As a runner, if you've been experiencing persistent groin pain for six months or more, you may be diagnosing and treating your discomfort inaccurately. I recently encountered a client dealing with this exact situation. This got me thinking about the misconceptions surrounding muscular injuries and their management.
Typically, muscle injuries, unless they evolve into tendinopathy, do not last for six months. If the pain moves around appearing sometimes in the groin, at other times on the outside of the hip or the back of your thigh, it's unlikely to be a muscle injury. Muscle behavior doesn't align with such inconsistency.
Similarly, if the pain doesn't follow a predictable pattern related to muscular activity — for instance, running long distances without discomfort and then experiencing pain after running a short distance or not running at all — it's a signal that we might be dealing with something other than a muscle issue.
Muscle injuries, like strains or pulls (both euphemisms for tearing), behave in very predictable ways. A tear doesn't move around, it stays where it is. If you've ever pulled a hamstring, you know the pain flares up when you use the muscle and eases when at rest. This doesn't line up with the feeling of a pain that seems to migrate and flare up unpredictably.
So what could it be? If you've tried all traditional muscle pull treatments such as rest, massage, foam rolling, strength building and consulted with a physio or other medical professionals but the pain persists or eases temporarily and then returns, it's time to rethink your diagnosis. This rule doesn't only apply to the groin but extends to any chronic, inconsistent pain, whether it's in the calf, the knee, or elsewhere.
In many instances the pain isn't originating from the part of the body where you're feeling it. One of the most common misdiagnoses I encounter is localizing pain that actually stems from the back. An alarming number of runners with persistent knee, groin, or ankle pain are actually dealing with issues originating from their back.
This could be due to the irritation of a nerve in the back that causes pain further down the body. Treatments aimed at the local area might provide temporary relief, but unless the root cause in the back is addressed, the pain will persist.
Understanding the body's pain response system can help to make sense of this. Nociceptors, or danger receptors, are scattered throughout the body. They send signals to the brain, which then assesses the potential danger based on past experiences and decides whether to generate a pain response. This response isn't always tied to physical damage.
If you've ever experienced phantom limb pain, you'll understand this concept. The pain doesn't originate from the removed limb – that's impossible since it no longer exists. Rather, the brain generates the pain based on signals received from nociceptors.
Taking this into account, we need to reconsider how we approach chronic running pain. If you're experiencing a constant tightness, a burning sensation, or a persistent knot, you must shift your focus from the location of the pain to finding the actual cause of the pain. Treating the symptom is like trying to un-kink a hose by increasing the water pressure. Sure, you might get a little more water out of the end, but the kink is still there.
Commonly diagnosed conditions, such as greater trochanteric bursitis or glute medius tendinopathy, are often linked to low back issues. Similarly, chronic stiffness in the hamstring or hip flexor might be a protective response from the body due to a problem in the lower back. For instance, the hip flexor (specifically the psoas) connects directly to the spine. When the brain senses an irritation in the back, it may cause the hip flexor to tighten, restricting movement to facilitate healing.
To tackle such issues effectively, we need to first promote an environment conducive to healing. This often means reducing stress on the affected area to allow the body to do its work. Only after the healing has occurred can we start stretching, mobilizing joints, and building strength to return to a normal routine.
Remember, we must also consider the potential contributors to continued discomfort, like lack of mobility, strength, or control. Addressing these elements can prevent future problems.
So the next time you feel that recurring twinge or tightness, remember: it's probably not your groin, it's likely your back. This insight may well change your approach to managing pain and help you return to running, or any other activity, sooner.
If you've tried all traditional muscle pull treatments and consulted with other medical professionals but your pain persists... I recommend hopping on a totally free 15 minute consultation call with our team to see how we can help!