Wednesday 4 August 2010

The second diagnosis

You may have read last weeks post where I was diagnosed with an Rectus Addominis and Inguinal Tendon injury.  You may have also detected that I was a little pessimistic about my prognosis, and unsure of how just physio was going to fix it.  Well, today I went along to meet my physiotherapist and expected to be ushered in and given a raft of core strength and glut med exercises.  I was wrong.  The physio I think detected that I was a little confused by my diagnosis (it's all the big Latin words!). I guess I really couldn't understand why glut muscle weakness was giving me such specific pain in one small area by my groin.

He did provide a good explanation as to why the diagnosis could be the case, but then decided to take my case history and do some additional tests.  Many of the tests the consultant, who was very thorough, had perfomed last week, but also did a few extra ones.  The room was punctuated with "does this hurt?", "err, no"...."what about this?"...."no, that's ok too"...."and this?..."Ouch!!", for about half an hour.  I think I had been referred to a physio who was really up to date on the latest research in the area; he said was literally months old.  The killer pain-inducing exercise for me is a sit up, especially a sit up with a twist to the left, which aggrivates my right Rectus Addominis where it joins my pubic bone.  At least that's precisely what I told the physio, and demonstrated as such to him.  After several more tests the physio then said, I believe I know what could be wrong and it's not your rectus abdominis.  He squeezed my hips together hard, stabilising them (simulating wearing a pelvic belt apparently), and had me to another sit up. Amazingly, I had no pain.

He said, like others have, and everything I have read, that diagnosing groin pain is very hard because the area is just like spaghetti; everything meets here.  He narrowed it down to two possible diagnosis, saying it was impossible to nail it to one without an expert-guided ultrasound by someone who specialised in this problem.  He is going to refer me to a London specialist who he says is the only person he would send me to, to diagnose it; a doctor who deals with UK elite athletes apparently.  The physiotherapist went on to explain that I did indeed have Glut medius and abductor weakness as identified last week (which he has given me some exercises for), as well as chronicaly tight femoris muscle which I have to stretch.  The combination of all of this weakness and tightness, and the resulting twist of my pelvis (my right foot is currently twisted outwards, visibly), has out undue strain on the area and resulted in the damage (that's my lamens explanation, not the practioners incidentally). 

So, what is it?

Either:- A Conjoint Tendon Tear or an Abdominal Wall Tear. 

So, basically we are back to what I had half diagnosed myself a few months back, a hernia in effect.  Albeit kindly titled a "sportsman's hernia".  The doctor last week had initially diagnosed this too, and then second guessed himself.  The ultrasound may show his gut instinct may have been right first time.  We'll just have to wait and see now.

The specialist I need to see is away on holiday and also has is usually very busy, so right now I have no idea when I will get to see him.  I will however start work on the exercises I have been given.  I'm half clinging onto a vain hope that the diagnosis will change to conjoint tendonitis (you can tell I got home and started googling can't you) and may be resolved with 4-6 months physio.  Sadly, the more likely outcome (I hate to suspect it) is that I need surgery; maybe a surgical repair of the conjoint tendon and posterior inguinal wall, perhaps also an adductor tendon release done as well.  They may as well throw in an obturator nerve release at the same time, and make sure all bases are covered. 

So it's essentially doom, gloom and some extra doom. 

I am seriously considering taking up endurance knitting, but I suspect there are some nasty hand injuries that I could pick up.


  1. Sorry to hear that Rich, hoping that with some physio the results are better than expected and you manage to avoid surgery. Must be gutting though...

  2. Rich,

    I came across your blog after hours of research into Gilmore's groin, which my GP suggested I had after a groin strain was ruled out. I had not heard of it before and so like yourself I googled it and alot of the symptoms I could relate to. The clincher for me is doing a sit up with a twist to the left and this causes alot of pain and this is why it was a relief to read your blog. The strange thing for me is I can power upstairs without any pain but as soon as I run on the flat or climb into bed I can feel my groin hurting. Not excruciating but enough to annoy me.

    I am very interested into how your injury pans out, it seems so far you have had a very thorough investigation. Due to the inconsistency of the NHS I am slightly concerned that I may be fobbed off by a mediocre physio, however, I'm still trying to get over the first hurdle of actually getting an appointment.

    Looking forward to further updates and hopefully things take a turn for the better :)

  3. Hi Neil. Thanks for your reply, sorry to hear you are suffering too. I've got a follow up appointment with the physio today (Tuesday 24th August) to discuss the next step, which is likely to be the ultrasound diagnosis. Alongside this I am doing a daily routine of core strength exercises in an effort to give me a stable pelvis. This will either:

    1) Go some way to resolve the problem if there is no trauma.
    2) or, more likely reduce the annoying pain (which is mostly low level but more acute after exercise. running on the flat etc as you describe).

    Either way, these exercises are required anyway even if I need surgery. Surgery will fix the problem, but won't address the cause, which is essentially poor biomechanics.

    I've just got back from holiday, so I'll update the blog in the next day or two with the latest details.