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Reply to "Hip Flexor Pain"

1) On the "good or bad news" question, I was wondering if it was a clue to the severity of the injury?

There's not a clear 1:1 correlation between pain and damage. We see this rotator cuff tears, SLAP tears, with pitchers, volleyball players, etc... being pain free and fully functional. We see people with disc herniations, osteoarthritis, again being pain free and fully functional. If it is a strain, the pain level doesn't really tell you how serious it is. Low levels of self-efficacy (i.e. I can't do anything for this vs. I have the tools to improve my outcome), catastrophizing (i.e. this hurts so bad something serious must be wrong), high stress can all play a part not only in the recovery but also some of that in pain levels.

The more you think you need to protect a certain area because you fear something is wrong and damaged, your brain will pump up the sensitivity to protect that area. Case in point, there was a construction worker that jumped onto a plank and had a 7 inch nail pierce through his boot in the 90s. He went to the ER, needed strong drugs for the pain, they took an X-ray and then removed the boot. The nail had passed between his toes, it didn't pierce anything. But his pain was through the roof because of the situation (context) and his belief that he needed to protect that area. That pain was real. So pain doesn't always tell you about damage, and pain can be influenced by many things.



2) He says it's very painful now. Too painful to play. In his mind, he's convinced that it's a tear and it's going to be a long recovery and possibly surgery - and there's zero chance of him playing this HS season.

See this tells me more about where his head is at. This happened before, it happened again. It hurts, something must be wrong. And there could be, I have no idea and this isn't medical advice to him, the athletic trainers could have spoken to him about what is or isn't going on, the doctor may have done that too, so that could play into it.



3) Anyway, back to the good/bad news motrin thing. My thought/wondering is this: If taking an OTC pain reliever masks the pain well enough to allow him to go and play and play as if nothing is wrong, is that a tip off on the severity of the injury?

The severity of the injury would be assessed through taking a thorough history and through examination. So they would have asked: Has it happened before, if so what happened? How long did it take to resolve the first time? Does this feel like it does before or is there anything different? What did you do during the off season, did it hurt at all during the off season and if so what happened and how long before it felt better. What happened to cause this problem, had anything changed leading up to the event? What do you think is going on, what do you think will make this better? How much does it hurt just nothing, how much does it hurt walking, how much does it hurt swinging a bat, playing baseball, whatever aggravating activity, all good questions that I'm sure have been asked.

The examination would then look for swelling, ecchymosis, any defects in the muscle, range of motion, strength. So after all that, they'd have a good idea of how severe the injury is or isn't.



4) Could it possibly be a Grade 3 or a tear - worse case scenarios and most painful - and nullified by motrin? Or, does the OTC painkiller providing 99% relief mean that it's probably a Grade 1 strain and there's hope that it might be more like 2 or 3 weeks recovery rather than 4 to 6?

A grade 3 tear you're going to see a defect in the muscle, swelling, ecchymosis, sometimes pain but sometimes not, but it's nothing that's going to be played on.

If it's a muscle strain but he keeps hammering into the pain it won't feel better anytime soon. That doesn't mean you can't play or practice, things just may need to be modified while it settles down a bit and then build him back up to the demands of the sport. Recovery would be again anywhere from 2-7 weeks.

If it's a tendinopathy it won't feel better just slamming into it over and over, the same thing applies, except recovery would be out at least 12 weeks. People can practice and play with tendinopathy, it just depends, sometimes it's not the case.

If it's a bone injury it's not something that you'll want to play/practice on, and recovery won't be 2-3 weeks.

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