Chronic pain or injury are common in this hip and groin, or ‘inguinal’ region, particularly in directional change sports such as soccer and australian rules. Although athletic hip and groin pain is an umbrella term, our ability to identify and specific tissues involved in each individual’s presentation has come a long way over the last decade. This has been aided by the use of more routine MRI, an abundance of research, and improved understanding of the biomechanics involved, resulting in more targeted and specific rehab approaches. Symptoms that once upon a time may have been thrown under the ‘osteitis pubis’ umbrella, now can be grouped under the following categories:
The image below demonstrates some of these key tissues that act to stabilise the pelvic region, all with complex interactions with one another and the numerous other tissues that act on the pelvis. The diagnosis of a specific tissue source of an individual’s pain relies on a practitioner’s clinical tests and physical examination, and often a careful consideration of imaging findings.
The following studies give an interesting insight into how the diagnosis of hip and groin pain have somewhat followed trends over time, in particular the more recent awareness of hip joint and abdominal involvement. This highlights the complexity of these conditions and importance of staying up to date with the latest research, underpinned by a detailed knowledge of anatomy and biomechanics.
Identifying the source of an individual’s pain, can provide crucial information for us as physiotherapists to understand the driver of this pathology. Is it something about the key movement patterns of running, or kicking a ball that overstress these tissues? Are their weaknesses or imbalances that need to be addressed with strength and conditioning? Is surgery something to be considered seriously?
All questions to be answered in our next blog; Athletic hip and groin pain: Components of rehabilitation.
Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study [published correction appears in Br J Sports Med. 2009 Apr;43(4):310-1]. Br J Sports Med. 2008;42(10):851-854. doi:10.1136/bjsm.2007.039685
Falvey ÉC, et al (2016). Athletic groin pain (part 1): a prospective anatomical diagnosis of 382 patients—clinical findings, MRI findings and patient-reported outcome measures at baseline. Br J Sports Med; 50:423–430. doi:10.1136/bjsports-2015-094912.
Hölmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 207 patients. Br J Sports Med. 2007;41(4):247-252. doi:10.1136/bjsm.2006.033373
Lovell (1995). The diagnosis of chronic groin pain in athletes: A review of 189 cases. The australian journal of science and medicine in sport, 3: 76-79.
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