yogabook / pathologie / gracilis syndrome

gracilis syndrome (adductor syndrome, footballer’s groin, sportsman’s groin, pubalgia)

Definition of

Gracilis syndrome is an insertional tendinopathy, an overuse syndrome of the lower branch of the pubic bone, sometimes accompanied by aseptic bone necrosis of the osseous intertion area, the ostitis pubis. It must not be confused with pes anserinus syndrome, which can also affect the gracilis, but at its distal insertion. Gracilis syndrome often occurs in soccer players as overuse syndrome. The muscles most commonly affected are the adductor longus, adductor magnus, adductor brevis and gracilis.

Cause

1. Overuse
2. Traumatic: movement with extreme passive or active eccentric contraction „overstretching“
3. Stress fracture of the pubic bone
4. Bone inflammation of the pubic bone

Predisposing

– Behavior

1. Sports with pronounced stance/playing leg sequences
2. Sports with forced abductionand adduction movements
3. Sports with rapid changes of running direction or contact with opponents such as soccer (also due to kicking technique)
4. Sports with fast acceleration and deceleration
5. Asymmetrical loads such as when hurdling
6. Endurance running
7. All sports that have a muscular effect on the shaving area

– Musculoskeletal system

1. Static incorrect loads such as those caused by leg length discrepancies
2. muscular imbalances
3. shortened adductors, weak adductors
4. Diseases and malpositions of the hip joint

– General factors

1. M > W

Diagnosis

1. Medical history
2. Physical examination(lateral comparison!): Pain on stretching, pain on pressure at the affected origin, pain on straining against resistance
3. MRI shows intraosseous signal enhancement of the parasymphyseal bone marrow

Symptoms

1. Painful pressure in the insertion area
2. slight pain on movement
3. marked pain on exertion, radiating along the course of the gracilis
4. Painful stretching
5. Often, but not necessarily bilateral infestation
6. usually longer existing, gradual onset of symptoms before diagnosis
7. Quick stimulation div after a training break
8. dominance of pain alternating between the sides
9. Starting pain that subsides with normal walking
10. Triggered by jerky movements and changes in direction

Complications

1. Delayed healing due to the difficulty of completely immobilizing the area.
2. Formation of abnormal scar tissue
3. Bone resorption
4. Cysts
5. Stress fracture

Therapy

1. Rest, including a break from sport, followed by a careful return to sport
2. Therapy of risk factors
3. PT
4. NSAIDS
5. Neural therapy
6. Local injections of corticosteroids and local anesthetics
7. If conservative treatment is unsuccessful, symphyseal curettage with removal of the inflammatory tissue

DD

1. Osteomyelitis close to the symphysis, for example after UGT infection or surgery
2. Necrosis of the femoral head
3. Koxitis
4. Nerve bottleneck syndromes
5. Other referred pain
6. Inguinal hernias
7. Athlete’s hernia or „soft groin“
8. Osteomyelitis
9. Strains of the adductors or groin strains
10. SI joint blocks

Asana practice and movement therapy

Since this is an insertion tendinopathy of the adductors, whether of the gracilis or other adductors, good stretching of the adductors must be ensured. The typical pain should be avoided as far as possible. It is also good to stretch the adductors in all rotational situations and at different flexion angles of the hip joint. In addition to stretching, the resilience of the muscles should be increased; all strengthening exercises that are not jerky or jerky, but rather sustained(isometric) or performed calmly and dynamically, are helpful here. Again, the typical pain should not be triggered. As with stretching, various rotation situations and flexion anglesshould also be practiced here.

If the gracilis is to be stretched, a more or less extended knee joint is required. However, it cannot be strengthened in isolation, as other adductor muscles are always involved. However, the degree of flexion in the knee joint changes the length of the sarcomere in which the gracilis works.

In principle, all standing postures that involve moving or holding the adductor group in all possible sarcomere areas are indicated here. However, postures other than standing postures can also have a strengthening effect on the adductors, e.g. the lower leg in jathara parivartanasana is held in position by the adductors. Another example is maricyasana 1, in which the upright leg stabilizes the position of the pelvis and presses against the arm from behind.

It is well known that every muscle must be considered with its group of antagonists. However, the abductors should not play a significant role here, because on the one hand, apart from garudasana, there are hardly any adductions in everyday life or in yoga that are so pronounced that a reduced flexibility of the abductors could cause damage to the adductors or be involved in its development.

Since the adductors, even if they are not counted among the classic hip flexors, do have a hip flexing effect, the extension ability of the hip joint should also be tested and improved if necessary, all the more so as this direction of movement occurs very little in everyday life. In the case of gracilis, because of its knee-bending effect, hip extensions can be practiced with the legs extended or stretched wide, such as urdhva dhanurasana, in addition to the known highly effective exercises.

Because of the hip flexion effect of the adductors, the strength for hip flexions should also be practiced. Even though the hip flexors will certainly provide most of the strength there, depending on the construction of the postures, the feet can be pressed towards each other so that the adductors have to work for two directions of movement. This can be practiced in jathara parivartanasana as well as in tolasana or supta dandasana and similar postures.

Asanas

1. Asanas in 751: Stretching the adductors
2. Asanas in 752: Strengthening the adductors
3. Asanas in 756: Stretching the gracilis
4. Asanas in 757: Strengthening the gracilis
5. Asanas in 711: Stretching the hip flexors
6. Asanas in 816: Stretching the rectus femoris
7. Asanas in 711: Stretching the hip flexors
8. Asanas in 712: Strengthening the hip flexors