Groin Pain in Athletes
Overview:
Groin pain is a common compliant in athletes It is typically a multifactorial injury that can involve many different structures and is usually categorized by the region/tissue suspected to be involved. Multiple diagnoses are often common with groin injuries due to the overlapping structures and symptoms. The most common sub-grouping categories are:
Causes:
Are typically multifactorial and involve: adductor dysfunctions, osteitis pubis, abdominal wall weakness, and muscle strains (typically adductors)
Risk Factors:
Pathogenesis:
Clinical Presentation:
Examination:
--History -
Differential Diagnosis:
Clinical Bottom Line:
Refer if a fracture or other non-musculoskeletal cause is suspected. Acute treatment should include symptom reduction, rest, light passive stretching, and pain-free AROM and strengthening. Chronic treatment should include: reduction of tissue dysfunction; strengthening/stretching as appropriate; sport specific training when full pain-free ROM and strength are achieved.
See Groin Pain in Athletes References
Groin pain is a common compliant in athletes It is typically a multifactorial injury that can involve many different structures and is usually categorized by the region/tissue suspected to be involved. Multiple diagnoses are often common with groin injuries due to the overlapping structures and symptoms. The most common sub-grouping categories are:
- Adductor muscle related
- Abdominal wall related
- Pubic bone related
- Psoas muscle related
- Hip joint related
Causes:
Are typically multifactorial and involve: adductor dysfunctions, osteitis pubis, abdominal wall weakness, and muscle strains (typically adductors)
Risk Factors:
- Participation in sports such as soccer, ice hockey, and rugby that require sudden acceleration or changes in direction, and overstretching of the hip in abduction and external rotation
- Previous groin injury
- Low levels of sport-specific preseason training, including: decreased preseason hip abduction range of motion, hip adductor weakness, and imbalance between hip abductor and adductor strength ratio
- Core muscle weakness or delayed muscle activation of transverse abdominus
- Age - less common in pediatric populations
Pathogenesis:
- Tissue damage and/or entrapment of anatomical structures resulting from strain placed on musculoskeletal structures through repeated loading
- Direct anatomical connections and close proximity of bony fixations on the anterior pelvis(6) cause overlapping pathology
- Increased adductor muscle tone may be present as a protective mechanism to provide stabilization to the area
- Osteitis pubis occurs from inflammation of the pubis symphysis and is characterized by bony changes of the pubis symphysis and hardening of the ligament
- Bone stress injury may occur as a consequence of repetitive loading - most common cause in runners due to primarily sagittal motions
- Decreased neuromuscular control of transverse abdominus muscle during activity
Clinical Presentation:
- Acute: a groin injury that does not resolve or may develop gradually with no identified injury
- Chronic: pain is variable and often associated with vague or diffuse symptoms, inconsistent findings, and varied response to interventions
- Athletes can present with complaints that may have been recurrent or longstanding
- There is typically a gradual onset of exercise-induced pain in the lower abdomen and/or medial thigh that affects function or athletic performance
- Pathologies are often already well established at presentation due to chronic nature and/or insidious onset
Examination:
--History -
- Mechanism of injury, including typical sporting activities
- Previous injury/therapy
- Aggravating factors (typically activity) Easing factors (typically rest)
- Hip active/passive range of motion (typically limited in hip abduction or extension)
- Hip muscle testing (usually weak and/or painful on adduction or flexion)
- Hip joint integrity: FABER, Gillet test for SI Dysfunction
- Palpation and skin assessment
- Neurological testing: sensation and reflexes should be intact and equal bilaterally
- X-ray radiography to rule out fractures; MRI to assess for soft tissue injury/tears
Differential Diagnosis:
- Palpable inguinal hernias should be referred to a surgeon
- Genitourinary abnormalities such as: urinary tract infection, prostatitis, testicular abnormalities, or gynecological abnormalities)
- Intra-abdominal disorders: appendicitis or inflammatory bowel disease
- Acetabular labral tear
- Inguinal neuralgia
- Pubic stress fracture
- Hip/pelvic fracture (femoral, acetabular, pubic, or ischial)
- Lumbar radiculopathy
Clinical Bottom Line:
Refer if a fracture or other non-musculoskeletal cause is suspected. Acute treatment should include symptom reduction, rest, light passive stretching, and pain-free AROM and strengthening. Chronic treatment should include: reduction of tissue dysfunction; strengthening/stretching as appropriate; sport specific training when full pain-free ROM and strength are achieved.
See Groin Pain in Athletes References
