THIGH, HIP AND GROIN INJURIES

- THOMAS E,SPORTS MEDICINE
 Hamstrings
 Acute hamstring tears occur most commonly in sprinting, whether in an athletics event or when a player sprints as part of another sport. They account for many lost performances and layoffs by sports people, and are most likely to have occured when warm-up and stretching have been inadequate and in cold weather.
 The tear is usually in the belly of the muscle and is often accompanied by local haemorrhage. There is often tenderness and pain on movement. Movement, especially extension, may be inhibited by the pain and swelling.
 One danger is that scar tissue may form which predisposes the muscle to further tears, and makes the condition chronic. Physiotherapy, stretching, and a prohibition from competition until the injury is completely healed are essential. Early treatment will drastically reduce the length of the recovery period. RICE will help, but homoeopathic treatment immediately after the incident will prevent haemorrhage and its sequelae.
 Arnica
 The athlete must take Arnica in any potency at once and repeat it frequently for the first few hours. This will reduce the possibility of haemorrhage, swelling and immobility and the subsequent development of scar tissue. Recovery may not then take months. If Arnica does not seem to work after one or two doses, use Bellis instead. (See also 'Gastrocnemus Tears', page 00.)
 Dosage: One Arnica 6c, 30c or 200c, immediately and one every hour for up to one day.
 Arsenicum Album
 Stiffness and lameness with pain behind the thigh. He cannot extend the knee. It is a burning pain, but heat relieves it. He has to move his feet constantly, and may move from place to place. Is much worse from cold in any form. Worse at 1 or 2 a.m.  Very sensitive, fastidious, irritable and careful with money. Believes he cannot recover, and forecasts all kinds of disaster as a result of the injury.
 Dosage: One Arsenicum 30c three times daily will help recovery. Stop the remedy when the pain, stiffness and lameness begin to ease.
 Rhus Toxicodendron
 If there is stiffness, better from heat and from continued movement, but worse on first movement. Typically the athlete has warmed up well, then cooled down, and then gone into a violent sprint or surge of effort.
 Dosage: One Rhus Tox. 30c.
 Ruta Graveolens
 If there is soreness and stiffness in the muscle. Worse from cold, damp, lying and sitting. Better from warmth, rubbing, motion. The person is uncomfortable sitting with his leg on the edge of a seat. He is dissatisfied and depressed by his injury.
 Dosage: One Ruta 30c three times a day for three days. Then stop. Repeat if necessary.
 Symphytum
 This remedy will promote healing of the tear.
 Dosage: One Symphytum 30c daily for two weeks.

Quadriceps
 Intramuscular haematoma, 'deadleg' or 'charley horse', results from a blow or kick to the thigh in contact sports. The muscles will have become engorged with blood before and during a match and a blow ruptures blood vessels, causing a massive extravasation of blood. This may be as much as a litre, distending the fascial compartment of the muscle. This impairs flexion of the knee to a greater or lesser degree. The greater the haemorrhage, the more the distension and the longer the recovery time, as the system has to break down and reabsorb the haemorrhage.
 Anything that controls the haemorrhage naturally reduces the length of the recovery time.
 There is a further danger. Further haemorrhage may occur if the athlete resumes competition too early. This can lead to ectopic calcification and myositis ossificans, or bony spur, that may interfere with quadriceps action.
 There may be severe post-traumatic pain and hot swelling. It may be tender to touch, movement is limited (especially flexion), and the tenderness gets worse with time. Orthodox management of the condition mainly aims to limit the disability. Homoeopathic remedies will help effective healing.
 Arnica
 Taken in any potency immediately after the trauma, Arnica will limit the haemorrhage and greatly reduce the possibility of myositis ossificans traumatica.
 Dosage: One Arnica 30c, immediately after the injury. Use Ruta, Rhus Tox. and Bryonia as necessary, according to the symptoms.
 Hecla Lava
 Has the power to arrest exostoses and bony growths that are sensitive and painful to touch.
 Dosage: One Hecla Lava 200c daily for two weeks.
 Rhus Toxicodendron
 This rememdy has a special affinity with bony outgrowths, and has been known to reduce them if the patient manifests other Rhus Tox. symptoms. It may prevent their development.
 Dosage: One Rhus Tox. 200c daily for two weeks.
 Quadriceps Strains
 Treat strains of the quadriceps homoeopathically with Arnica, followed by the appropriate remedy. See those listed immediately above.
 Groin Strain and Pain
 Groin strain and pain are a common cause of layoffs among soccer, rugby and hockey players. The condition is difficult to diagnose and to manage. Fortunately you can prescribe homoeopathic medicines on the symptoms presented by the patient without long investigations. They will not interfere with any other treatment, have no side effects and will promote healing if correctly prescribed and used.

CASE 21
 Peter, aged 40, is an international hockey player. He complained of paroxysmal cramping pain in the groin that seemed to come on when he was sitting at his desk, especially in the morning after a match. The pain was so violent it frightened him. He was very worried that it meant a hernia, and was afraid to cough in case it produced the condition. There was no record of trauma, and the condition had come on suddenly. He was reluctant to keep playing and his GP had advised against it, but offered no diagnosis.
 A long case-taking gave me some insight into Peter's mental, emotional and general symptoms. He was very enthusiastic about everything, work, and play, and was a great organiser. He hated time-wasting in any form, and had to be busy all the time. He became bored very easily. He admitted drinking too much, quite often, but enjoyed alcohol. He sometimes felt very bad the morning after a party and avoided breakfast. He was irritable with people who should know their jobs. 'I get furious' was how he described his reactions. He often woke at about 3 a.m.  and could not get back to sleep unless he made a list of all the things that occurred to him then about work. He hated cold windy days unless he could be active. Asked to sum up his approach to life he described himself as impatient for the next day.
 Peter's mental and emotional symptoms were clearly those of Nux Vomica, but the remedy only has inguinal pain from coughing and 'as if he has a hernia'. I gave him Nux Vom. 10M, one at night for three nights.
 One month later he reported that he had experienced no more episodes of pain and had continued playing hockey. He questioned whether my remedy could have affected the way he worked because he felt much calmer and positive. Three months later he was still free of pain. Six months later, still no pain, and he told me he had decided to take a redundancy scheme that would allow him to work at a more relaxed and much less stressful job.
 Comment
 The lesson from Peter's case is that the correctly chosen homoeopathic remedy will work despite the lack of an orthodox diagnosis. This is not to say that I do not always refer sports injury patients for diagnosis and orthodox treatment, but when one system does not satisfy the patient's needs, another may. I would always refer patients reporting inguinal or rectal pain for diagnosis, because of potential underlying pathology.
 Some remedies that have inguinal pain among their more specific spheres of action are given below. However, the remedies are more likely to work if other symptoms match too. Choose one according to the manifested and detailed symptomatology.
 Berberis
 Aching tension in the groin, which is very painful to touch. Sensation that something will protrude when walking or standing. Throbbing, shooting pain in groin, extends to the testes and thighs and into the back. Worse from jarring and stepping hard, walks very tenderly and carefully. Groin pain may be associated with backache and urinary problems.
 Dosage: One Berberis 30c, hourly during the worst of the pain. Stop when the pain eases, then one daily for seven days.
 Bryonia
 Cramp-like, stitching, cutting and shooting pains in the groin, which is very tender. Tha pains come on even when sitting but are much worse from any movement, especially abduction of the leg.
 Dosage: One Bryonia 30c hourly for three or four doses, then daily for up to seven days.
 Calcarea Carbonica
 The pains of Calc. Carb. are typically stitching, inguinal and the result of a sprain following physical exertion. The condition may follow exertion after the person has been warm and cooled off. This remedy has an affinity with the inguinal glands and could be effective if infection is a suspected cause of the pain. There may also be painful haemorrhoids that are worse when walking and better sitting. The person is typically slow-moving and indolent. You may think of them as flabby. Cold feet and hands.
 Dosage: One Calc. Carb. 30c daily for three days.
 Mercurius Solubilis
 Cutting, stitching pains in the lower abdomen and groin, worse from walking. Sensation of knives in the groin. Painfully sensitive when walking or standing. Especially painful on the left side. The person is worse from being heated and from draughts, from sweating, and lying on the right side, tends to speak in hurried way and time passes very slowly for them.
 Dosage: One Mercurius 30c, three times daily until the pain eases, but not for more than seven days.

Adductor Strain
 This condition is sometimes called groin strain or rider's strain and comes about because of a tear in the adductor longus muscle when it is used for propulsion as in sprinting, lunging and twisting on a straight leg. It can be caused by sudden overstretching while sitting with the legs abducted, the dancer's 'second position'. It can be the cause of long-term indisposition.
 Arnica
 Dosage: One Arnica 30c or 200c immediately the pain occurs.
 Ruta Graveolens
 Dosage: One Ruta 30c or 200c three times daily during rehabilitation, but for not more than one month.

 Bursitis
 See under 'Bursae and Bursitis' in the knee section above (page 000).
 Bones and Fractures

CASE 22
 A 35-year-old broke his femur in a climbing accident and had been lying on a ledge for three hours before being rescued. I saw him when he had been in hospital for four hours. A chest X-ray showed much effusion into his lungs, and he was in shock and hypothermic. Arnica 10M was indicated, and I gave him enough to take one tablet hourly for three doses.
 He had been very cold and frightened and there was a lot of pain, which the Arnica relieved. I gave him Aconite for the fright and to help with the pain. His lungs cleared in two days, and there was little sign of the traumatic accident in the way of bruising.
 He was to spend six weeks in traction. Bach Rescue Remedy and Aconite helped him to sleep and to relieve the pain. He took Symphytum 6c three times daily for the duration of his stay in hospital to promote bone formation and healing. He performed a rigorous daily programme of exercises, including isometrics for both legs and upper body strength.
 A week after discharge he returned to work in a hinged full leg brace. He was able to exercise daily, but his ankle swelled badly after sitting. First movement was painful. Continued movement relieved his pain and restlessness. Interferential treatment promoted healing and gave analgesia.
 He took Rhus Tox. 30c as the symptoms demanded and used Bryonia 30c when he felt that movement would be painful. I gave him a stock of remedies and briefed him on their use, but he called me regularly to ask which one to take.
 Ten weeks after his accident he was jogging lightly. Twelve weeks after it he was climbing again. Twelve years later he is still very fit and active. Helped by good orthotics he climbs, runs and exercises, and has recently completed a major expedition to the Himalayas.
 Comment
 This is only one of many cases I could quote of rapid healing of fractures and return to active sport as a result of homoeopathic treatment combined with physiotherapy.
 All fractures need Arnica as a first remedy. Then, depending on the symptoms presented, a selection of remedies may be used. Symphytum promotes bone healing. Stress fractures of the femur will respond in the same way as described for those of the tibia.
 Young People
 One should always be conscious of the potentially serious implications of pain in the hip, femur and knee in young people. If you suspect a slipped femoral epiphysis, Perthes' disease or osteogenic sarcoma of the femur you should at once refer the patient for a medical diagnosis. Homoeopathy can help these conditions, but only when prescribed by a qualified homoeopath.

 Nerve Pain
 Tingling, numbness and pain may be felt down the front and lateral aspect of the thigh from pressure on the lateral head of the inguinal ligament. The pressure is usually from tight clothing or equipment and this must be removed or loosened. One Ruta 30c three times daily will help to relieve the discomfort.