Sharp pain in Rhomboid and Groin

[zameslee]

Hi everyone!!

I experience a sharp pain in my right rhomboid every time I deadlift (more painful during the descent) and front squat (more painful while ascending). I first started experiencing this pain when I was doing front squats with about 85kg (187 lbs). The pain was quite mild when I first felt it, but it became worse and worse with each training session. Been having this pain since last year October (8 months). The pain is about 8/10.

I also have a sharp pain in my right groin/adductor (and occasionally some pain in the right hamstring) every time i squat. Pushing my knees out causes it to hurt more as compared to letting my knees travel forward. I first got this injury when I was climbing up a flight of stairs 2 days after a very high squat volume session (when my legs were experiencing DOMS). While climbing up the stairs, I felt a very sharp and intense pain shooting through my right adductor and right hamstring. Since then, my right adductor hurts every time I squat, and this pain would last for the next few days after a squat session (it's a sharp & intense pain, so I know it's not DOMS). Been having this pain since last year December (6 months). The pain is about 6/10.

For both injuries, there was no bruising, swelling, popping or tearing. Both injuries feel like muscle strains due to overuse (though I'm not too sure). I have tried foam rolling, lacrosse ball rolling, stretching, using ice, using heat, using NSAIDs, fully resting 1 month for my rhomboid and fully resting 2 weeks for my adductor. I even went for corticosteroid injections (3 times!) where the doctor injected bufencon and rosiden (which are even more potent than hydrocortisone) into the injured areas. But all these only helped to reduce the pain temporarily.

I'm at a loss now and I'm extremely frustrated. I have not been able to have a proper training session for the past many months, and I feel that my years of progress and hard work is slowly diminishing. Can anyone advice me on what to do? Thanks!

[zameslee]

Sorry for the long posts, but I have additional questions to ask. I'm currently considering to do either ART massage or PRP (platelet rich plasma) therapy for my 2 injuries. However, I heard from some of my friends that ART did not help them with their injuries. And PRP therapy is extremely expensive. I'm quite wary of trying all these treatments now, as I have spent quite a fair bit on the 3 corticosteroid injections which did not help me in the end.

I have also come across the Bill Starr rehab protocol from this forum, but before I start doing it, I would like to ask:
1) My rhomboid and groin injuries are not new injuries (injured for 8 months and 6 months respectively). Does the Starr rehab still work for injuries that have lasted for several months? Any scar tissue would have already formed during this time.
2) My groin injury is very near to the adductor tendon, can I still use the Starr rehab for this injury? Since it is not supposed to be used for tendon injuries right?
3) For the rehab protocol, how much weight should I start with, and how much weight should I increase every day? Is there a percentage that I can use? My squat 5RM is 165kg (364 lbs) and my deadlift 3RM is 195kg (430 lbs). If I start with the empty bar and increase by only 10 lbs everyday, it will take several months before getting back to the original weights I have been lifting.
4) Am I supposed to feel pain while doing this rehab protocol? I find that I only start feeling my groin pain when I squat about 80kg and above, and I only start feeling my rhomboid pain when I deadlift about 100kg and above. Does that mean I have to start with a heavier weight instead of using the empty bar?
5) Coach Rip mentioned that "no other heavy work should be done". Does this apply only to the exercise that was chosen for the rehab protocol, or does it apply to all exercises? For example, for someone who is using the squat as the exercise for the rehab protocol, can he still train the deadlift and upper body work as per normal? Or does he have to do a deload for every exercise? I really don't want to suffer any more strength loss in my lifts, since my squat and deadlift has suffered so much from my injuries.
6) Can I use this rehab protocol for both my rhomboid and my groin injury at the same time? Or should I focus on rehabbing them one at a time?
7) Can I do this rehab protocol together with ART and PRP therapy (if I choose to do them)?
8) Is it mandatory to apply ice during this protocol? There is increasing research which shows that ice is not only ineffective in injury treatment, it also inhibits the healing process by interfering with the natural inflammatory response that the body creates in order to heal soft tissue injuries (10 Reasons ? Icing Injuries is Wrong | Stone Athletic Medicine).

Thanks so much for any help and once again sorry for the long posts!!

[zameslee]

UPDATE: I have started doing the Starr rehab protocol (using the low bar back squat as the rehab exercise for my right groin) about 2 weeks ago. I'm on the 13th day of the Starr rehab. While there was no pain in my right groin during the first few days of the rehab program (since the weight was very light), the pain started to come back over the past few days, as the weight was increasing. I found that I start feeling the groin pain when I squat a weight over 80kg.

It seems like the Starr rehab didn't work for me. Nevertheless, I will continue to finish my last few days of the rehab program as laid out. I'm f*cking pissed off right now. I have tried literally everything for this stupid motherf*cking injury but nothing worked. This injury has held me back for 6 months. I don't even know if I will ever be able to squat normally again. F*ck this shit.

[Tom K]

Post a form check video. Sounds like your form breaks down as the weight goes up.

[Emily]

Hi Zames,

I received your PM with your link to this thread. I'll reply here, as others might find it helpful when reading the boards.

I hear you on the injury frustrations. I can see you've tried many different treatments, which makes me wonder what specific diagnoses have been given to you?

Rhomboid- Are you sure this is an injury? Many pains are magically erased with some quality coaching. Do you have pain at any other time than deadlifting or front squatting? Have you been coached in these lifts? Post a form check video of each, which may help us elucidate a simple fix.

Groin- The Starr protocol is for acute muscle belly strains. Your injury history does not fit a muscle strain. It does present like an adductor tendinopathy. Is it painful very close to the pubic bone? Is it only sore when you squat, or press hard on it? When you say it is sore for a few days after, is it sore constantly, or only when you squat down? Stop the Starr method. You tendon is load intolerant right now, and adding high volume will flare you further. What you need to do, is gradually add load that you can tolerate. You asked if the isometrics were appropriate. Yes, they are a good place to start.

[zameslee]

Hi Zames,

I received your PM with your link to this thread. I'll reply here, as others might find it helpful when reading the boards.

I hear you on the injury frustrations. I can see you've tried many different treatments, which makes me wonder what specific diagnoses have been given to you?

Rhomboid- Are you sure this is an injury? Many pains are magically erased with some quality coaching. Do you have pain at any other time than deadlifting or front squatting? Have you been coached in these lifts? Post a form check video of each, which may help us elucidate a simple fix.

Groin- The Starr protocol is for acute muscle belly strains. Your injury history does not fit a muscle strain. It does present like an adductor tendinopathy. Is it painful very close to the pubic bone? Is it only sore when you squat, or press hard on it? When you say it is sore for a few days after, is it sore constantly, or only when you squat down? Stop the Starr method. You tendon is load intolerant right now, and adding high volume will flare you further. What you need to do, is gradually add load that you can tolerate. You asked if the isometrics were appropriate. Yes, they are a good place to start.

Thanks for ur reply Emily. It is most painful at the spot between the tendon of the adductor and the highest point of the hamstring. Yup it only hurts when I squat or press hard on it.

I remember u recommended to someone else to do isometrics by putting a foam roller between the legs and squeezing it hard. I tried this and I found that I'm working my hip flexors more than my adductors. Is it a better idea to use a resistance band to do standing leg adductions (similar to the movement in the "good girl machine" in the gym) and holding it for a few reps of 30 seconds?

I will try to upload a form check video in a few days time.

[Emily]

The idea behind the isometric is to introduce tolerable load, in a 'non-threatening' mode. You could use a band, but it would need to be strong enough to resist the highest isometric force you can generate. You mentioned that you have already tried resistance bands, and they have not helped. I am trying to picture what you mean- can you send me a video of you doing this? It sounds like there's a balance component that may make it difficult to load the adductor tendon adequately.

I have not yet encountered an issue with someone over-using their hip flexors. What makes you certain you are over-using your hip flexors?

Honestly, the squeezes are pretty hard to screw up. Try this for 5 days:
1. No squatting. Continue with all other lifts.
2. Sit on a standard chair. Place foam roller between knees. Hold, hard, for 30 seconds.
3. Move the foam roller up to the mid-thigh. Repeat, for 30 seconds.
4. Move the foam roller up to the groin. Repeat, for 30 seconds.
5. Repeat three times a day. Breakfast, Lunch and Dinner.

Then, we'd look at how your tendon is reacting, and add isotonic load accordingly.

[zameslee]

Hi Emily,

Previously when I used resistance bands to do rehab work, I only did like 5 sets of 12-15 reps without using any isometrics. I have just started using resistance bands to do isometrics (3 reps of 30 second holds) and my groin is already feeling much better. I also tried squeezing the foam roller between my legs according to your instructions, but I found that it doesn't work the groin as much as using a resistance band. The isometric was more intense when using a resistance band as compared to squeezing a foam roller. It could be because my resistance band is very strong.

As for my right rhomboid pain, it hurts most when doing deadlifts and front squats. Somehow, deficit deadlifts and rack pulls are more painful than normal deadlifts. Also, high bar squats cause it to hurt, but low bar squats are ok. Overhead press and barbell rows also hurt a little, though among all the exercises that cause my right rhomboid to hurt, these 2 exercises (OHP and barbell rows) are the least painful.

Just like my groin pain, my rhomboid doesn't hurt at light weights and only starts to hurt above a certain weight. Could my rhomboid be experiencing the same issue as my groin (tendinopathy)? Can I also start implementing isometrics for my rhomboid? Will it work just as well? Thanks!!!

[zameslee]

UPDATE: I have just done PRP therapy for both my right rhomboid and right groin, and I'm also continuing to do isometrics using my resistance band. I really hope my injuries can be fully recovered after wasting so much time and spending so much money and putting my progress on a stop for almost 9 months.

[Emily]

Hi Emily,

Previously when I used resistance bands to do rehab work, I only did like 5 sets of 12-15 reps without using any isometrics. I have just started using resistance bands to do isometrics (3 reps of 30 second holds) and my groin is already feeling much better. I also tried squeezing the foam roller between my legs according to your instructions, but I found that it doesn't work the groin as much as using a resistance band. The isometric was more intense when using a resistance band as compared to squeezing a foam roller. It could be because my resistance band is very strong.

Perfect. Same concept, as long as the desired effect is occurring.

As for my right rhomboid pain, it hurts most when doing deadlifts and front squats. Somehow, deficit deadlifts and rack pulls are more painful than normal deadlifts. Also, high bar squats cause it to hurt, but low bar squats are ok. Overhead press and barbell rows also hurt a little, though among all the exercises that cause my right rhomboid to hurt, these 2 exercises (OHP and barbell rows) are the least painful.

Just like my groin pain, my rhomboid doesn't hurt at light weights and only starts to hurt above a certain weight. Could my rhomboid be experiencing the same issue as my groin (tendinopathy)? Can I also start implementing isometrics for my rhomboid? Will it work just as well? Thanks!!!

I doubt this is a tendinopathy. I'd be more inclined to look at your thoracic range, and lifting form. Unfortunately, I need to see more to be able to offer advice.

UPDATE: I have just done PRP therapy for both my right rhomboid and right groin, and I'm also continuing to do isometrics using my resistance band. I really hope my injuries can be fully recovered after wasting so much time and spending so much money and putting my progress on a stop for almost 9 months.

What was the justification for PRP in the upper back? Did they diagnose the pathology before injection?