Peter's Adductor Rehab

by Adam Skillin | June 21, 2018

One of the things I have to admit I enjoy when watching the videos posted by Starting Strength Online Coaching client Peter Butler is his habit of putting the bar back in the rack and immediately unleashing a string of profanities in his Kiwi accent. This pleasure is, unfortunately, reserved for sets that he feels he performed poorly or that were particularly hard. On January 16, 2016, he robbed me of that pleasure, placing the bar back in the rack with a grimace that was palpable via video from the opposite side of the planet. He had injured himself during the set and was in quite a bit of pain. From his description and the location of the pain, it was clear to me that he had suffered an adductor tear – pain and bruising on the inner thigh, what we usually think of as a “groin pull.”

Adductor tears are one of the more common injuries that occasionally plague lifters of heavy weights, one I’ve suffered and rehabbed myself. I do not mean to suggest that lifting weights is inherently dangerous or highly injurious. It’s not. Those arguments have already been made and evidence regarding that matter is available elsewhere. The problem is that muscle tears and lifting technique don't always fit neatly into a perfect causal narrative. It's often impossible to say with any confidence that a particular technique error resulted in a specific injury. In Peter's case, his descent was a little less controlled than it could have been, which may have contributed to the injury, but nothing else in the video suggested that he had torn his inner thigh muscle due to gross negligence or recklessness. This stuff just happens sometimes, albeit rarely.

The task of getting Peter back up and running was simple, but extremely important. While Peter's job is in IT, he's an avid hiker and adventurer both local to his current home, Kuala Lumpur, Malaysia, and in far off places (he recently scaled the 20,000-foot Mount Siguniang in Western China). Not only did he need to heal for training, but the adductor tear would impact his pastime.

We used the same stress/recovery/adaptation cycle to force Peter’s adductor injury to heal that we used to get him strong in the first place. In cases of muscle belly tears, Rip has told us for years to rehab it in accordance with the protocol Bill Starr initially developed. The protocol begins with some very high-rep work at extremely light weights utilizing the lift that most directly stresses the affected muscle.

The cellular-level mechanisms of the protocol we use to rehabilitate muscle belly tears are likely better understood by those with deeper backgrounds in physiology than my own. My surface-level understanding is that a few different things occur. One is that fresh blood is pumped at a much higher rate into the tissue when the muscle is used to move a weight in its normal fashion, pushing out waste products through the vascular system and thereby accelerating the healing process.

The second is that the tear itself represents an actual discrepancy in the normal architecture of the muscle cells. Starting Strength Coach Darin Deaton, DPT, explains that repeatedly lengthening and shortening the muscle under load in the early post-injury phase (which is what happens when the eccentric, or negative, portion of the movement is followed by the concentric, positive, portion) forces the fibers of the injured tissue to respond to the stress of mechanical loading and repair themselves more completely and more quickly than immobilization and rest.  Additionally, Starting Strength Coach and Occupational Therapist Michael Burgos suspects that the use of the tissue throughout the timeframe during which scar tissue forms likely causes the collagen to arrange itself in alignment with the muscle fibers rather than as a haphazard glob of scar tissue which is more likely to be torn again and to inhibit full function of the repaired tissue.

Peter began his rehab squatting ramping sets of 20 up to about 60 pounds – his injury occurred at 135 kg (about 297 pounds). A more extreme injury would have likely required a greater deload in terms of the weight, but fortunately Peter's wasn't too bad. He reported feeling relief immediately upon finishing each set, but that the pain simply returned to its pre-workout level after the fact. I had him drop the weight a little further and perform sets of 20 across 5 days a week, with a few days off to accommodate Peter's age and lifestyle. We kept his bench press, press, and deadlift moving along during the rehabilitative period.

While rehabilitating a muscle belly tear in this manner can be quite uncomfortable at times, it works surprisingly well. As the weight continued to increase, I decreased the frequency with which I assigned Peter doses of the rehabilitation stress (the squats) and dropped reps as needed. By the end of February, Peter had his squat back up to 125 kilograms. In late April, Peter squatted 3 sets of 5 at 137.5, an all-time 3x5 PR for him.

Peter Butler mainly wants to be a fit, strong hiker and adventurer, and a capable person. We stressed the injured tissue directly, forcing it to recover and adapt to a progressively higher dose of stress each time, until Peter was not only “all better,” but literally better than ever, as proven by setting new lifetime PRs since the injury. Whatever the mechanical and physiological mechanisms that describe why the Starr-inspired rehab protocol works, the fact that it works for muscle belly tears, and that it works impressively well is undeniable. Other types of injuries, (tendinitis, for example) require different approaches.

While most Starting Strength Coaches aren’t licensed to practice medicine, we can provide appropriate coaching and guidance for a myriad of issues that crop up in the gym, specifically those issues that are best treated by getting stronger – from poor squat mechanics to injuries – assisting all of our clients with their evolving goals and increasing achievements.