Rehabilitating a Severe Adductor Group (Groin) Tear

Under the bar with the Starr rehab protocol

by Joe Leppo, SSC | January 21, 2016

Self-assessment is hard for most dedicated lifters. As workouts become more difficult (with heavier weights) and more complex (with programming modifications) there is often an internal debate that goes on within the mind of the lifter: usually after a really, really hard set. This internal debate can usually be simplified down to two voices: one calling for caution (more rest, lift less weight, skip that last set, etc.) and one extolling the virtues of backbone and grit while imploring the trainee to lift the damn weight in order to get stronger (Don't be a pussy). Unfortunately, sometimes we listen to the wrong voice; I'm certainly no exception.

After a significant training lay-off, that included an overseas relocation, I was anxious to resume training and regain some of my lost strength levels. Once I was settled in at my new home, with a newly equipped garage gym, I dove right back into a modified linear progression and was rewarded with steady progress towards my goals. Everything was going great – until early November.

The Injury:

On a Monday night, following the first of three planned squat sets at 345x5x3, I found myself engaged in the previously mentioned internal debate. The first set was a lot harder than it "should have" been based on last Friday's workout and I felt an unusual sensation in my left inner thigh while performing the reps: an extreme tightness that extended from the knee up through the groin into my lower abdomen that made me think of an overly tightened guitar string. Not exactly pain, but certainly an indication that something was not quite right. I thought about it for a little while, and decided to take a few extra minutes of rest and then continue on with my planned workout. I chose very, very poorly.

During the descent on the first rep of the second squat set, I felt as though my left thigh had been coated with an invisible and highly flammable solution that was ignited by jamming a cattle prod into my groin – just as I felt an unwelcomed tearing sensation radiate throughout my inner thigh. This level of pain gets your attention very quickly. Completely incapable of resisting further downward movement, I fell forward immediately with the power rack safety arms catching the barbell and preventing me from being stapled to the deck like a rat caught in a trap.

Later, while I was waiting in the Emergency Room for something stronger than ibuprofen – after driving for 45 minutes while trying to ice the injury site without freezing the delicate, sensitive, and very important structures located nearby – I had some time to reflect on how I'd managed to injure myself. To begin with, I'd started the workout feeling stale and tired. I strongly suspect I'd not fully recovered from the previous Friday's squat workout. In this instance, I was trying to milk a few more weeks out of linear progression before moving on to more complicated programming. So in a nutshell: a lack of adequate recovery, greed and impatience with respect to training progress and significant stubbornness contributed to my injury.

The Rehab:

Until you significantly injure your adductor group, you don't realize how much the muscle group is used during normal daily activities. Everything hurts: walking, getting out of bed, rolling over, trying to climb into your pick-up truck, etc. Daily activities become difficult and painful. Based on the injury mechanism, the results of the physical exam and sonogram performed at the Emergency Room, and the significant bruising present, I knew I was dealing with a muscle belly injury. I immediately equated muscle belly injury with the Starr Rehabilitation Protocol. I'd successfully used it before for other minor injuries, but this was the most serious and painful injury I'd ever experienced lifting weights. I figured it couldn't hurt to consult with a more experienced Coach; someone I knew had much more experience than me in dealing with a multitude of injuries. So, in a phone call on the Thursday afternoon following the injury:

I can remember thinking, "Wow. That certainly escalated quickly...I guess I'm going home and squatting tonight. Looks like I don't have much choice…"

I spent the rest of the afternoon dreading the upcoming workout. My trepidation was not unwarranted. The first couple of rehabilitation workouts were VERY unpleasant. Sets of 20 or 25 absolutely suck under the best of circumstances; with an injury they become diabolical – even at light weights. I kept thinking that Jesus might show up and speak to me during the final reps of each set. He didn't, but Sheev Palpatine sure did. However, the injury area did feel ever so slightly better following the first workout. I decided to continue on with the rehabilitation program despite the discomfort. I noticed marked improvement while performing daily activities after about a week. By the time I finished the rehab program, although I wasn't 100% recovered, the injury was only really bothering me during subsequent squat workouts.

The key elements of the Starr Rehabilitation Protocol are light weights with high reps while using perfect form, lifting everyday consecutively for 2 weeks, and dropping the number of reps as required while increasing the weights used daily. It is a deceptively simply program, but hard, hard work to actually execute.

Some notes and takeaways:

1. Rip pushed me to start rehab 72 hours post-injury. Left to my own devices, I probably would have waited another day or two to start--which would've been a mistake. The hardest part is starting and completing the first 2-3 workouts. The goal is to accelerate healing without excessive scar tissue formation in the muscle belly.
2. Based on this specific injury, my working weights, training history, etc., Rip advised me to work up to 65 lbs on Day 1 and 85 lbs on Day 2. Otherwise, I would have started Day 1 at 45x25x3 and Day 2 at 45x25 / 45x25 / 55x25, and then continued on with the progression. Depending on the injury and the rehab exercise used, you might have to use smaller jumps than 10 lbs based on what you can tolerate.
3. Missing Day 7 did impact rehab progress with significant stiffness and increased soreness when I came back and worked the injury on Day 8. I don't think missing Day 14 had much impact, however, since it was the final day anyway.
4. I should've started with sets of 25 instead of 20. Somehow I had fixated on sets of 20 in my mind, even though I was previously familiar with the Starr Protocol. I don't think this had a significant impact, but I wish I had done it optimally.

The Starr Protocol is highly effective when used correctly for appropriate injuries. However, it is much more aggressive than usual physical therapy rehabilitation methodology. When I attended my mandatory physical therapy follow-up appointment (required by military medicine), and explained to the therapist (DPT) what I was doing and then showed him my training log progression, he was very surprised. He basically told me, that if I was willing to endure the discomfort and continue to exercise the area as I'd described, there wasn't really anything else he could do for me to speed recovery. He also indicated he wished more of his patients were willing to work that hard on rehabilitating their injuries – something that has been discussed on a number of occasions within the Starting Strength community boards and social media.

This little injury cost me nine weeks of progress, but I was able to bounce back, rehab the injury, and continue on with my training thanks to the use of the Starr Rehab Protocol. I hope you never need to use it yourself, but if you do, I hope my narrative is helpful as you learn to deal with your own injuries and continue pursuing your own training goals. And watch out for Sheev, he usually shows up around rep 17 or so.