on her website, stating that her elbow had been “damaged” during the recent Australian Open.
“In these recent months I have rarely been spared of the pain,” she said.
“The doctors told me my elbow is too fragile and therefore I cannot continue my profession at this high level.”
Henin’s final match was a third-round defeat by Russia’s Svetlana Kuznetsova in Melbourne last weekend.

The Belgian, who won seven Grand Slams during her career, first quit the sport in 2008 when she was ranked number one in the world before returning to the WTA Tour in January 2010.

She reached the Australian Open final that month but her comeback was curtailed when she fractured a ligament in her elbow at Wimbledon. (See Henin Elbow Inury)
Despite her elbow injury Henin began this season by leading Belgium to the final of the Hopman Cup, winning all of her matches.

And at the Australian Open, the 2010 finalist beat India’s Sania Mirza and Britain’s Elena Baltacha before falling to current world number 26 Kuznetsova.
“I suffered a lot the last week and every day gave me more and more pain, but I believed that my will would take the upper hand,” she added in her open letter.
“I’m in shock, of course. After having considered the advice of doctors, it is now clear and accepted that my career finally ends.”
Henin won her first Grand Slam title in 2003, when as Henin-Hardenne, she defeated compatriot Kim Clijsters to win the US Open.

Her long-running battle with her fellow Belgian was one of the sport’s great rivalries in recent years.
Henin won the US Open again in 2007, the Australian Open in 2004 and the French Open on four occasions.
The only Grand Slam title to elude her was Wimbledon, where she was the beaten finalist in 2001 and 2006.
The Liege-born player also won Olympic gold in 2004 when she beat Frenchwoman Amelie Mauresmo 6-3 6-3 in the final.”

Elbow Injury

After Wimbledon where she injured her right elbow when she fell in a fourth-round loss to her Belgian rival Kim Clijsters. She spent the next few weeks deciding whether to risk surgery to repair the problem, but according to her longtime coach and confidant, Carlos Rodriguez, surgery would have forced her to miss another “year and a half realistically” and so she decided to take her chances without surgery. She returned for the exhibition team event, the Hopman Cup, this month, then won two rounds in Melbourne before another longtime rival, Svetlana Kuznetsova of Russia, beat her in an intense yet error-strewn match, 6-4, 7-6 (8).

Justine said “I am in shock, obviously, even if the struggles these last seven months had made me understand that perhaps one day I’d have to accept this,” Henin said in her letter. “Having considered it thoroughly and on the advice of my doctors, it’s time to bow to the evidence and accept that my career ends here, definitively, even though it’s tough, very tough when I was coming back with great desire.

“I am sad,” she continued. “I had hoped for another kind of comeback and dreamed of another end.”

In total, she won 43 singles titles, including four French Opens, one Australian Open and two United States Opens. Wimbledon, where she was twice a finalist, is the only hole in her Grand Slam résumé. Henin also finished the year at No. 1 in 2003, 2006 and 2007, and won the Olympic gold medal in singles in 2004.

But statistics are limited when it comes to expressing Henin’s impact. She was a purist’s delight, and Martina Navratilova, one of the game’s great champions, once said that there were only two players in this era she would pay to watch: one was Roger Federer, the other Henin.

The Adductor Squeeze Test is a simple test that you can use to decide if you have a Groin Strain / Adductor Strain. It is very easy to carry out the test. It is easy to evaluate the results of the test. Click and watch the video below:

If you do not have a football then you could use a folded bath towel or use two fists placed side by side between your knees.

Adductor Squeeze Test Results

Positive Adductor Squeeze Test

If ANY of the 3 positions produces pain in your groin area then the test is positive.

What muscles does the Adductor Squeeze Test stress

The muscles tested are shown in the diagram opposite.


They are numbered in the diagram

1. Pectineus Muscle which runs from high on the front of the pelvis and attaches to the upper Femur
2. Adductor Longus Muscle has a cord like tendon which is easily felt in the upper groin. It attaches to the upper third of the Femur.
3. Gracilis is long and thin and attaches quite high on the front of the pelvis also. It runs down the inner thigh and attaches below the knee to the inner aspect of the Tibia. It is the only Adductor to cross the knee joint.
4. Adductor Magnus is the largest of the Adductor muscles. It is attached quite far back on the underside of the pelvis near to the attachment of your Hamstring muscles. It has almost 3 separate parts to the muscle. A set of fibres which run almost horizontally at the top of the Femur. Then there is a massive ‘fan’ of fibres whcih are attached all the way down the back of the Femur. Lastly there is a collection of fibres which run vertically much like Gracilis, but these fibres attach just above the inner aspect of the knee.
5. Adductor Brevis lies deep to the Adductor Longus and Pectineus Muscles

For more detailed information see Adductor Strain Anatomy
and Adductor Strain

Adductor Strains affect any of the five Adductor Muscles.
These are Adductor Longus, Adductor Magnus, Adductor Brevis, Pectineus and Gracilis Muscles.
For more detailed information see Adductor Strain Anatomy
Most commonly affected are the

1. Adductor Longus (2 in the diagram)
2. Gracilis (3 in the diagram)
3. Vertical fibres of Adductor Magnus (4)

Less often injured are

4. Adductor Brevis (5)
5. Pectineus (1)
6. Horizontal and oblique fibres of Adductor Magnus which are attached all the way down the femur

An Adductor Strain (groin strain) is a strain or tear to any of these muscles.
These strains are graded

• Grade 1 which affects less than 5-10% of the muscle fibres
• Grade 2 affecting more fibres than Grade 1 but not a complete tear
• Grade 3 affects all the fibres resulting in a complete tear.

Signs and Symptoms of an Adductor Strain

Grade 1 Adductor Strain

mild pain or discomfort in the inner thigh area. This may be noticed at the time or sometimes it is not until after exercise stops that you feel the pain here. Generally the adductor muscles will be tight or will feel tight.
It might be that there is an area in the Adductor muscle which is painful on palpation (to touch firmly). You will feel uncomfortable or painful when running fast or changing direction. Generally walking is fine apart from first thing in the morning or getting up from a chair after sitting about for a while. There will be mild pain with the Adductor Squeeze Test – see Video

Grade 2 Adductor Strain

You generally feel a sharp sudden pain in the groin muscles while exercising.
You may get some bruising or swelling generally after a day or so.
There will be some tightening of the Adductors either immediately or the next day post injury.
Pain on the Adductor Squeeze Test (see Video) and probably some weakness.
Walking will be painful and you will almost certainly have a limp and won’t be able to run properly.
There will be pain on stretching the muscle.

Grade 3 Adductor Strain

Sudden sharp pain in the groin while exercising.
Significant pain and / or weakness on the Adductor Squeeze Test.
Substantial swelling and bruising on the inner thigh within 24 hours.
Stretching the Adductor muscles will be painful (generally).
On palpation (firm touching) you may be able to feel a lump or gap in the muscle.
You won’t be able to run at all.
Walking and getting out a chair etc will be difficult.

Simon Katich suffered an injury blow by limping through most of day three of the Ashes Match in Adelaide with a “heel” problem.
This was later clarified as being an Achilles swelling see -Lump on Achilles Tendon .
His pain was compounded further by knowing that he was going to have to bat for a long period to help Australia save the game.
He also managed to get himself run out in the first innings without facing a ball!

Australia’s captain Ricky Pointing later admitted that
“He’s been pretty hindered in the field.
His achilles is quite badly swollen and we have got him on and off the ground a couple of times to get some ice on it knowing that he’s got plenty of batting to do over the next couple of days.”

In fact Katich did manage to bat for a few hours until after lunch before being dismissed caught behind for 43.

The Australian Medical Team have a lot to do if they want to try and get him fit for the Third Test in Perth starting on the 16th December. It depends on how bad the Katich Achilles tendonitis injury is and whether he has had significant previous problems here. As Achilles Tendonitis is a degenerative condition this is very likely. See Achilles Tendonitis Injury- Your Top 10 Questions Answered for much more information.

Adductor Muscle Group

There a FIVE muscles in the Adductor Group
1 – Pectineus
2 – Adductor Longus
3 – Gracilis
4 – Adductor Magnus
5 – Adductor Brevis muscle is deeper and therefore hidden in this diagram.

These muscles are all attached at the top to the Pelvis and below four of them to the Femur (Thigh Bone) with Gracilis attached to the Tibia on the inside of the knee.
With these attachments the Adductor Group help to control movements of the thigh away from the mid-line and also help to stabilise the hip and leg in one-legged standing or running.

Adductor Strain

An Adductor Strain is damage to one of the Adductor Muscle Group.
The most commonly damged muscles are the

• Adductor Longus – No. 2 in the diagram
• Gracilis – No. 3
• Vertical Fibres of Adductor Magnus – No.4

The large fan shaped part of Adductor Magnus along with Pectineus and Adductor Brevis are ‘greyed out’ in the diagram for emphasis.
The Gracilis and Adductor Longus are both attached to the front of the Pubis and lie very superficially just below the skin.
The vertical fibres of Adductor Magnus are attached to the Ischial Tuberosity towards the back of the pelvis (where the Hamstrings originate).
The Adductor Magnus lies much deeper and is more difficult to feel.

Adductor Strains are injuries to the Adductor muscles – I will deal with injuries to the Adductor Tendons in a separate post.

A strain to a muscle can be considered as Grades 1 to 3

GRADE ONE STRAIN – is damage to a few of the small fibres only – less than 5%
GRADE TWO STRAIN – is damage to many more fibres but there is not a complete tear of the muscle
GRADE THREE STRAIN – is a complete rupture of the muscle

Adductor Strain Causes

As explained above these muscles help to stabilise the hip and thigh when you are running.
That means that at every step you take these muscles are subjected to forces in several planes at once.
Front to Back or Flexion / Extension in the Sagittal plane (Red)
Side to Side or Abduction / Adduction in the Coronal plane (Blue)
Rotations – Medial or Lateral in the Transverse plane (Green)
AND most Importantly – ANY COMBINATION of these!!

Overuse Adductor Strain

The Adductors are actively controlling Abduction and Lateral Rotation forces acting on the thigh.
This can happen up to 80-90 times on each leg per minute. Strenuous training, running or playing can put significant strain on the Adductors.
If the recovery between workouts does not allow adequate repair, fibres in the Adductor muscles may break down and become injured.
So you can see why overuse is a common cause of Adductor Strain.

Poor Warm-Up

A good warm-up serves many purposes. It increases blood flow through the muscles, increases body temperature, increases flexibility and most importantly prepares the nervous system to control the muscles in an optimal way. If the warm-up is poor especially before strenuous activities, then the adductor muscles are not sufficiently ‘switched on’ or loose enough to cope with the sudden increase in stresses. This inevitably leads to sub-optimal use of the muscles and increased strain leading to injury.

Sudden, Unexpected Strain

Sudden change in speed, stretching the leg out for the ball or in a tackle, landing awkwardly from a jump, sprinting, sudden change in direction or getting knocked off balance while running quickly can all cause a sudden or unexpected stress to the
Adductor muscles. This greater than expected forces can cause injury to the Adductors.

Outside Forces Acting on the Adductors

Unexpected contact with an opponent in the tackle situation in football or any other ball sport, catching your foot in a divot, slipping on the surface while changing direction or hitting an object with the leg eg goalpost or ski gate. Any of these type of external forces when applied to the leg and pulling it away from the mid-line will cause a sharp and possibly injurious strain to the Adductors.

See Next Article Adductor Strain – Signs and Symptoms

Where are the Groin / Adductor Muscles?

The Adductor Muscle Group which when injured produce a groin strain are found in the upper inner thigh.
In this diagram of the front of the Right Thigh you can see the Adductor Muscles numbered on the inner side of the thigh.


There are FIVE muscles in the Adductor Muscle Group
1 – Pectineus
2 – Adductor Longus
3 – Gracilis
4 – Adductor Magnus
5 – Adductor Brevis muscle is deeper and therefore hidden in this diagram.

Pelvic Attachments of Adductor Muscles

Each side of the Pelvis is formed from 3 bones which are fused together.
These bones are the Pubis, the Ischium and the Ilium.


All the Adductor Muscles attach to the front of the pelvis.
1 – Pectineus – high on the Pubis bone
2 – Adductor Longus from a rounded tendon high on the front of the pubis
3 – Gracilis from a long thin attachment on the body and inferior ramus of the Pubis and the ramus of the Ischium
4 – Adductor Magnus arises from part of the Pubic ramus and Ischeal ramus and tuberosity
5 – Adductor Brevis muscle lies posterior to Adductor Longus and Pectineus .

Femur Attachments of Adductor Muscles

All the Adductor Muscles apart from Gracilis attach to the back of the Femur (thigh bone).
1 – Pectineus – high up near the top of the shaft of the Femur
2 – Adductor Longus attaches to the middle third of the Femur below Adductor Brevis
3 – Gracilis does not attach to the Femur but actually crosses the inside of the knee joint to attach to the upper Tibia
4 – Adductor Magnus is a massive muscle which is attached all the way down the back of the Femur
5 – Adductor Brevis muscle attaches to the upper third of the Femur above Adductor Longus

Adductor Magnus has an upper part in which the muscle fibres run horizontally and can be known as the Adductor Minimus.
This part of the muscle lies behind the Pectineus and is shown in the diagram by the red dotted line just below the number 1.
It also has a medial part whose fibres run almost vertically downwards. This bulky part of the muscle ends in a tendon which attaches to the Adductor Tubercle on the medial condyle of the Femur just above the knee.

The Adductor Brevis muscle lies deep to Adductor Longus and Pectineus muscle.
These parts of the muscle are shown in the diagram by the purple dotted lines.

Most groin pain from Adductor Muscle Strains affects the upper attachments of the Adductor Longus and Gracilis muscles.
Now you have an understanding of where the Adductor Muscles lie and where they attach to the pelvis and the Femur.
You are probably surprised at the size and extent of the Adductor muscles.

Head Coach of the Washington, Mike Shanahan, said he had never seen anything like the injury wave that hit his Redskins on 21st November 2010 when they played Tennessee Titans in Nashville.
They had several injury problems before the game but that was nothing compared to what happened in the game.
A the end of the game Mike Shanahan said “I’ve been in a lot of football games through the years, not just in the pro level, and I have never had that many guys go down and the team stay together and keep on fighting and find a way to win. It says a lot about our football team. How they handle themselves, how hard they work. … We were able to survive.”

Redskins Injuries – before the game

Already without right guard Artis Hicks who had started every game this season.
He was out with a thigh injury.

Cornerback Carlos Rogers was missing with hamstring injury

Strong safety LaRon Landry was out with an Achilles tendon problem

No. 2 running back Ryan Torain with another hamstring injury

Redskins Injuries – during the warm-up

Washington lost backup running back Chad Simpson in the pre-game warmup with a foot injury.
He was spotted after the game wearing a walking boot – so not trivial.

Redskins Injuries – during the game

Rookie special-teamer Anderson Russell collected a knee injury.
He was injured trying to stop the Titans only touchdown on a punt return.

Linebacker Lorenzo Alexander injured his hamstring in same play!
So that was two out almost immediately.

Early in the second quarter center Casey Rabach left with a knee injury

Rocky McIntosh crashed out with a thigh injury

Reserve guard Derrick Dockery went down with a knee injury

Midway through the second quarter, Clinton Portis re-aggravated his groin injury.
He was just back after tearing his groin in Week 4

Also Santana Moss left the game briefly with a sore hamstring.

Defensive end Kedric Golston was sidelined with a groin injury late in regulation.

Cornerback DeAngelo Hall was hurt in the third quarter but returned before it was over and was instrumental in Washington’s last-ranked defence to keep the Titans out.

Even the trainer got hurt see www.greenfieldreporter.com Duct Taped Redskins

And yet, Washington prevailed 19 -16 in on a 48-yard field goal in overtime from Graham Gano, who had missed earlier from and 47 and 51 yards.

All images from the Official Site of The Washington Redskins

What is a watershed

A watershed is not a garden water feature despite its name!
It is defined in the merriam-webster dictionary as “a crucial dividing point, line, or factor”.

Achilles Watershed

The Achilles watershed area is the area where there is a decrease in blood supply in the tendon
between 3 and 6 cm up from the attachment to the calcaneum.
The blood supply is meant to come down from the musclotendinous junction at the top,
and up from the bony attachment to the heel at the bottom.
This is represented in the diagram opposite by the blue arrows.

The area in the middle (pink) has a lower supply – the Achilles watershed area – where most ruptures take place.

This was first described in 1959 by Lagergren & Lindholm who examined the blood vessels supplying the Achilles Tendon.

This was taken on a stage further by Carr and Norris in 1989 who injected a dye into the vessels of cadavers. They concluded “there was a reduction in both the number and mean relative area of vessels in the mid-section of the tendon.”

In 2000 Stein, Laprell, Tinnemeyer and Petersen used radioisotopes to measure the intra-vascular volume of the human Achilles tendon and concluded “When the tendon was divided into three regions, we found the lowest intravascular volume in the middle region (3–6 cm above the tendon insertion).”

All of these studies used cadavers and the average age of the cadavers was early 70′s!
There is a decrease in blood supply to the Achilles Tendon with increasing age so perhaps these subjects
are not the best for the projection of results onto a fit and healthy population of athletes.

Blood flow in chronic Achilles tendinopathy disputes Achilles Watershed Area

Aström in 1994 measured blood flow and reported a significantly lower tendon blood flow at the insertion (bottom end), but otherwise even vascular distribution – no Achilles watershed area in symptom-free individuals.
More recently in 2008 an article by Knobloch stated “we found that in symptomatic tendinopathy neovascularisation is associated with a significantly increased capillary blood flow in the Achilles tendon at the point of pain” This means that there is an increase in blood flow at the mid-portion area of the Achilles tendon when painful.