On-Demand Webinar: Utilizing Aquatic Therapy for Groin Injury: A Case Review

In a recent webinar, Todd Lewarchick, PT, DPT, OCS, FAAOMPT, Outpatient Rehabilitation Manager at the Cleveland Clinic, located in Avon, Ohio shared a case study of a high school junior who was diagnosed with osteitis pubis while pursuing a Division I football scholarship. The general rule thumb for any groin injury is to rest and offer time for the injury to heal, however, the athlete tried to push through the pain at an Ohio State University football camp and after 5 months the pain gradually got worse. The athlete had difficulty with cutting and severe pain in the right groin.

Todd evaluated the athlete’s current state during the first visit. He began his first two rehabilitation appointments with land-based therapy to see how the athlete’s reaction was to the exercises. By the third visit, Todd believed the plan of care needed to incorporate aquatic therapy to help reduce pain that the athlete felt in the adductor region, lower abdominal muscles, perineal region and scrotum. The goal was to integrate manual therapy with aquatic therapy in order to get the athlete back on the field as quickly as possible to resume his pursuit of earning a football scholarship.

Since there is no standard protocol for osteitis pubis, Todd created his own plan that included:

• Correcting any joint dysfunction and optimizing exercises for extension and rotation testing
• A focus on core stabilization and functional exercises
• General progressions – start in the sagittal plane, gradually introduce frontal plane and progress to transverse plane
• An end goal of getting him back on land and able to play football

View the FREE on-demand webinar here.

In the webinar, Todd discussed why he uses aquatics in general as well as for this diagnosis.

Why aquatics in general?

• Proven to be an effective tool in rehab early in the process
• Supplements manual therapy very well via the premise of unloading
• Alleviates pain, unloads to help correct mechanical problems
• Strengthens muscles
• Aquatic aerobics proven to have analgesic effect
• Helps with healing
• Reduces inflammation (4-feet depth)
• Increases intensity of exercise and reduction of cardiac output
• Maximizes stroke volume

Why aquatics for this diagnosis?

• Routine conservation therapy frequently fails which results in more aggressive management strategies which is not desired.
• Patients with this condition cannot tolerate full weight-bearing making land therapy very difficult and almost impossible.
• The referring doctor wanted a mechanical evaluation and treatment approach of getting the athlete unloaded

Todd began the rehabilitation plan of care by performing aquatic therapy twice per week for two weeks then once per week for two weeks for a total of 6 visits. Then he returned the athlete to land for two visits for functional weight-bearing exercises. Todd wanted to re-evaluate his findings after a few rehabilitation visits to better analyze how the exercises were improving the athlete’s progression. Each session was 60 – 70 minutes with different exercises incorporated such as power step-ups with lateral pulldown, lateral step downs and holding a medicine ball overhead while side stepping on an underwater treadmill in the clinic’s HydroWorx 3500 Series. The exercises were modified based on the athlete’s progression and the exercises were performed using different muscles with a focus on lower extremity function.

Once Todd was able to get the athlete in the water and correct his joint issues, he started to progress very quickly. These injuries typically result in injections or surgery and this athlete did not have to go through either. Todd was very happy with the plan of care and the success the athlete experienced in the pool so he documented the effective results for the future. The athlete was able to return to practice pain-free after the 7th visit and was cleared to play in a game after the 8th visit. The athlete is now playing football for a Division I university.

Are you interested in learning more of the specific aquatic exercises used to improve the athlete’s function, stabilization and strength? Learn more by viewing the webinar FREE on-demand here.