Summary: Groin injuries constitute up to 5% of sports injuries and are a significant concern in sports med. Athletes who participate in disciplines as diverse as dancing, kickboxing, ice hockey and football, are among the sports where groin pain is common. Sustaining a groin injury can be a significant setback for athletes, affecting performance and quality of life.
This article delves deep into the causes, risk factors, and treatments of groin pain, with a special focus on athletes. Here’s why you should read this article: you’ll gain insights into the importance of accurate diagnosis, effective management strategies, and preventative measures to help maintain peak athletic performance.
Article Outline
- What Causes Groin Pain in Athletes?
- Structures involved in groin pain
- How Does Imaging Help in Diagnosing Groin Pain?
- Understanding Sports Hernia: A Common Culprit
- Risk Factors Associated with Groin Pain in Sports
- Can Osteitis Pubis be the Cause of Persistent Groin Pain?
- Adductor Strain vs. Groin Strain: What’s the Difference?
- The Role of the Hip Joint in Athletes’ Groin Pain
- Stress Fractures and Groin Pain: Connecting the Dots
- Why Are Female Athletes Often Prone to Groin Injuries?
- Long-term Management Strategies for Chronic Groin Pain
What Causes Groin Pain in Athletes?
Groin pain in athletes is frequently caused by a complex interplay of overuse and acute injuries, affecting muscles, tendons, and bones. Common conditions include adductor strains, inguinal hernias, and issues related to the hip joint and pubis. Understanding the specific cause is crucial for effective treatment and prevention of further injury.
The causes of groin pain must be understood so appropriate management can be implemented in collaboration with your sports physical therapist.
Structures involved in groin pain
There are several possible structures in which pain around the groin often emanates; more often than not hip and groin injuries in athletes involve a combination of these structures.
The possible structures include:
- hip flexor muscle and tendons, important structures in evaluating athletes for causes of groin and hip pain.
- the adductor muscles and tendons
- the hip joint
- the lower back
- the abdominal muscles
- the pubic symphysis
How Does Imaging Help in Diagnosing Groin Pain?
Imaging techniques such as MRI (Magnetic Resonance Imaging), X-rays, CT scans, or ultrasound scanning are often pivotal in diagnosing athletes with groin pain. They provide clear images of the soft tissues and bones, allowing healthcare providers to identify specific pathologies like sports hernias or stress fractures. This information is useful for guiding treatment options.
Your physiotherapist will recommend if diagnostic imaging is indicated after they have undertaken their assessment and physical examination and discussed your differential diagnosis. It must be remembered that the diagnostic accuracy of clinical testing for most things is limited so using appropriate imaging modalities in the evaluation of groin pain is vital.
Understanding Sports Hernia: A Common Culprit
A sports hernia, also known as athletic pubalgia or Gilmore’s groin, is a significant cause of longstanding groin pain and tenderness in athletes. It involves the soft tissue of the groin or lower abdomen and is common in sports requiring sudden changes of direction or intense twisting movements.
The early examination of athletes with groin pain must be and in the instance of inguinal pain the evaluation should look for any inguinal disruption in athletes. Identifying a sports hernia early can prevent the progression of symptoms.
Risk Factors Associated with Groin Pain in Sports
Several risk factors contribute to groin pain in athletes, including inadequate warm-up, previous groin injuries, and muscle imbalances. Recognising these can help in tailoring prevention and management strategies to individual athletes, reducing the risk of injury recurrence. Some of the common themes we see in acute hip and groin pain are:
- Insufficient strength for the required task can be a factor for hernias, a common cause of groin pain. Eg a kickboxer who is required to perform repeated high kicks, and has weakness of the psoas and iliacus muscles, may then compensate through overuse of the other hip flexor muscles (such as tensor fascia latae), which can lead to muscle injury due to imbalance and overuse.
- Insufficient flexibility/stretching. Most sports involve the repetition of certain movements, which lends itself to certain muscle groups becoming tight. In the absence of a tailored flexibility program, some athletes will then be at greater risk of developing groin pain.
- Sudden increases in activity. Our muscles and joints like things to stay the same – any changes should be gradual. This is especially true from approximately the 4th decade of our life onwards. People who might be at risk include individuals who go to the gym and suddenly decide to do 100 squats in one session, or athletes who are training for a marathon and increase their mileage too rapidly.
Can Osteitis Pubis be the Cause of Persistent Groin Pain?
Osteitis pubis is an inflammation of the pubic symphysis and surrounding muscle insertions. It is often seen in athletes involved in sports requiring repetitive hip adduction, such as soccer and hockey. Long-standing groin pain from this condition requires a focused treatment approach, including rest and a carefully managed return to active physical training.
Adductor Strain vs. Groin Strain: What’s the Difference?
Understanding the difference between an adductor strain and a groin strain is key for accurate diagnosis and treatment. While both involve pain in the groin area, adductor-related groin pain in athletes affects the muscles on the inner thigh, such as adductor longus. A groin strain however, could involve any number of muscles and tendons in the groin region although these are often iliopsoas-related groin pain.
The Role of the Hip Joint in Athletes’ Groin Pain
The hip joint plays a crucial role in the biomechanics of an athlete’s body, and issues here can lead to groin pain. Conditions such as labral tears, arthritis, and impingement should be considered when athletes present with groin pain, especially when accompanied by limited range of motion.
Stress Fractures and Groin Pain: Connecting the Dots
Stress fractures in the pelvis or proximal femur can manifest as groin pain in athletes, particularly those involved in high-impact sports. These injuries are serious and require immediate attention to prevent worsening of the condition.
Why Are Female Athletes Often Prone to Groin Injuries?
Female athletes may experience groin pain, we suspect, due to pelvic anatomy and hormonal factors. Understanding these differences is important for customised treatment and prevention strategies that cater specifically to the needs of these athletes.
Long-term Management Strategies for Chronic Groin Pain
Managing chronic groin pain in athletes involves a combination of physical therapy, strength training, and, sometimes, surgery. Long-term management strategies are tailored to the specific cause of the groin pain and aim to prevent recurrence while maintaining the athlete’s performance levels. You are unlikely to ever need surgery for a simple muscle strain but surgery for chronic groin pain can be more likely.
What would physiotherapy for groin pain include?
It is likely to be difficult to self diagnose the exact cause of your groin pain. An experienced physiotherapist would examine the entire groin carefully. Particularly looking at strength, flexibility, and balance before reaching a diagnosis of groin pain.
If you need to see a physiotherapist regarding your groin pain, they will firstly try to establish the exact nature and severity of your problem. The assessment will include questions on activities or the periods of the day when your symptoms are worse, whether you have been experiencing any night pain – indeed we will also be keen to know about anything you have done which helps your symptoms (eg stretches, ice packs, painkillers). For athletes with acute groin pain, working out what causes pain may also be the key to future rehab strategies.
The physical assessment would include palpation of the joints and muscles around the painful area to ascertain which structures are painful, essential for diagnosing causes of groin or acute hip pain. Equally important is to look at the range of movement of the relevant joints – especially the hip and lower back, as restricted motion here can be a cause of groin pain in athletes.
Assessment of the muscle function around the hip & pelvis is also crucial – especially the gluteal (your bottom!), which can be involved in sports-related hip pain. muscles. For example, the examination might include an assessment of how well you can perform a task such as a single leg squat, or a step up onto a step.
Treatment is likely to include strengthening of weak muscles (possibly the glutes, hip flexors or adductors), stretching of any tight muscles and if appropriate manual therapy (manipulation or mobilisation) of the hip joint and lower back.
You can also check out some videos of exercises to work on groin strength to help manage or prevent groin pain in athletes. here.
Key Takeaways
- Groin pain in athletes often stems from a combination of acute and overuse injuries.
- Imaging is crucial for an accurate diagnosis, highlighting the importance of MRI in identifying internal disruptions.
- Sports hernia is a common and often overlooked cause of groin pain.
- Prevention strategies must consider specific risks unique to each athlete.
- Effective management of chronic groin pain requires a multidisciplinary approach to ensure optimal recovery and performance sustainability.
Our expert physiotherapists will also be able to advise you if you need to see another health professional for further investigation such as a sports medicine doctor or an orthopaedic surgeon. Whether you are a young athlete, an amateur or a professional athlete, or anything in between, our team can help you with your groin pain.
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