Is a cortisone jab in my groin injury likely to help??

Now 8 months injured and going up the walls/very down.

After physio, ultrasound, mRI scan the specialist doctor diagnosed 'thigh splints' or stress changes at the adductor insertions (more formal name)

Have a regular dull low level ache round my right groin, the discomfort moves about and varies in intensity, its vague to pinpoint.

Any time i run the pain increases very quickly - so i cant run. I Can use an exercises bike

Has anybody had a cortisone injection in their groin?? Or anywhere for that matter ? The specialist doc is considering this as conservative treatment not working.

Is a cortisone likely to help me?? Will i run again - any tips or stories or advice would be most welcome.

Many thanks 

Thanks for your responses much appreciated!

I have to say six physio, that my physiotherapist who advertises himself as sports physio and has a reputation for treating known sports people round this area, has never ever had a look at my back or hip/pelvic control. I have been going to see him on and off for 8 months. Nor as he ever talked at any length as to the reasons behind why i got the injury??

He initially assumed it was a simple groin injury and used an electric light plus a metal scraper with gel to promote recovery. Didnt work and then i had an ultrasound, then saw the Professor specialist  who looked at me for a few minutes , thought i had an 'adductor tear' and that i had a 'right-sided' weakness, but sent me for an MRI  from which he concluded 'stress changes at the adductor insertions'. He seemed to think that such an injury wasnt as bad as it might have otherwise been diagnosed, and sent me back to physio for conservative treatment before considering other options - cortisone, surgery etc. The physio over the past 1 month has had me doing drills mostly with resistance bands. Sometimes i think this is helping, at other times not. Its difficult to tells whether the soreness i feel is soreness from working the muscles in the area of the injury, or whether it is the actual injury. And like i say it varies in intensity, sometimes i can go 3-4 hours without feeling hardly any pain or discomfort at all, at other times its very noticeable.

I should say that i ran 4 marathons between Jan and June 2011, and then on the first day i joined a local running club we were doing hill sprints - a type of running i had never done before- and woke up the next day with the symptoms that have not alleviated since.

 sixphysio, i note you say that at 8 months down the road ill have much changes in the area-what is meant by this, i note that i now get some of this vague pain over the left side of my groin is it to do with overcompensation??

I would really appreciate any further observations you have and/or especially any ideas about how to proceed, as it has been the longest 8 months of my life. Really is much appreciated!!

ps - there doesnt seem to be much literature on this type of injury and treatment options - most of the literature seems to centre on how to interpret an MRI scan for this injury - would you be aware of any books, articles etc?/

PL

Cor - that's rough and shouldn't be this tricky.

The hill sprints all that time ago were most likely the straw that broke the camels back, rather than "the single" incident. 

The cause should be pretty easy to see - something like a SKS on your right will be very different comapred to your left. This lack control around your right hip will cause your thigh to roll in, increasing the shear of your adductors, which try to overcompensate to give you more control. Add more time and the left start to overwork too.

Your adaptation to change will also lead to spinal postural changes (a very stiff thoracic spine, and a more mobile lumbar spine), poor glut control, maybe overdominant hamstrings and some tib post stuff too - all of this needs a look.

Research on what to do is poor, that's why good treatment seems to be few and far between. Doing less for you is the way forward - I don't think you need any strengthening at all at the moment. Stability yes, yes, yes .Strength no.

Don't stress, I don't think you've failed at conservative treatment, you just haven't had the right stuff done yet. It's frustrating on a time front, but much better than somene sticking a needle/knife into you. 

Thanks Sixphysio you have given me a lot of ideas on things to research, to try and to discuss with the physio - i think he needs to be more focused.

Have started pilates and will look to bring in a lot more stability work -truth is i dont even really know what this this but will find out!

Apologies, just 2 last questions - do you think its ok for me to continue on the exercise bike? in absence of running this is the closest i get to a stress-buster but i note my upper legs muscles have been strengthening quite a bit as a result

secondly - what do you think of the resistance band drills ive been doing would they help at all

Thanks again for your time

Hi,

I had Cortisone injections in my groin (left side and centre) 6 years ago performed by a Musculoskeletal Physician. This got rid of all my pain in the groin area after having a Hernia Operation. I was fine for the 6 years and able to return to heavy weight training and live a normal life. I injured my abbuctor muscles on both sides whilst running at top speed on a thread mill. This has caused pain in both sides of my groin again. I have rested,taken medication, osteopath and that did not work. I have had a deep tissue massage by a muscalar theripst and it helped heaps. I am going to see the Musculoskeletal Physician tomorrow and may get another top up shot of cortisone.

I have read and heard alot of negative things about it but from expirence it helped me alot and therefore an reconsidering having it again. In saying this I would only recommend it as a last resort after trying other options.

Thanks for the latest responses think i'll give an update and the ask for more advice.

Basically, in hindsight, my first physio was a plank and i am hearing he may also be a bluffer. I went to a different physio in mid April and the difference between her skill knowledge and pracerice and the first idiot is actually scary. I'm going to write about that under a new thread when i have more time.

Anyway, the second physio carried out a very thorough assessment, noticed a lot of right sided weknesses particularly my glute and poor core. However, she also immediately said on taking my history that there would be alot of scar tisssue around my adductors and she got to work on 'frictioning' it off. She also taught me in vwery structured fashion a number of pilates/core strenghteneing exercises. I had 3 main areas to my groin pain, and a total of 16 session later pain remains in just one. She also graded me back to a little running.

I saw the specialist again last week. He examined me and was satisfied that the adductor issues were resolved. Hoiwever, we discussed this discomfort that remained (which to be crude, is just right under, and slightly to the right of where my right testicle sits,). I can run at half pace on grass and its only slight, but any more and this particular irritation/discomfort begins to increase. He felt this might be due to 'hip problems' and is sending me for a more advance scan where dye is injected.

Scan due in 10 weeks (NHS). We didnt talk anymore about what he meant by hip probs but on my internet research i think he he considering a labral tear. Reading the internet scares thae crap out of me if this is what he thinks it might be, as it seems that surgery is the main option. Ive read horror stories about very long recovery times, immobilisation, complications, cantwork drive etc...Could the specialist be thinking of any other hip problem?

Any oibservations/comments/experiences appreciated and i will write more on  all this soon

Thanks

I don't think you've failed at conservative treatment, you just haven't had the right stuff done yet.

parklife - it's good that you're getting a scan and injection dye.  I had one in April and it gave more detail than the MRI I had last year (for my left hip).  With just the MRI, the labrum was 'poorly defined', which suggested a tear (I think) - which was later confirmed during surgery.  The latest dye scan has more specific detail about the tear and other cartilage damage in the right hip. Good luck with it all - I hope you don't need surgery, but there are lots of us on the femoroacetabular impingement thread who have had hip surgery and tear repair, if you want to ask anything (although I doubt you'd have the impingement as well - they'd probably have picked that up with the earlier scan).  I'll look out for your updates.

Thanks pipes for your answer - my laptop has been broken and at a friends to get fixed only now just got it back.

I gues i have to wait for the second scan. Where you able to run any while you waited for surgery, and is running on the injury likely to cause further greif. I seem to be able to run but only at a slowish tempo.

I tried a higher tempo run last night but halfway through the discomfort moved round to the back of the hip and this morning to my back for gthe first time ever. Really dont want to do myself longterm damage (obviously).

Im just assuming the specialist thinks its a could be a labral tear. No hip probs were picked up on the first scan

Parklife, you have perfectly described my situation.  I was running a lot during the summer of 2012, then felt and heard a distinct pop while playing softball, with immediate pain in my groin afterwards.  I was fortunate enough to start with a good physical therapist, but after about 6 months, I still have pain, as you said, "...right under, and slightly to the right of where my right testicle sits."  My PT has corrected hip position, done ultrasonic, dry needling, used balance training for stability, used bands, checked spine and associated areas, with little to no improvement.  He is now suggesting a cortisone shot and an MRI. I was curious if the shot helped you, and what the enhanced MRI showed.  Like I said, from reading your description of location, duration and causes of pain, it sounds like a very similar injury.  Thanks!

These old threads of mine from yesteryear seem to be resurfacing of late!

Be very cautious of cortisone, it may reduce inflammation but that's not much cop if the original problem is still there. So you run etc post cortisone, pain free, thinking this is great but all the while you are actually making the underlying problem worse, then cortisone wears off and you are worse than before.

Sounds a little like a desperate health professional not sure what to do next.

You need a nailed down diagnosis before considering treatment.

I did not have cortisone in the end - those 'stress changes at adductor insertions' where more a symptom/effect rather than the underlying cause - I was eventually diagnosed with femoro-acetabular impingement with labral tear and I continued posting on a thread on this website of the same name. This diagnosis is no picnic and only surgery can alleviate it, 5 months post op and still doing rehab. Hope that's not what you've got mate - I didn't have a 'pop'.

It was really an Xray which finally diagnosed me mate, I had an arthrogram before that which indicated probable labral tear but the Xray should the bony protusion on the femur causing all the probs. I had also had MRI and Ultrasound but these hardly showed anything.

Any other questions please don't hesitate! This July it will be 2 years since I had symptoms and still no running!

Really appreciate you getting back to me.  I actually found another of your threads while I was researching this.  Running community to the rescue.

Labral Tear was the initial thought of both my Orthopedist and my Physical Therapist, but both ruled it out very early through a series of hip movement tests.  I had my PT retest (great guy, not at all put off with my neurotic Dr. Google research).  Again, negative for labral.

I saw my orthopedic guy again, and he retested for labral.  Negative again.  I was very tender to the touch (high groin area, near the testicles), so retested for sports hernia.  Negative.  

Orthopedic decided to administer a shot of local anesthetic and corticosteroid to the site of pain.  His explanation, which I agreed with, was that it would definitively answer the adductor vs hip labral tear debate, while also providing pain and inflammation relief if it did turn out to be the adductor.

One minute after, groin pain was almost non-existent whereas I was very tender to the touch previously (this is starting to sound like a Penthouse Forum).  This verified that it was not referred pain from the hip, but the adductor, and that the steroid had been applied to the correct location.

We’ll see what happens with the injection.  I’ve been reading more about this, and it seems that a fairly high percentage of people do not experience a recurrence. 

I’ll keep this updated for anyone that is curious about the shot.

I found this interesting: http://www.ncbi.nlm.nih.gov/pubmed/19797582