Groin pain in athletes – the sports physiotherapist’s perspective

by | Jan 13, 2021 | Uncategorized | 0 comments

Groin pain in athletes can be a frustrating injury, associating itself with significant time away from sport, as well as having high recurrence rates – even higher than ankle sprains. For this reason, there has been more recent development of research for the care and management of such pain. Here’s a look from the sport physiotherapist’s perspective.

WHO IS COMMONLY AFFECTED WITH GROIN PAIN, AND WHY?

Soccer, hockey, karate, and rugby are among the sports with the highest groin injury rates, potentially due to their explosive and multi-directional nature. It appears to be particularly noted in the male population, though that may be due to the limited numbers of females incorporated in the epidemiological studies.

Although not fully understood among clinicians and researchers, the mechanism to the injury often lies within the movement requirements of the sport. A study completed by Serner et al. in 2015 revealed some of the common mechanisms to the injury that included: kicking, change of direction, rapid acceleration/decelerations, jumping, and sprinting.

Modifiable risk factors that have been associated with groin injury include reduced hip adductor strength, and lower exposure of sport-specific training.

WHAT DOES REHABILITATION INCLUDE?

If your groin pain is limiting your daily function, or does not allow you to participate to your fullest in sport – it may be the right time to seek advice from a sport physiotherapist. In addition to an in-depth history taking surrounding your groin pain, our role is also to understand your goals and expectations of your journey through rehabilitation, and to help formulate a path to best care.

  1. CLINICAL EXAM:
    • Groin pain can originate from several different anatomical structures or physiological processes, though often multiple mechanisms and origins of pain may be affected at the same time. Our clinical exam provides insight on potential structures and mechanisms at play.
    • Additionally, the exam may help us quantify baseline measurements that we will continue to monitor progress through your rehabilitative process. The sport physiotherapist may also be able to determine associated causative factors that may have led to your pain, including the impact of past injuries – even if not local to your pain. With this process complete, and your questions responded to, the sport physiotherapist will work with you to determine next steps.
  1. EDUCATION
    • Understanding your current pain, and how you can play an active role in its management will be of great importance.
  1. MOBILITY OF THE LOWER EXTREMITIES AND SPINE:
    • Your sport physiotherapist may implement techniques or guide self-mobility drills to optimize mobility limitations in different areas of the body.
  1. MOVEMENT CONTROL OF THE LOWER EXTREMITIES:
    • Modifying potentially pain-provoking movements that relate to the way you move your body in life and in sport will be paramount to your successful recovery.
  1. STRENGTHENING OF LOWER EXTREMITIES:
    • This may be to specifically target injured tissue, to build strength and fatigue resistance in sport-specific movements, though it may even boost your performance to levels you were unable to achieve before injury! Although the exercises may seem simple to begin, we will push to provide more dynamic and powerful movements with greater speeds in late stages of care.
  1. MAINTAINING FITNESS:
    • If safe to do so, we will guide you from reducing losses of your current fitness level.
  1. PROVIDING HOMEWORK:
    • What is done in clinic is an aspect of your care. How you manage outside of our institution’s doors is just, if not more important. Self-care and athlete empowerment will be included to help promote recovery.

 

REFERENCES

  1. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med [. 2015;49(12):768–74.
  2. Orchard J. Epidemiology of injuries in the Australian Football League, seasons 1997-2000. Br J Sports Med. 2002;36(1):39–44.
  3. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic Risk Factors for Groin Injuries Among Male Soccer Players: A Prospective Cohort Study. Am J Sports Med . 2010;38(10):2051–7.
  4. Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc. 2001;(April 2000):1423–33.
  5. Hölmich P, Thorborg K, Dehlendorff C, Krogsgaard K, Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med. 2013;1:1–7.
  6. Serner A, Tol JL, Jomaah N, Weir A, Whiteley R, Thorborg K, et al. Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med. 2015;43(8):1857–64.
  7. Maffey L, Emery CA. What are the risk factors for groin strain injury in sport? A systematic review of the literature. Sport Med. 2007;37(10).
  8. Whittaker JL, Small C, Maffey L, Emery CA. Risk factors for groin injury in sport : an updated systematic review. Br J Sport Med. 2015;49:803–9.
  9. Hammoud S, Bedi A, Magennis E, Meyers WC, Kelly BT. High Incidence of Athletic Pubalgia Symptoms in Professional. J Arthrosc Relat Surg . 2012;28(10):1388–95.
  10. Roling M, Mathijssen NMC, Bloem RM. Incidence of symptomatic femoroacetabular impingement in the general population : a prospective registration study. J Hip Preserv Surg. 2016;3(3):203–7.
  11. Grif DR, Dickenson EJ, Donnell JO, Agricola R, Awan T, Beck M, et al. The Warwick Agreement on femoroacetabular impingement syndrome ( FAI syndrome ): an international consensus statement. Br J Sport Med. 2016;50:1169–76.

Submit a Comment