Your core is called such for a reason. Abdominals, lower back, oblique muscles, hamstrings and the pelvic floor interplay to provide a base for athleticism. In sports such as dancing, baseball, tennis, football and wrestling, athletes can injure the core through repetitive wear-and-tear or with a quick, sharp transition. A quick explosive movement or change of direction to catch a line drive or return a serve, for example, can strain a hip adductor or abdominal muscle. While many of these injuries can be treated without surgery, some do require interventional treatment.
Core injuries can lead to joint problems, too, such as a hip impingement. “When approaching a hip problem, therapists assess whether the hip is the source, site or solution to pain,” said physical therapist Pete Draovitch. The kinematic chain (segments connected by joints, such as in the musculoskeletal system) can provide insight to the source of injury. A pelvic injury may be one of mobility, stability, structure (hardware) or neurology (software), or threshold. Hip inflexibility and pain can come from an issue seemingly as inconsequential as weakness in the foot or stiffness in the upper back. “You try to find where the error occurred first,” said physical therapist Jaime Edelstein. “It’s so important to look at these other components in the kinematic chain.”
In recovery of a core or hip injury, one should strengthen abdominal, back and side muscles, ensuring a good base of core strength. Strengthening should begin with exercises that require co-contraction of muscles with the feet on the ground while maintaining good lumbo-pelvic stability. Following surgery for a core injury (athletic pubalgia), a patient can walk to reduce scarring, advance into core stabilization exercises and graduate into agility and functional training before returning to competition. Based on the degree of the injury, it can take three to 12 weeks to get back to play.
This post was compiled from a session at the Seventh Annual Current Concepts in Sports Medicine on April 19, presented by Draovitch; Edelstein; Dr. Anil Ranawat, HSS orthopedic surgeon; and Dr. William Meyers, professor at Drexel University College of Medicine; and moderated by Theresa Chiaia, HSS physical therapist.