Pain in Groin and Butt

[Frank_B]

Before ever starting training, I dealt with an occasional bout of deep right buttocks pain. Sometimes a deep groin pain would be associated with this. This started about 10 years ago.

After 8 years of running and two years of training, the problem has progressively worsened. My massage therapist will sometimes dig her heel deep into my right cheek and get something to release. Other times her elbow in my groin (very close to the inguinal canal all the way to the top of the pelvic bone) will catch a hard “knot” that decides to break free. Either method offers almost immediate relief.

It’ll be ok until my next training day and then I have a 50/50 shot at pissing it off. This has been a slowly worsening chronic issue for years and I’m reasonably certain there’s a deeper issue going on. My buddy had a labral tear in his hip and described things much the same way as me.

I’m not one to big deal injuries and I’ll train through quite a bit. The pain isn’t a show stopper, but it’s starting to aggravate me in other areas. Long drives get pretty painful and sometimes sitting for an hour or two causes it to “lock up.”

At what point should I get this checked? If it is a labral tear, am I better off getting it checked/fixed or should I just keep training until something finally gives up the ghost? I’m pretty masochistic, so I don’t mind training through it, but if it’s something I could fix surgically that only sets me back a few weeks, yet offers a vast improvement, I’m at the point where I’d be willing to get it fixed.

I’ll be happy to provide more details if needed.

[Will Morris]

Before ever starting training, I dealt with an occasional bout of deep right buttocks pain. Sometimes a deep groin pain would be associated with this. This started about 10 years ago.

After 8 years of running and two years of training, the problem has progressively worsened. My massage therapist will sometimes dig her heel deep into my right cheek and get something to release. Other times her elbow in my groin (very close to the inguinal canal all the way to the top of the pelvic bone) will catch a hard “knot” that decides to break free. Either method offers almost immediate relief.

It’ll be ok until my next training day and then I have a 50/50 shot at pissing it off. This has been a slowly worsening chronic issue for years and I’m reasonably certain there’s a deeper issue going on. My buddy had a labral tear in his hip and described things much the same way as me.

I’m not one to big deal injuries and I’ll train through quite a bit. The pain isn’t a show stopper, but it’s starting to aggravate me in other areas. Long drives get pretty painful and sometimes sitting for an hour or two causes it to “lock up.”

At what point should I get this checked? If it is a labral tear, am I better off getting it checked/fixed or should I just keep training until something finally gives up the ghost? I’m pretty masochistic, so I don’t mind training through it, but if it’s something I could fix surgically that only sets me back a few weeks, yet offers a vast improvement, I’m at the point where I’d be willing to get it fixed.

I’ll be happy to provide more details if needed.

Hip surgery and the statement "that only sets me back a few weeks, yet offers a vast improvement" is comical. For one, hip surgery is not something that anyone living in reality would assume would be better in a few weeks. Further, hip surgeries are not as successful as one might hope. Alex Rodriquez had 250 million reasons to get better after his bilateral labral repairs, and, yet, the greatest baseball player of his generation did not.

The alternating deep buttock and groin pain does lead me to believe this is intra-articular, but I don't know if I would immediately assume labral tear. Since you have been running for a long time and you are very irritable, I might suggest that FAI is (at this point and in my humble, very uneducated opinion) a better working hypothesis. Then again, I can't see your squat or other movement patterns from here, so what do I know? I'm just some anonymous dude on the internet.

[Frank_B]

Hip surgery and the statement "that only sets me back a few weeks, yet offers a vast improvement" is comical. For one, hip surgery is not something that anyone living in reality would assume would be better in a few weeks. Further, hip surgeries are not as successful as one might hope. Alex Rodriquez had 250 million reasons to get better after his bilateral labral repairs, and, yet, the greatest baseball player of his generation did not.

The alternating deep buttock and groin pain does lead me to believe this is intra-articular, but I don't know if I would immediately assume labral tear. Since you have been running for a long time and you are very irritable, I might suggest that FAI is (at this point and in my humble, very uneducated opinion) a better working hypothesis. Then again, I can't see your squat or other movement patterns from here, so what do I know? I'm just some anonymous dude on the internet.

Hey Will,

So sorry for the delayed response. I had some family issues crop up, followed by some other things at work that kept pulling me away every time I tried to write a response. I think I may have given the impression that I've been running AND training, which isn't the case. I did "something" in this hip 10 years ago (as a runner), kept running for 8 more years; stopped running when I picked up training 2 years ago. I certainly attribute the pain more to running on the damn thing for that long than I do training, but it has gotten a bit worse in the last few months. Also, I suppose I was being a wee bit optimistic in thinking that maybe there would be some sort of procedure that might keep me down for a few weeks, but would improve this pain in my ass.

I looked up FAI and also saw a few videos on the McCarthy Test, which I think I'd probably be OK on. But, if you had me do a butterfly stretch where I was pushing my elbows into my knees, something deep in my ass would feel "pinched" and the groin would tighten up and resist more. Just figured I'd mention it.

Is there anything that you like for these issues when people flare it up? Heavy singles? Heavy triples? Light 5's, etc... Personally, I feel like I want one of those resistance bands wrapped around my leg on one end, and something immovable on the other while I pull away from it. If it's relevant, the pain is never more than a 3/10 on its worst day, but it just doesn't go away and is often a 1/10 just reminding me that it's pissed off.

I'd be happy to submit a squat video if you like.

[Will Morris]

You might try a Gaenslens Test and see what shakes out from that. Then, if the squat is the movement that hurts the most, I have had a lot of success using support gear (powerlifting briefs, squat suit without utilizing the shoulder straps), and, if I can get the client / patient into the position I want them to be in for a movement, I load with heavy doubles or triples. If I can’t get them into proper position, I lighten the load until we can and then up the volume to make up for the reduced load.

[Frank_B]

You might try a Gaenslens Test and see what shakes out from that. Then, if the squat is the movement that hurts the most, I have had a lot of success using support gear (powerlifting briefs, squat suit without utilizing the shoulder straps), and, if I can get the client / patient into the position I want them to be in for a movement, I load with heavy doubles or triples. If I can’t get them into proper position, I lighten the load until we can and then up the volume to make up for the reduced load.

Just looking at the Gaenslens Test, I can tell you that I used to do this to myself for relief. I used to have access to a high table that I could dangle my legs from and would do this exact thing when it would flair up. The gym that had that table closed during COVID and I’ve since forgotten about it until just now. The stretch in my hip flexors was very intense, but it did seem to help, now that I think about it.

Squatting doesn’t bother it that badly. I can even say that sometimes it helps. Deadlifting will piss it off if I pull a heavy set and fail to keep my knees out (specifically the right knee). The thing that truly pisses it off, though, is when I unrack the bench. Since I train alone, without a spotter, I push my feet into the ground really hard and drive my ass into the air to unrack.. This often means I am squeezing the hell out my ass cheeks. It’s usually there or once my butt returns to the bench and I start to push with my legs that I’ll start to feel it. Later that night, I’ll be guaranteed to have problems.

[Will Morris]

Just looking at the Gaenslens Test, I can tell you that I used to do this to myself for relief. I used to have access to a high table that I could dangle my legs from and would do this exact thing when it would flair up. The gym that had that table closed during COVID and I’ve since forgotten about it until just now. The stretch in my hip flexors was very intense, but it did seem to help, now that I think about it.

Squatting doesn’t bother it that badly. I can even say that sometimes it helps. Deadlifting will piss it off if I pull a heavy set and fail to keep my knees out (specifically the right knee). The thing that truly pisses it off, though, is when I unrack the bench. Since I train alone, without a spotter, I push my feet into the ground really hard and drive my ass into the air to unrack.. This often means I am squeezing the hell out my ass cheeks. It’s usually there or once my butt returns to the bench and I start to push with my legs that I’ll start to feel it. Later that night, I’ll be guaranteed to have problems.

That sounds very much SI Joint. The issue with the groin might be because the pelvis is an enclosed ring with three joints contained therein. The left and right sacroiliac joints at the back and the pubic symphysis in the front are those three joints. The adductors have attachments around the pubic symphysis, and we sometimes will treat individuals with pubic symphysitis with adductor work, and / or adductor tendon insertional pain with manual therapy targeting the pubic symphysis.

Might be worth making a quick appointment with your neighborhood friendly chiropractor instead of the massage therapist.

[Frank_B]

That sounds very much SI Joint. The issue with the groin might be because the pelvis is an enclosed ring with three joints contained therein. The left and right sacroiliac joints at the back and the pubic symphysis in the front are those three joints. The adductors have attachments around the pubic symphysis, and we sometimes will treat individuals with pubic symphysitis with adductor work, and / or adductor tendon insertional pain with manual therapy targeting the pubic symphysis.

Might be worth making a quick appointment with your neighborhood friendly chiropractor instead of the massage therapist.

Thanks so much, Will! I’ll see if I can find a good chiropractor near me.