Groin injuries in Athletes

Groin injuries are typically associated with athletes involved in multi-directional fast paced sports such as Hurling and Football.

The incidence of groin injuries in elite Gaelic footballers was shown to be as high as 9% (Murphy et al, 2012).

There are many different causes of groin pain in the sporting athlete, the most common diagnoses including acute groin strains, adductor tendinopathy and osteitis pubis. It can be an extremely debilitating injury associated prolonged periods on the sideline. There are many structures around the hip and groin region that must be considered when managing a groin injury, for instance there are 5 different muscles that act as adductors of the hip. When too much pressure is put on a certain part of the pelvis during movement this can lead to failure of other local tissues. This is often seen in sport when players have an unusual way of cutting/turning which can become problematic over time, thus leading to a groin injury as an example.

Red flags for groin injury often seen in GAA are limited hip ROM, reduced groin strength (groin squeeze) and poor lumbopelvic control, characterised by a player leaning excessively over their planting foot during a cutting movement.

Treatment begins with accurate diagnosis of the pathology as without clarifying the exact cause it is hard to implement a fully functional rehab programme due to the complexity of the hip/groin region. Muscle control and de-loading of affected tissues are two components that I like to focus on when approaching these injuries initially. It is important to introduce sports specific drills when suitable especially in multidirectional sports as the groin muscle has a massive role in decelerating the hip movements during quick turns.

 

Paddy Hannon, MISCP


Groin Injury Screening In Gaelic Football

 
The role of musculoskeletal screening has been a hot topic in recent time, see here, with the debate on the validity and efficacy of some tools. It can cause serious confusion for some clinicians on whats the most effective strategies to put into place, what is worth measuring etc.
The past 10 years clinicians have been sold false promises on the role of the FMS and other such tools in predicting and preventing injuries.
And while we shouldn’t abandon the screening process to reduce injuries, we need to be a bit more aware on what they actually measure and does it even help the clinician? 
 
A recent paper by the group led by Dr. Eamonn Delahunt has looked at the adductor squeeze test and the Copenhagen Hip and Groin Outcome Score (HAGOS) questionnaire to assess its ability to identify Gaelic Football players at risk of developing groin injury. There was 55 players within the cohort and they where followed over a 9 month period. The chartered Physiotherapist during pre-season as part of an injury screening evaluation included both the adductor squeeze test and HAGOS. No groin injuries or other injuries where found during the pre-season testing. 
 
Results revealed a significant difference in pre-season adductor squeeze test scores between those players who did (median = 210 mmHg, n = 10) and did not (median = 260 mmHg, n = 45) sustain a groin injury, U= 107.5, z =  2.58, p = 0.01, r = 0.35.
The optimal cut point for the squeeze test to discriminate between players who did and did not sustain a groin injury, to be 225 mmHg. 
 
Results of the Mann-Whitney Test revealed a significant difference in pre-season HAGOS function,sport and recreation subscale scores between those players who did (median=76.56, n=10) and did not (median=96.87, n=45) sustain a groin injury, U=114.5, z=2.48, p=0.01, r=0.33. With regard to the HAGOS function,sport and recreation subscale score, the cut point with maximal sensitivity (0.70) and specificity (0.73) to discriminate between players who did and did not sustain a groin injury was 87.50.
 
What should be of great interest to clinicians when reading this study is both the ease to administer of both tests and the cost-effectiveness. Unlike many studies which look at expensive and time-heavy methods, these are available to all clinicians with no heavy burden also. While the relative sample size was small, it does give clinicians both some normative data and cut off points to make some meaningful decisions within the team setting. It may also allow the clinicians to individualise both Strength and Conditioning programs and injury prevention methods within a group setting. 
Thomas Divilly

Groin Rehab

Groin rehab

Groin Injury Rehab

Rehabilitation for groin injuries

A groin injury is one of the most complex injuries we see at Sports Physio Ireland. It’s location and anatomy is one of the main reasons for this. This area consists of the adductor longus, magnus, brevis and gracilis, all of which insert to the underside of the pelvis.  The primary role for these group of muscles as a whole is the stabilisation of the pelvis during motion (running, jumping, cutting). These muscles also play a role in swinging the leg when turning and twisting during movement in scenarios such as game play.

When designing a rehabilitation program, it’s important not to only focus on the area of pain. You have to look at the overall balance between both groin areas, left and right. Tension or restriction of movement in one can directly effect the forces and pressures on the other side.

It is also important to assess and analyse the areas above and below the injured groin. Lack of ankle balance or stiffness can cause an overload in the groin when cutting or tackling. Quite often I see groin injuries in players who have had a history of bad ankle sprains or achilles injuries in the past. Strength in the core muscles above the area of pain and stiffness in the hip also have a huge impact on the cause and the design of the rehab program at SPI.

It is for this reason that we choose whole body movement exercises to rehab groin injuries. By doing so, you improve your overall movement and offload any imbalances that have contributed to developing the injury. The key thing with exercises such like side lunges, squats or single leg deadlifts is the attention to detail. I see many players performing these exercises in a rushed environment which can actually just compound the imbalances that are already there.

 

Key Messages

  • The groin has multiple roles for an athlete.
  • Don’t focus on the pain, look at the overall movement pattern.
  • Find your imbalances.
  • Attention to detail with your rehab.

 

Joey Boland,

Head Physiotherpaist

www.sportsphysioireland.com

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