Sharp pain in Rhomboid and Groin

[zameslee]

There was no justification for the PRP. No diagnosis as well. The doctor just told me that PRP will help my injuries to heal since PRP has been used extensively for various soft tissue injuries involving tendons and ligaments, with great success. I also did my own research online and I found that PRP is one of the most powerful treatment methods for soft tissue injuries. Which is why I decided to go for it.

[Emily]

There was no justification for the PRP. No diagnosis as well. The doctor just told me that PRP will help my injuries to heal since PRP has been used extensively for various soft tissue injuries involving tendons and ligaments, with great success. I also did my own research online and I found that PRP is one of the most powerful treatment methods for soft tissue injuries. Which is why I decided to go for it.

You agreed to go ahead with injections, despite a lack of explanation as to how they might "heal" your injuries? "Heal" is wishy-washy, as is "soft tissue injuries."

You need an explanation of the pathology occurring at your mid-back. The management for a muscle strain vs. tendon vs. thoracic/costal issue is different. You've already had 3 c/s injections with no explanation, and no improvement. PRP seems like a desperate last attempt. I suggest you consult another doctor/physiotherapist.

For the record, there is little evidence for the efficacy of PRP in treating tendinopathy. PRP simplistically proposes to promote tendon healing by increasing available growth factors. Unfortunately, there is no quality evidence that this actually occurs, or if tendon stimulation is actually a good thing. Also, PRP tends to be really,really painful, interfering with the actually useful process of restoring load tolerance.

Tendinopathy is caused by training error. You need to get your load under control. Don't let PRP distract you from this goal. This didn't just come on out of the blue. It was brewing. It may be in your programming, or the way you are executing lifts- in someway you have overwhelmed your tendon's ability to squat.

Hence, my requests for form videos, so I can see what's going on, and be of better use. Do you have any videos from around December 2016?

At some point, if you're going to get over the other side of this, you're going to need to have a hard look at your training.

I'm kind of a dick sometimes. Sorry. However, please still feel welcome to get in touch if you would like to ask for advice.

[zameslee]

You agreed to go ahead with injections, despite a lack of explanation as to how they might "heal" your injuries? "Heal" is wishy-washy, as is "soft tissue injuries."

You need an explanation of the pathology occurring at your mid-back. The management for a muscle strain vs. tendon vs. thoracic/costal issue is different. You've already had 3 c/s injections with no explanation, and no improvement. PRP seems like a desperate last attempt. I suggest you consult another doctor/physiotherapist.

For the record, there is little evidence for the efficacy of PRP in treating tendinopathy. PRP simplistically proposes to promote tendon healing by increasing available growth factors. Unfortunately, there is no quality evidence that this actually occurs, or if tendon stimulation is actually a good thing. Also, PRP tends to be really,really painful, interfering with the actually useful process of restoring load tolerance.

Tendinopathy is caused by training error. You need to get your load under control. Don't let PRP distract you from this goal. This didn't just come on out of the blue. It was brewing. It may be in your programming, or the way you are executing lifts- in someway you have overwhelmed your tendon's ability to squat.

Hence, my requests for form videos, so I can see what's going on, and be of better use. Do you have any videos from around December 2016?

At some point, if you're going to get over the other side of this, you're going to need to have a hard look at your training.

I'm kind of a dick sometimes. Sorry. However, please still feel welcome to get in touch if you would like to ask for advice.

Hi Emily, it's ok. I know that u are just trying to help me and u mean well. The PRP only hurt for the first 3 days though. And the pain was very mild and bearable.

It's already been proven that corticosteroid injections do not help in recovery. It only suppresses inflammation (which is a natural process that is necessary for soft tissue injuries to heal) and temporarily relieves pain and masks the symptoms. In fact, corticosteroid injections can actually make injuries worse. I wish I learnt about this before taking 3 injections. I should never have done it in the first place.

I will try to search for my form check videos again. Will upload them if I can find. But my right rhomboid pain is such a mystery. What could it possible be? What could have caused this "injury" and how can I fix it? I have asked so many of my friends who are powerlifters, strongmen, physiotherapists, etc. But no one knows or have experienced this before.

[zameslee]

I found some videos and will upload them here!!


190kg X 4 conventional deadlift


147.5kg X 5 low bar squat (side view)


135kg X 3 low bar squat with resistance band around the knees (front view)

I have a lot of forward lean in my squats due to my excessively long femurs in comparison to my torso. Which is why my squat looks like Layne Norton's.

Thanks Emily for ur help and understanding.

[zameslee]

My right rhomboid is not getting any better. I have found out that front squats and high bar squats actually hurt my rhomboid more than deadlifts. Also, comparing all the different variations of deadlift, rack pulls hurt the most, followed by deficit DL, then followed by normal DL (which is the least painful among these 3 DL variations). Barbell rows and overhead presses also hurt (very slightly). So I really don't think that this injury is caused by my DL form. I have been using this DL form for several years with no issues, until this injury occured.

My right groin has gotten slightly better, thanks to the isometrics. But the healing is very slow, and squats still hurt. Some days it hurts more, and some days it hurts less. For example, it didn't really hurt much during last week's squats. But when I was squatting this week, it was actually more painful than last week. I also discovered that pushing my knees out usually hurts MORE as compared to letting my knees point straight forward during the squat. However, squatting with knees pointing forward (instead of pushing them outwards) is a less than optimal way to squat for me, as I have femurs that are much longer than my torso. Squatting in this manner makes my already excessive forward lean even worse, to the point that my squats are almost like a good morning now.

I'm really at my wits end. It has been almost a year since I have gotten these injuries and I'm still not getting better despite trying literally everything. I'm beginning to lose my sanity.

[Emily]

I will try to search for my form check videos again. Will upload them if I can find. But my right rhomboid pain is such a mystery. What could it possible be? What could have caused this "injury" and how can I fix it? I have asked so many of my friends who are powerlifters, strongmen, physiotherapists, etc. But no one knows or have experienced this before.

I doubt it is actually a rhomboid. More likely along the lines of a costovertebral irritation.

Thanks for posting the videos Zames. I'm not a SSC, so I'll reserve providing a proper form check. There are however, a number of form issues you could work on. I would not attribute your pain to one individual error, but on the whole they flag the need for greater attention to detail in execution of lifts.

Deadlift: What was the programming context of these reps? A PR? How often do your training reps look this tough? The bar is forward. You drop your hips too much in the start position. This makes the pull off the floor harder than it needs to be. I can't see what your thoracic spine is doing from the video angle unfortunately.

Work on tidying up your set-up, and build up from a reasonable weight. Have a study of the 5 steps the Starting Strength method uses to set up a deadlift.

Squats: The side view shows you need to lean over more in the descent. When you come out of the hole, your back angle changes and you lose your back shape. That's a potential injury flag; particularly if performed numerous times over the training cycle. You appear to be slackening off in the hole, and dropping too deep in the squat; which has the potential for undue load on the adductor.

The front view tells me you could narrow your stance up. Your knees are inside of your toes. (That could just be that band.) You appear to be cutting off your depth, in this video. Both of these have the potential to overload an adductor over time- feet too wide by asking more length than the adductor has to give, and high depth by allowing you to load the bar up more than you can actually handle.

My right groin has gotten slightly better, thanks to the isometrics. But the healing is very slow, and squats still hurt. Some days it hurts more, and some days it hurts less. For example, it didn't really hurt much during last week's squats. But when I was squatting this week, it was actually more painful than last week. I also discovered that pushing my knees out usually hurts MORE as compared to letting my knees point straight forward during the squat. However, squatting with knees pointing forward (instead of pushing them outwards) is a less than optimal way to squat for me, as I have femurs that are much longer than my torso. Squatting in this manner makes my already excessive forward lean even worse, to the point that my squats are almost like a good morning now.

I'm really at my wits end. It has been almost a year since I have gotten these injuries and I'm still not getting better despite trying literally everything. I'm beginning to lose my sanity.

I hear you, training disruptions just suck. Let's find you a starting point. A weight you can manage, and work your way up from there. Slowly but surely, and cleaning up your technique along the way.

I'm glad the static holds have assisted in settling the tendon. Let's get you squatting with toes forward. At a light weight. Then, build in small jumps from there. This will be a stepping stone to the, as you point out, more efficient toes out.

What can you get on the bar for Deads before it starts to bother you?

Where about are you located? Can you get in-person coaching? What is your actual program at the moment? Email/PM me if you'd prefer to discuss these particulars in private.

[zameslee]

Hi Emily, what is costovertebral irritation? And how do I fix it?

I'm living in Singapore. I can get in-person coaching from my powerlifting and strongman friends. However, none of them have been able to help me with these issues that I have been facing.

[Emily]

Hi Emily, what is costovertebral irritation? And how do I fix it?

I'm living in Singapore. I can get in-person coaching from my powerlifting and strongman friends. However, none of them have been able to help me with these issues that I have been facing.

Can you see this Starting Strength Coach? I think you need a more stringent eye over your form than you're currently getting. Every SSC I have seen, without failure, has been a wealth of knowledge and experience.

SSCA : Coaching


A costovertebral joint irritation is like a slight sprain/tweak at the articulation between rib and thoracic vertebra. I am only supposing here, having not examined you. It may well not be- an internet diagnosis is not something to be trusted. It normally settles once you return to activities in a gradual manner.

[zameslee]

Emily, thanks for the referral to the Starting Strength Coach.

1) I have previously taken several rests that last up to 1 month. After the month long rest, I returned to my training in a gradual manner. However the rhomboid pain did not get any better; it was equally as painful even after resting for 1 whole month. Does this mean that the rhomboid pain is not a costovertebral irritation? Can we rule it out?

2) As for the resistance band isometrics for my right adductor, how do I progress from here? Are there any variations that I can do?

3) I would sometimes do these isometrics for up to 10 sets of 1-2 minutes. Is this too much? I experience that the injured area feels better when I do this much isometrics, as compared to only doing 3 sets of 1 minute.

4) Recently, my adductor pain has moved from the tendon on the groin (just beside the private part) to the part of my adductor that is closer to the upper hamstring. The resistance band isometrics are very good at targeting the tendon just beside the private part, but don't really target the part of the adductor close to the upper hamstring. How do I relieve the pain in this area? I tried squeezing a foam roller between the legs, but I found it to be even less effective than using a resistance band.

[Emily]

Emily, thanks for the referral to the Starting Strength Coach.

1) I have previously taken several rests that last up to 1 month. After the month long rest, I returned to my training in a gradual manner. However the rhomboid pain did not get any better; it was equally as painful even after resting for 1 whole month. Does this mean that the rhomboid pain is not a costovertebral irritation? Can we rule it out?

2) As for the resistance band isometrics for my right adductor, how do I progress from here? Are there any variations that I can do?

3) I would sometimes do these isometrics for up to 10 sets of 1-2 minutes. Is this too much? I experience that the injured area feels better when I do this much isometrics, as compared to only doing 3 sets of 1 minute.

4) Recently, my adductor pain has moved from the tendon on the groin (just beside the private part) to the part of my adductor that is closer to the upper hamstring. The resistance band isometrics are very good at targeting the tendon just beside the private part, but don't really target the part of the adductor close to the upper hamstring. How do I relieve the pain in this area? I tried squeezing a foam roller between the legs, but I found it to be even less effective than using a resistance band.

1. Not necessarily. Unfortunately, a physical examination is necessary to give you more guidance.

There was no mechanism of an acute muscle pull; you had a slow onset on pain. I presume your doctor to rule out systemic/serious pathology. This is one to train your way out of.

2. The isometrics are a bridge to isotonics, i.e squatting, deadlifting. Try doing them before you squat and deadlift, as a desensitising warm-up.

3. That's fine - they are not stressful enough to be a problem. They are simply intended to have a descending pain inhibitory effect.

4. Perhaps one of your other adductors (adductor magnus), referred pain, or possibly the hamstring. Banded Prone Knee Flexion holds are a good option for getting at hamstring origin. However, at this stage, you really should be looking at getting back to your lifts.