What a pain in the groin!

Groin pain and injuries are a nuisance. They are often caused by multiple factors and can be difficult to assess, diagnose and treat effectively. So when I read a recent paper looking at reducing groin injuries in sport I thought it would be good to discuss the potential contributing factors the development of groin injuries and some potential solutions that are starting to be discussed.

Typically groin injuries fall into a few categories. There are the sudden onset injuries (strains) and the insidious development injuries (tendinopathy, pubic symphysis overload etc). These insidious injuries are generally considered overuse injuries and represent up to 80% of all hip and groin complaints, Moore and Young 2010. Work by Falvey et al 2009 described the groin triangle suggesting that the anatomical site of the pain is important to describe the treatment progressions. They identified that typically groin pain is associated with the adductor tendons and attachment, the rectus abdominis (the abdominals and associated attachment), the ligaments of the pelvis or the pubic symphysis. These descriptions are helpful, however they go onto discuss the biomechanical overload nature of groin injuries and how address the anatomical site alone may lead to insufficient rehabilitation.

So what do we need to assess and then treat when someone has groin pain?

The Moore paper identifies that musculoskeletal imbalances (weak and tight hip, groin, lumbar and thigh musculature), poor skill execution, fatigue, incomplete rehabilitation, repeated trauma and inappropriate training/competition loads can all contribute to the development of groin pain and injuries. With so many factors involved where should we start?

The first thing to identify is always the aggravating factors, the site of the pain, the associated capacities of the tissue (strength measures, range measures) and then look to place this within the context of that athletes training and competition schedule. If they are weak, have poor hip and groin range and are training in a sport that requires great capacity through the groin over a repeated training or competition season, then it is a straightforward process to start to address these factors. The more complex part of the rehabilitation is often working with the sport specific coaches to identify the biomechanical skill factors that contribute to groin loading and then aim to correct faults whilst increasing the load of skill training. The difficult part of overuse groin injuries is that they can take significant time to work on all factors and therefore can be a length process.

So how do we potentially reduce the incidence of groin injuries in the first place?

A recent study in Norwegian semi pro soccer players show that basic implementation of groin strength exercises reduces groin injury complaints by up to 40% across a soccer season, Haroy et al 2018. With this in mind addressing the adductor strength capacity as well as maintaining joint and tissue range around the hip is likely to lead to a significant reduction in the incidence of injuries in sporting populations such as soccer. This is obviously only a few factors, however it does highlight that basic implementations of training to address capacities such as strength are effective in groin injuries and are a great place to start if you are working with a sporting team.