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Context: Osteitis pubis (OP), which occurs as a result of excessive use of the symphysis pubis and parasymphysis bones, is more common in long-distance runners and kicking athletes, especially football players. Due to the poor results of commonly used treatments for OP, there is a need for investigation of more effective treatments, such as ozone therapy. Ozone therapy is used to treat a variety of diseases, including musculoskeletal conditions. Case Presentation: A 30-year-old amateur soccer player diagnosed with OP received conservative treatment with traditional physiotherapy and analgesic medications. After 6 months and no resolution of symptoms, the patient presented to the sports medicine outpatient clinic seeking alternative therapy options. Management and Outcomes: The patient received ozone injections in 3 sessions administered at 10-day intervals. At 1, 3, 6 and 12 months after the treatment, the patient's complaints and pain levels were re-evaluated and examined. The patient was able to return to competition at the same level after the first injection. No recurrence was revealed at a minimum of 12 months of follow-up. Conclusion: In this article, we present a case in which OP was successfully treated with ozone injection. [ABSTRACT FROM AUTHOR] more...

Introduction: Groin injuries are common in soccer players and often involve adductor muscle strains. The Copenhagen Adduction Exercise (CAE) is a targeted intervention whose effectiveness in rehabilitation for these injuries warrants investigation. Objective: To investigate the impact of a rehabilitation program, which includes the CAE, on eccentric hip adduction (EHAD) strength, hip joint range of motion (ROM), self-reported disability, and pain among soccer players with adductor-related groin pain. It was hypothesized that the addition of CAE to the rehabilitation program would yield greater improvements. Methods: Employing a randomized controlled trial with a two-group parallel design, thirty male soccer players with a mean age of 26.4 ± 3.9 years were randomized into an intervention group (IG) including CAE (n = 15) and a control group (CG) without CAE (n = 15), based on a power analysis to ensure 80% power to detect significant differences. Both groups engaged in their respective rehabilitation programs twice a week for eight weeks. The primary outcome measured was EHAD strength, while secondary outcomes included hip joint ROM, self-reported disability measured by the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain levels. Results: Significant improvements within groups were observed across all measures (p < 0.001). The IG demonstrated a greater increase in EHAD strength (Mean Difference [MD] = 0.49 Nm/kg, 95% Confidence Interval [CI] [0.31, 0.66]), a more pronounced reduction in pain (MD = -1.60, 95% CI [−2.18, −1.02]), and betterment in all HAGOS subscale scores compared to the CG. There were no significant between-group differences in hip joint ROM. Conclusion: Incorporating the CAE into rehabilitation programs significantly improves EHAD strength, decreases pain scores, and reduces self-reported disability in soccer players with adductor-related groin pain. Registration: ClinicalTrials.gov identifier: NCT05589623 [ABSTRACT FROM AUTHOR] more...

Background: Controversies remain regarding the diagnosis, imaging, and treatment of acute adductor injuries in athletes. Purpose: To investigate the diagnostic imaging, treatment, and prevention of acute adductor injuries based on the most recent and relevant scientific evidence. Study Design: Systematic review; Level of evidence, 4. Methods: The PubMed and Web of Science databases were searched according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines to identify articles studying acute adductor injury in athletes. Inclusion criteria were original publication on acute adductor injury in amateur or professional athletes, level 1 to 4 evidence, mean patient age >15 years, and results presented as return-to-sport, pain, or functional outcomes. Quality assessment was performed with the CONSORT (Consolidated Standards of Reporting Trials) statement or the methodological index for non-randomized studies criteria. Articles were grouped as imaging, treatment, prevention focused, or mixed. Results: A total of 30 studies published between 2001 and 2021 were selected, involving 594 male patients with a mean age 26.2 years (range, 16-68 years). The most frequent sports were soccer (62%), basketball (14%), futsal (6%), American football (3%), and ice hockey and handball (2%). Risk factors for acute adductor injury were previous acute groin injury, adductor weakness compared with the uninjured side, any injury in the previous season, and reduced rotational hip range of motion. The frequency of complete adductor muscle tears on magnetic resonance imaging was 21% to 25%. For complete adductor tears, the average time to return to play was 8.9 weeks in patients treated nonoperatively and 14.2 weeks for patients treated surgically. Greater stump retraction was observed in individuals treated surgically. Partial acute adductor tears were treated nonoperatively with physical therapy in all studies in the present systematic review. The average time to return to play was 1 to 6.9 weeks depending on the injury grade. The efficacy of adductor strengthening on preventing acute adductor tears has controversial results in the literature. Conclusion: Athletes with partial adductor injuries returned to play 1 to 7 weeks after injury with physical therapy treatment. Nonoperative or surgical treatment is an acceptable option for complete adductor longus tendon tear. [ABSTRACT FROM AUTHOR] more...

Groin pain syndrome (GPS) is a prevalent issue in soccer. This study assessed the effectiveness of a new preventive protocol on GPS for youth soccer players. The protocol included targeted stretching and strengthening exercises for the adductor and core muscles from preseason to midseason. A questionnaire and two pain provocation tests were used for the evaluation. Mild GPS required positive results in at least two evaluations, while severe GPS was associated with pain incompatible with engagement in any activity confirmed by diagnostic ultrasound. Forty-two elite male athletes (aged 16.9 ± 0.7 years) participated in the study, with half of them assigned to the usual training (control group) and the remaining athletes undergoing the preventive protocol (treatment group) for 24 weeks. GPS rates were 14.3% (three diagnoses: two mild, one severe) in the treatment group and 28.6% (six diagnoses: three mild, three severe) in the control group. Toward the end of the season, three players, one from the treatment group and two from the control group had to stop playing due to severe GPS problems. In addition, one player in the control group stopped midseason. Even though the reduction in the risk of developing GPS was not significant (relative risk of 0.50 ([95%CI 0.14 to 1.74], p = 0.2759), the halved incidence of severe GPS and the increased muscle strength related to the treatment (p = 0.0277) are encouraging data for future studies. [ABSTRACT FROM AUTHOR] more...

Introduction: Groin pain is one of the prevalent injuries in soccer players.1 Since groin pain takes time to heal and affects the performance of the players, it is necessary to monitor the groin condition regularly to prevent its onset and reccurence. The Groin Injury Screening Questionnaire (GISQ) was developed in Norway to evaluate the groin condition for soccer players.2 GISQ has already been translated in several language, but not into Japanese. Objectives: To develop the Japanese version of the GISQ (GISQ-J), and to examine its validity and reliability. Moreover, to investigate the relationship between a history of groin pain and GISQ-J scores. Study design: Cross-sectional study Methods: The GISQ-J, translated with permission from the original author, was distributed twice to 114 Japanese high school and university soccer players by Google Forms. The second response was given within 72 hours of the first 79 80 response, recalling the condition of the groin at the time of the first response. The GISQ-J is a 100-point scale, with a higher score indicating better groin conditions. Cronbach's α was calculated to assess the validity of each GISQ-J scale, and the intraclass correlation coefficient (ICC) was calculated to evaluate the reliability. In addition, an unpaired t-test was used to compare GISQ-J scores by the presence or absence of a history of groin pain. Results: A total of 60 soccer players (52.6%) responded. Cronbach's α for each scale ranged from 0.71 to 0.97, and the ICC from 0.72 to 0.86. Those with a history of groin pain (n=14) had significantly lower GISQ-J scores than those without (n=46)(p<0.05). Conclusions: The GISQ-J showed good validity and reliability on each scale. The GISQ-J scores were poor with a history of groin pain, suggesting that the GISQ-J may be useful in the evaluation of groin conditions in Japanese soccer players. [ABSTRACT FROM AUTHOR] more...

Context: Athletic pelvic and groin injuries are a common yet challenging problem. Pelvic belts have been successfully used to reduce pain and improve function but are not a practical solution for athletes. Therefore, there is scope to explore the use of a more dynamic intervention developed to aid in the management of this type of injury. Objectives: To undertake a preliminary investigation into the effectiveness of a dynamic elastomeric fabric orthosis (DEFO) in supporting the management of athletic pelvic and groin injury. Design: A case series with an AB design. Daily assessments were undertaken over 15 days; the onset of intervention was randomized with a minimum baseline period of 6 d. Follow-up assessment was undertaken after 1 mo. Settings: Community and university. Participants: 8 athletes presenting with pelvic or groin injury confirmed through clinical screening. Intervention: A bespoke DEFO. Main Outcome Measures: Force produced on bilateral resisted hip adduction and self-scored pain (using a numerical rating scale of 0-10) at rest and during an active straight-leg raise and a broad jump. Results: In 7 cases a significant improvement was observed on at least 1 measure (2-SD method, celeration line, and/or the point of nonoverlapping data). The remaining case showed minimal symptoms during testing. [ABSTRACT FROM AUTHOR] more...

This study investigated the weekly prevalence of groin problems over a 3-week football pre-season, compared to a 39-week competitive in-season. We registered time-loss groin injuries, and self-reported weekly groin-pain in 17 amateur male football teams (386 players). The average weekly prevalence of groin problems (prevalence ratio (PR)) was 1.8 times higher (95% CI 1.6 to 2.0) during pre-season (21%) compared to in-season (12%). We found a higher weekly prevalence (PR 1.8; 95% CI 1.6 to 2.1) of groin problems without time loss, during the pre-season (19%) compared to the in-season (10%), but no significant difference in the weekly prevalence of groin problems with time loss (PR 1.5; 95% CI 1.0 to 2.4). Attention should be given to optimal load progression, and early implementation of preventive measures during the football pre-season to reduce the prevalence of groin problems in both pre- and in-season. [ABSTRACT FROM AUTHOR] more...

Background: Athletic pubalgia, commonly referred to as a "sports hernia," is a disease process characterized by groin pain produced by physical exertion often occurring in patients whose athletic activities require them to make rapid changes in direction. The groin pain is due to the traction-countertraction relationship between the adductor muscles and the weaker abdominal muscles. Hence, a few studies have shown inguinal hernia repair with adductor tenotomy to be an effective treatment for this pathology (Brody in Hernia 21:139-147, 2016, https://doi.org/10.1007/s10029-016-1520-8 ; Rossidis et al. in Surg Endosc 29:381-386, 2015, https://doi.org/10.1007/s00464-0143679-3 ). However, these studies are small and few in quantity but have demonstrated promising results. Thus, we sought to further study this combined surgical approach as a treatment for this multifactorial disease to improve our understanding and outcomes.Methods: With IRB approval, we retrospectively reviewed the charts of all patients who underwent adductor tenotomy and inguinal hernia repair for the treatment of athletic pubalgia at Mount Sinai Medical Center, Miami Beach FL. Parameters gathered included basic demographics, past medical and surgical history, athletic activity, length of surgery, length of time between surgery and follow-up, intraoperative and postoperative complications, and time to return to athletic activities.Results: A total of 93 patients underwent inguinal hernia repair with adductor tenotomy. These procedures were all performed by a single surgeon at two academic institutions. The average age of patients was 23.4 years. Athletic activities reported by the patients were as follows: American football (n = 36), soccer (n = 18), triathlon (n  = 11), track and field (n = 8), and baseball (n = 5). Less-represented activities included swimming (n = 3), tennis (n = 2), lacrosse (n = 1), golf (n = 1), and other (n = 8). Mean operative time was 72.4 min. Most patients were found to return to athletic activity in 28 days following a standardized physical therapy regimen (92.5%). Postoperative complications included recurrence of pain/symptoms (7.5%, n = 7), urinary retention (2.2%, n = 2), pain along the adductor magnus/brevis muscle group with more extraneous activity (1.1%,  n = 1), and adductor brevis hematoma 3 months following surgery and rehabilitation (1.1%, n = 1). Of the patients with recurrent pain, 2/7 reported contralateral pain.Conclusions: Total extraperitoneal laparoscopic inguinal hernia repair with adductor tenotomy appears to be a relatively quick and safe procedure with few postoperative complications. The majority of treated athletes are able to return to full athletic activities within 28 days of operation. While a return of symptoms has been seen in some patients, it is frequently observed on the contralateral side. [ABSTRACT FROM AUTHOR] more...

OBJECTIVE: To investigate the relationship between repeated clinical measures and the progression of rehabilitation of male athletes with acute adductor injuries. DESIGN: Prospective observational cohort study. METHODS: Male athletes with acute adductor injuries received a standardized criteria-based rehabilitation program with 4 repeated clinical measures during rehabilitation: the extent of palpation pain (length and width in centimeters), the bent-knee fall-out test (BKFO; in centimeters), hip abduction range of motion (in degrees), and eccentric hip adduction strength (in Newton meters per kilogram). We analyzed the association between each clinical measure and the percent progression of rehabilitation until return to sport (RTS), divided into 2 RTS milestones: (1) clinically pain free, and (2) completion of controlled sports training. RESULTS: The analyses included 61 male athletes for RTS milestone 1 and 50 athletes for RTS milestone 2, and 381 to 675 tests were performed for each clinical measure. The median time to RTS milestones 1 and 2 was 15 days (interquartile range, 12-29 days) and 24 days (interquartile range, 16-34 days), respectively. Each repeated clinical measure individually explained 13% to 36% of the variance in rehabilitation progression to the RTS milestones. The extent of palpation pain explained the highest variance of the progression of rehabilitation (R² = 0.26-0.27 for length and R² = 0.36 for width, P<.001). Eccentric adduction strength (R² = 0.19-0.27, P<.001) improved throughout rehabilitation, whereas the flexibility tests (BKFO, R² = 0.13-0.15; P<.001 and hip abduction range of motion, R² = 0.19-0.21; P<.001) returned to normal values early in rehabilitation. CONCLUSION: Repeated measures of adductor strength, flexibility, and palpation pain provided only a rough impression of rehabilitation progress following acute adductor injuries in male athletes. These clinical measures cannot define a precise recovery point during rehabilitation. [ABSTRACT FROM AUTHOR] more...

The time‐loss definition of injury is commonly adopted in epidemiological groin‐injury studies in football, with a significant risk of underestimating the impact of these injuries. This study investigated the extent of groin problems, beyond the time‐loss approach, over a full Spanish football season. Players from 17 amateur male teams were followed over 39 consecutive weeks. Groin‐injury time loss and self‐reported groin pain, irrespective of time loss, were combined to calculate the average weekly prevalence of all groin problems with or without time loss. A subscale measuring hip‐ and groin‐related sporting function from the Copenhagen Hip and Groin Outcome Score questionnaire (HAGOS, Sport/Rec) was registered every 4 weeks. In total, 407 players participated in the study. The average (range) weekly prevalence of all groin problems was 11.7% (7.2%‐20.8%); 1.3% with time loss (0.0%‐3.2%) and 10.4% without time loss (6.3%‐17.6%). Players with groin problems reported lower scores (mean difference) on the HAGOS, Sport/Rec subscale compared with players without (−19.5 [95% CI: −20.7 to −18.4]), while there was no difference between players reporting groin problems with and without time loss (4.0 [95% CI: −1.1 to 9.1]). The traditional time‐loss measure only captured 10% of all groin problems. Hip‐ and groin‐related sporting function was not different between players reporting groin problems with or without time loss, suggesting the reason for continuing to play is not only related to the severity of symptoms. These findings question the judicious use of the time‐loss approach in overuse conditions, such as groin pain in footballers. [ABSTRACT FROM AUTHOR] more...

* DESIGN: Prospective cohort. * OBJECTIVE: To explore the association between preseason assessments of (1) isometric hip adductor and abductor strength using a novel field test and (2) the Copenhagen Hip and Groin Outcome Score (HAGOS) and subsequent hip/groin injury in male professional soccer players. * METHODS: In total, 204 male elite soccer players from 10 professional A-League and English Football League Championship clubs underwent assessments of hip adductor and abductor strength and completed the HAGOS in the 2017- 2018 preseason. All subsequent hip/groin injuries were reported by team medical staff. Data reduction was conducted using principal-component analysis. The principal component for the HAGOS and 3 principal components for strength and imbalance measures were entered, with age and prior hip/groin injury, into a multivariable logistic regression model to determine their association with prospectively occurring hip/groin injury. * RESULTS: Twenty-four players suffered at least 1 hip/groin injury throughout the 2017-2018 season. The principal component for between-limb abduction imbalance (peak strength in the preferred kicking limb - nonpreferred limb) (odds ratio [OR] = 0.58; 95% confidence interval [Cl]: 0.38, 0.90; P = .011), the principal component for peak adduction and abduction strength (OR = 0.71; 95% Cl: 0.51,1.00; P = .045), and the principal component for the HAGOS (OR = 0.77; 95% Cl: 0.62,0.96; P = .022) were independently associated with a reduced risk of future hip/groin injury. Receiver operating characteristic curve analysis of the whole model revealed an area under the curve of 0.76, which indicates a fair combined sensitivity and specificity of the included variables but an inability to correctly identify all subsequently injured players. * CONCLUSION: Hip abduction imbalance favoring the preferred kicking limb, higher levels of hip adductor and abductor strength, and superior HAGOS values were associated with a reduced likelihood of future hip/groin injury in male professional soccer players. [ABSTRACT FROM AUTHOR] more...

Background: Long-standing groin pain (LSGP) is a chronic painful condition resulting in both impaired performance and time loss from participation in multidirectional field sport.Research Question: What are the differences in intersegmental coordination strategy and variability of trunk-pelvic and thigh coupling during change of direction in subjects with athletic LSGP and asymptomatic control subjects?Methods: A motion analysis system was used to collect 3-D kinematic data of the continuous relative phase and the variability of the right and left leg hip. Thoracic-thigh segment data were also collected during multiple ipsilateral turns at a self-selected pace from 16 males with LSGP and 16 asymptomatic controls. It is worth mentioning that, for a more detailed analysis, we divided each cycle diagram into four phases. Independent T-tests were used to compare the two groups.Results: Subjects with LSGP demonstrate except in phase 2 of the left foot, more out-of-phase movement with both increased variabilities in right/ left thigh - pelvic coupling, right/ left thigh-thoracic, and pelvic- thoracic in every 4 phases and in the decoupling of segmental coordination.Significance: Decrease in coordination with higher variability is apparent in subjects with LSGP and this aberrant coordination may lead to unexpected compensatory strategies and control impairments. [ABSTRACT FROM AUTHOR] more...

To provide descriptive data on injury presentation and treatment and to identify risk factors for requiring surgical treatment for athletes presenting with CrossFit-related hip and groin injuries. CrossFit-related injuries (n  = 982) were identified within a single hospital system from 2010 to 2017, with 83 (8.5% of total) identified hip or groin injuries. Patient demographics, injury diagnosis, surgical procedure and rehabilitation were assessed. Independent predictors of requiring surgery were analyzed via multivariate logistic regression analysis. Patients with hip or groin injuries were more often female (hip injuries: 63%; all injuries: 50%; P  < 0.001) with mean age 34.3 years (standard deviation 10.9). Median symptom duration was 4 months with 70% reporting insidious onset. Most common diagnoses were femoral-acetabular impingement syndrome (34%), hamstring strain (11%), non-specific hip/groin pain (imaging non-diagnostic) (11%), hernia (7%) and iliotibial band syndrome (6%). Most (90%) required physical therapy (median 2 months). Surgery occurred in 24% (n =  12 hip arthroscopy, n =  5 inguinal hernia repair, n  = 3 total hip arthroplasty), with 100% return to sport after arthroscopy or hernia repair. The only predictor of surgery was complaint of primarily anterior hip/groin pain (82% surgical patients, 46% non-surgical) (odds ratio 5.78, 95% confidence interval 1.44–23.1; P  = 0.005); age, sex, body mass index, symptom duration and symptom onset (insidious versus acute) were non-significant (P  > 0.25). CrossFit athletes with hip and groin injuries often present with prolonged symptoms with insidious onset. Most patients require several months of physical therapy and approximately one quarter require surgery. Patients presenting with primarily anterior hip/groin pain are at increased risk for requiring surgery. Level of Evidence IV, case series. [ABSTRACT FROM AUTHOR] more...

Purpose: The most effective treatment for longstanding groin pain with no hernia present has not been designated. The aim of this systematic review was to assess whether surgical or conservative treatment are the most effective in reducing pain and thereby returning patients to habitual activity.Methods: PubMed, Embase, and Cochrane were searched. We included adults diagnosed with longstanding groin pain with no hernia. Treatment included inguinal hernia repair, tenotomy, and nonsurgical management. Outcomes included return to habitual activity, pain, patient satisfaction, re-operations for the operated patients, and shift to surgery for the non-operated patients. We included randomized controlled trials and observational studies with more than 10 participants.Results: In total, 72 studies with 3629 patients were included. Only five studies used a comparison group. After inguinal hernia repair, 94% returned to habitual activity after median 10 weeks, 92% became pain free, and 92% were satisfied with their treatment. After adductor tenotomy, 90% returned to habitual activity after median 12 weeks, 90% became pain free, and 84% were satisfied. After combined inguinal hernia repair and adductor tenotomy, 97% returned to habitual activity after median 10 weeks, 92% became pain free, and 91% were satisfied with their treatment. After nonsurgical management, 80% returned to habitual activity after median 12 weeks, 67% became pain free, 56% were satisfied, and 21% shifted to surgery.Conclusion: We found that surgery seems to be more efficient in return the patients to habitual activity, reduce their pain, and satisfy them than conservative treatment. [ABSTRACT FROM AUTHOR] more...

Purpose: Hip and groin injuries in football are problematic due to their high incidence and risk of chronicity and recurrence. The use of only time-loss injury definitions may underestimate the burden of hip and groin injuries. Little is known about hip and groin injury epidemiology in female football. The first aim of this study was to examine the within-season (2014-2015) prevalence of total injury with and without time-loss in female amateur football players. The second aim was to study the within-season and preseason (2015-2016) prevalence of hip/groin injuries with and without time-loss. The third aim was to study the association between the duration of hip and groin injury in the 2014-2015 season and the severity of hip/groin problems during the 2015-2016 preseason.Methods: During the preseason, 434 Dutch female amateur football players completed an online questionnaire based on the previous season and current preseason. The hip and groin outcome score (HAGOS) was used to assess the severity of hip and groin injuries.Results: The hip/groin (17%), knee (14%), and ankle (12%) were the most frequent non-time-loss injury locations. The ankle (22%), knee (18%), hamstring (11%), thigh (10%), and hip/groin (9%) were the most common time-loss injury locations. The previous season prevalence of total injury was 93%, of which non-time-loss injury was 63% and time-loss injury was 37%. The prevalence of hip/groin injury was 40%, non-time-loss hip/groin injury was 36% and time-loss hip/groin injury was 11%. The preseason prevalence of hip/groin injury was 27%, non-time-loss hip/groin injury was 25%, and time-loss hip/groin injury was 4%. Players with longstanding hip/groin injury (> 28 days) in the previous season had lower HAGOS scores at the next preseason than players with short-term (1-7 days) or no hip/groin injury (p < 0.001). From all players with hip/groin injury from the previous season, 52% also sustained hip/groin injury in the following preseason, of which 73% were recurrent and 27% were chronic hip/groin injuries.Conclusion: Injury risk, and especially non-time-loss hip and groin injury risk, is high in female amateur football. Three-quarters of the players with longstanding hip and groin injuries in the previous season have residual problems at the start of the following season.Level Of Evidence: II. [ABSTRACT FROM AUTHOR] more...

The aim of this review is to (1) examine the current literature encompassing exercise therapy as an effective treatment strategy for athletic groin pain and (2) provide practitioners with appropriate guidelines for best rehabilitation and return-to-play. Therapeutic exercise as a conservative treatment strategy for athletic groin pain has long been acknowledged, however there is lack of quality evidence suggesting appropriate guidelines for rehabilitation. Despite several studies recognising reduced return-to-play durations, description of exercise duration and volume at staged milestones in the treatment and rehabilitation of the condition is lacking. MEDLINE, SPORTDiscus, EBSCOHOST and Google Scholar were searched for articles describing the effects of exercise therapy on athletic groin pain in athletes. Studies pertaining to other treatment protocols such as surgery, dextrose prolotherapy and corticosteroid injections were excluded. The search produced 10 articles that met the search criteria. Exercise protocols and outcome measures varied significantly across studies. A staged progressive strengthening program with distinct milestones for each phase of rehabilitation, with a progressive shift from static to dynamic strengthening exercises, including low intensity to high intensity running integration was a consistent theme. Specific strengthening of the adductor, abdominal and hip musculature has been recognised as essential aspects of rehabilitation. Towards the latter stages of rehabilitation (end-phase), sport specific exercises including both tactical and technical components, such as decisional change of direction and player contact drills are essential. From the information provided by the included articles, a staged progressive treatment protocol using therapeutic exercise, including a video example of potential exercises for each stage, has been developed. [ABSTRACT FROM AUTHOR] more...

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BACKGROUND: Groin injury and groin symptoms are common in soccer players. The relationship of groin injury and groin symptoms to reduced hip range of motion (ROM) and previous injury is unclear. OBJECTIVES: To conduct a retrospective assessment of associations between previous injury and preseason hip ROM and preseason prevalence of severe groin symptoms, and to prospectively identify risk factors for within-season groin injury. METHODS: During the period of 2015 to 2016, 190 players from 9 Dutch professional soccer clubs participated in this cohort study with prospective and retrospective elements. Univariate and multivariate logistic regressions were used to predict preseason severe groin symptoms, identified using the Copenhagen Hip and Groin Outcome Score, from a history of previous groin injury, general injury (minimum of 1 week in duration) in the previous season, and hip ROM. Cox regression was used to predict within-season groin injury. RESULTS: Point prevalence of severe groin symptoms was 24% and within-season incidence of groin injury was 11%. Total, training, and match groin injury incidences were 0.5, 0.2, and 2.6 injuries per 1000 playing hours, respectively. A history of more than 1 previous groin injury was associated with current severe groin symptoms (odds ratio = 3.0; 95% confidence interval: 1.0, 8.3; P = .038). General injury sustained in the previous season (ankle, knee, thigh, shoulder; median, 9 weeks of time loss) was a risk factor for groin injury (hazard ratio = 5.1; 95% confidence interval: 1.8, 14.6; P = .003). U UCONCLUSION: Severe injuries in the previous season to locations other than the groin increase the risk of groin injury the next season. A history of groin injury is associated with current severe groin symptoms. Preseason hip ROM does not identify players at risk for groin injury. U ULEVEL OF EVIDENCE: Prevention, level 2b. [ABSTRACT FROM AUTHOR] more...

Acute adductor injuries account for the majority of acute groin injuries; however, little is known about specific injury characteristics, which could be important for the understanding of etiology and management of these injuries. The study aim was to describe acute adductor injuries in athletes using magnetic resonance imaging (MRI). Male athletes with acute groin pain and an MRI confirmed acute adductor muscle injury were prospectively included. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. 156 athletes presented with acute groin pain of which 71 athletes were included, median age 27 years (range 18‐37). There were 46 isolated muscle injuries and 25 athletes with multiple adductor injuries. In total, 111 acute adductor muscle injuries were recorded; 62 adductor longus, 18 adductor brevis, 17 pectineus, 9 obturator externus, 4 gracilis, and 1 adductor magnus injury. Adductor longus injuries occurred at three main injury locations; proximal insertion (26%), intramuscular musculo‐tendinous junction (MTJ) of the proximal tendon (26%) and the MTJ of the distal tendon (37%). Intramuscular tendon injury was seen in one case. At the proximal insertion, 12 of 16 injuries were complete avulsions. This study shows that acute adductor injuries generally occur in isolation from other muscle groups. Adductor longus is the most frequently injured muscle in isolation and in combination with other adductor muscle injuries. Three characteristic adductor longus injury locations were observed on MRI, with avulsion injuries accounting for three‐quarters of injuries at the proximal insertion, and intramuscular tendon injury was uncommon. [ABSTRACT FROM AUTHOR] more...

Hip flexor injuries account for one‐third of acute groin injuries; however, little is known about specific injury characteristics. The aims of this study were to describe acute hip flexor injuries using magnetic resonance imaging (MRI) in athletes with acute groin pain and to compare specific muscle injuries with reported injury situations. Male athletes with acute groin pain were prospectively and consecutively included during three sports seasons. MRI was performed within 7 days of injury using a standardized protocol and a reliable assessment approach. All athletes with an MRI confirmed acute hip flexor muscle injury were included. A total of 156 athletes presented with acute groin pain of which 33 athletes were included, median age 26 years (range 18‐35). There were 16 rectus femoris, 12 iliacus, 7 psoas major, 4 sartorius, and 1 tensor fascia latae injury. Rectus femoris injuries primarily occurred during kicking (10) and sprinting (4), whereas iliacus injuries most frequently occurred during change of direction (5). In 10 (63%) rectus femoris injuries, tendinous injury was observed. The iliacus and psoas major injuries were mainly observed at the musculotendinous junction (MTJ), and two included tendinous injury. We have illustrated specific injury locations within these muscles, which may be relevant for the clinical diagnosis and prognosis of these injuries. Most proximal rectus femoris injuries included tendinous injury. In contrast, distinct acute iliacus and psoas injuries predominantly occurred at the MTJ. Only the iliacus or psoas major were injured during change of direction, whereas rectus femoris injuries occurred primarily during kicking and sprinting. [ABSTRACT FROM AUTHOR] more...

Background: The majority of surveillance studies in soccer have used a time-loss injury definition, and many groin problems result from overuse, leading to gradually increasing pain and/or reduced performance without necessarily causing an absence from soccer training or match play. Thus, the magnitude of groin problems in soccer has probably been underestimated in previous studies based on traditional injury surveillance methods. Purpose: To investigate the prevalence of groin problems among soccer players of both sexes and among male soccer players at different levels of play through a new surveillance method developed to capture acute and overuse problems. Study Design: Descriptive epidemiology study. Methods: We registered groin problems during a 6-week period of match congestion using the Oslo Sports Trauma Research Center Overuse Injury Questionnaire. A total of 240 players from 15 teams across different levels of play and from both sexes were included, and they responded to the weekly questionnaire. We calculated the average weekly prevalence of all groin problems and substantial groin problems. Results: Of the 240 players, 112 male players (59%) and 20 female players (45%) reported at least 1 episode of groin problems. The average weekly prevalence of any groin problem and substantial groin problem for all male players was 29% (range, 23%-32% across different levels) and 10% (7%-13%), respectively. Elite male players had an increased risk of experiencing groin problems (odds ratio: 3.1, 95% CI: 1.5-6.4, P = .03) compared with elite female players. There was no difference in the risk of experiencing groin problems among elite, subelite, and amateur male players. For substantial problems, there was no difference between elite male and elite female players or among levels of play for senior male soccer players. Conclusion: We found a high prevalence of groin problems among male soccer players during a period with match congestion. Time-loss definition as used in previous injury surveillance studies captured only one-third of the male groin problems registered with the new method. Elite male players had 3 times’ higher risk of reporting groin problems as compared with elite female players, while playing level did not influence the risk of reporting a groin problem among males. [ABSTRACT FROM AUTHOR] more...

Purpose: This study aimed to evaluate patient-reported outcomes as well as lower extremity and trunk muscle function in patients with long-standing hip and groin pain, in comparison with matched, healthy controls. It was hypothesized that patients with long-standing hip and groin pain would report more deficiency on the Copenhagen Hip and Groin Outcome Score (HAGOS) and have worse outcomes on performance-based measures than healthy controls.Methods: Nineteen patients with long-standing hip and groin pain and 19 healthy, activity level-, age-, gender-, and weight-matched controls were assessed with the HAGOS for self-reported outcomes, and a parallel squat (w/kg), single-leg triple jump (cm), single-leg rise (n), barbell roll-out (% of height), and plank test (s) for performance-based measures. Independent sample t test was performed to assess between-group differences. The paired t test was used to analyse between-limb differences in unilateral performance tasks.Results: The patients had worse scores than the controls in all HAGOS subscales (p ≤ 0.001), while no statistically significant differences were observed for any performance measure between groups or between symptomatic and non-symptomatic limbs.Conclusions: Despite significant self-reported functional limitations on the HAGOS, there were no significant differences between groups in performance-based strength or power measures. The results of this study highlight the need to identify performance-based measures, sensitive to functional deficiencies in patients with long-standing hip and groin pain in order to complement the clinical picture obtained by patient-reported outcomes such as the HAGOS.Level Of Evidence: III. [ABSTRACT FROM AUTHOR] more...

Introduction: Athletic groin pain requiring surgery remains a diagnostic and therapeutic challenge. This systematic review aims to identify the most common causes of groin pain in athletes requiring surgery. Additionally, it aims to further characterise their susceptible athlete profiles, common physical examination and imaging techniques, and surgical procedures performed. This will enable the orthopaedic sports medicine clinician/surgeon to best treat these patients.Materials and Methods: The electronic databases MEDLINE, PubMed and EMBASE were searched from database inception to 13 August 2014 for studies in the English language that addressed athletic groin pain necessitating surgery. The search was updated on 4 August 2015 to find any articles published after the original search. The studies were systematically screened and data were abstracted in duplicate, with descriptive data presented.Results: A total of 73 articles were included within our study, with data from 4655 patients abstracted. Overall, intra-articular and extra-articular causes of groin pain in athletes requiring surgery were equal. The top five causes for pain were: femoroacetabular impingement (FAI) (32%), athletic pubalgia (24%), adductor-related pathology (12%), inguinal pathology (10%) and labral pathology (5%), with 35% of this labral pathology specifically attributed to FAI.Conclusions: Given the complex anatomy, equal intra-articular and extra-articular contribution, and potential for overlap of clinical entities causing groin pain leading to surgery in athletes, further studies are required to ascertain the finer details regarding specific exam manoeuvres, imaging views and surgical outcomes to best treat this patient population. [ABSTRACT FROM AUTHOR] more...

Context: Groin pain is a common entity in athletes involved in sports that require acute cutting, pivoting, or kicking such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. It is considered an overuse injury predisposing to disruption of the rectus tendon insertion to the pubis and weakness of the posterior inguinal wall without a clinically detectable hernia. These patients often require surgical therapy after failure of nonoperative measures. A variety of surgical options have been used, and most patients improve and return to high-level competition.Evidence Acquisition: PubMed databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms groin pain, sports hernia, athletic pubalgia, adductor strain, osteitis pubis, stress fractures, femoroacetabular impingement, and labral tears.Study Design: Clinical review.Level Of Evidence: Level 4.Results and Conclusion: Athletic pubalgia is an overuse injury involving a weakness in the rectus abdominis insertion or posterior inguinal wall of the lower abdomen caused by acute or repetitive injury of the structure. A variety of surgical options have been reported with successful outcomes, with high rates of return to the sport in the majority of cases. [ABSTRACT FROM AUTHOR] more...

Background: Athletic groin pain remains a common field-based team sports time-loss injury. There are few reports of non-surgically managed cohorts with athletic groin pain.Aim: bold>To describe clinical presentation/examination, MRI findings and patient-reported outcome (PRO) scores for an athletic groin pain cohort.Methods: All patients had a history including demographics, injury duration, sport played and standardised clinical examination. All patients underwent MRI and PRO score to assess recovery. A clinical diagnosis of the injured anatomical structure was made based on these findings. Statistical assessment of the reliability of accepted standard investigations undertaken in making an anatomical diagnosis was performed.Result: 382 consecutive athletic groin pain patients, all male, enrolled. Median time in pain at presentation was (IQR) 36 (16-75) weeks. Most (91%) played field-based ball-sports. Injury to the pubic aponeurosis (PA) 240 (62.8%) was the most common diagnosis. This was followed by injuries to the hip in 81 (21.2%) and adductors in 56 (14.7%) cases. The adductor squeeze test (90° hip flexion) was sensitive (85.4%) but not specific for the pubic aponeurosis and adductor pathology (negative likelihood ratio 1.95). Analysed in series, positive MRI findings and tenderness of the pubic aponeurosis had a 92.8% post-test probability.Conclusions: In this largest cohort of patients with athletic groin pain combining clinical and MRI diagnostics there was a 63% prevalence of PA injury. The adductor squeeze test was sensitive for athletic groin pain, but not specific individual pathologies. MRI improved diagnostic post-test probability. No hernia or incipient hernia was diagnosed.Clinical Trial Registration Number: NCT02437942. [ABSTRACT FROM AUTHOR] more...

Purpose: Chronic pain of the inguino-crural region or "pubalgia" explains the 0.5-6.2% of the consultations by athletes. Recently, areas of weakness in the posterior wall called "sports hernias," have been identified in some of these patients, capable of producing long-standing pain. Several authors use different image methods (CT, MRI, ultrasound) to identify the lesion and various techniques of repair, by open or laparoscopic approaches, have been proposed but there is no evidence about the superiority of one over others due to the difficulty for randomizing these patients. In our experience, diagnosis was based on clinical and ultrasound findings followed by laparoscopic exploration to confirm and repair the injury. The present study aims to assess the performance of our diagnostic and therapeutic management in a series of athletes affected by "pubalgia".Methods: 1450 athletes coming from the orthopedic office of a sport medicine center were evaluated. In 590 of them (414 amateur and 176 professionals) sports hernias were diagnosed through physical examination and ultrasound. We performed laparoscopic "TAPP" repair and, thirty days after, an assessment was performed to determine the evolution of pain and the degree of physical activity as a sign of the functional outcome. We used the U Mann-Whitney test for continuous scale variables and the chi-square test for dichotomous variables with p < 0.05 as a level of significance.Results: In 573 patients ultrasound examination detected some protrusion of the posterior wall with normal or minimally dilated inguinal rings, which in 498 of them coincided with areas affected by pain. These findings were confirmed by laparoscopic exploration that also diagnosed associated contralateral (30.1%) and ipsilateral defects, resulting in a total of 1006 hernias. We found 84 "sport hernias" in 769 patients with previous diagnosis of adductor muscle strain (10.92%); on the other hand, in 127 (21.52%) of our patients with "sport hernias" US detected concomitant injuries of the adductor longus tendon, 7 of which merited additional surgical maneuvers (partial tenotomy). Compared with the findings of laparoscopy, ultrasound had a sensitivity of 95.42% and a specificity of 100%; the positive and negative predictive values were 100 and 99.4% respectively. No postoperative complications were reported. Only seven patients suffered recurrence of pain (successful rate: 98.81%); the ultrasound ruled out hernia recurrence, but in three cases it diagnosed tendinitis of the rectus abdominis muscle.Conclusions: Our series reflects the multidisciplinary approach performed in a sports medicine center in which patients are initially evaluated by orthopedic surgeons in order to discard the most common causes of "pubalgia". "Sports hernias" are often associated with adductor muscle strains and other injuries of the groin allowing speculate that these respond to a common mechanism of production. We believe that, considering the difficulty to design randomized trials, only a high coincidence among the diagnostic and therapeutic instances can ensure a rational health care. [ABSTRACT FROM AUTHOR] more...

Background Sport-related pubalgia is often a diagnostic challenge in elite athletes. While scientific attention has focused on adults, there is little data on adolescents. Cadaveric and imaging studies identify a secondary ossification centre located along the anteromedial corner of pubis beneath the insertions of symphysial joint capsule and adductor longus tendon. Little is known about this apophysis and its response to chronic stress. Aim We report pubic apophysitis as a clinically relevant entity in adolescent athletes. Methods The clinical and imaging findings in 26 highly trained adolescent football players (15.6 years ±1.3) who complained of adductor-related groin pain were reviewed. The imaging features (X-ray 26/26, US 9/26, MRI 11/26, CT 7/26) of the pubic apophyses in this symptomatic group were compared against those of a comparison group of 31 male patients (age range 9-30 years) with no known history of groin pain or pelvic trauma, who underwent pelvic CT scans for unrelated medical reasons. Results All symptomatic subjects presented with similar history and physical findings. The CT scans of these patients demonstrated open pubic apophyses with stress-related physeal changes (widening, asymmetry and small rounded cyst-like expansions) that were not observed in the comparison group. No comparison subject demonstrated apophyseal maturity before 21 years of age, and immaturity was seen up to the age of 26 years. Conclusions This retrospective case series identifies pubic apophyseal stress (or 'apophysitis') as an important differential consideration in the adolescent athlete who presents with groin pain. [ABSTRACT FROM AUTHOR] more...

Background Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area. Aim The 'Doha agreement meeting on terminology and definitions in groin pain in athletes' was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions. Methods A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting. Results Unanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes: 1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain. 2. Hip-related groin pain. 3. Other causes of groin pain in athletes. The definitions are included in this paper. Conclusions The Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research. [ABSTRACT FROM AUTHOR] more...

Groin pain in athletes is a priority area for sports physiotherapy and sports medicine research. Heterogeneous studies with low methodological quality dominate research related to groin pain in athletes. Low-quality studies undermine the external validity of research findings and limit the ability to generalise findings to the target patient population. Minimum reporting standards for research on groin pain in athletes are overdue. We propose a set of minimum reporting standards based on best available evidence to be utilised in future research on groin pain in athletes. Minimum reporting standards are provided in relation to: (1) study methodology, (2) study participants and injury history, (3) clinical examination, (4) clinical assessment and (5) radiology. Adherence to these minimum reporting standards will strengthen the quality and transparency of research conducted on groin pain in athletes. This will allow an easier comparison of outcomes across studies in the future. [ABSTRACT FROM AUTHOR] more...

Background Groin pain in athletes occurs frequently and can be dif cult to treat, which may partly be due to ? the lack of agreement on diagnostic terminology. Objective To perform a short Delphi survey on terminology agreement for groin pain in athletes by a group of experts. Methods A selected number of experts were invited to participate in a Delphi questionnaire. The study coordinator sent a questionnaire, which consisted of demographic questions and two 'real-life' case reports of athletes with groin pain. The experts were asked to complete the questionnaire and to provide the most likely diagnosis for each case. Questionnaire responses were analysed by an independent researcher. The Cohen's κ statistic was used to evaluate the level of agreement between the diagnostic terms provided by the experts. Results Twenty-three experts participated (96% of those invited). For case 1, experts provided 9 different terms to describe the most likely diagnosis; for case 2, 11 different terms were provided to describe the most likely diagnosis. With respect to the terms provided for the most likely diagnosis, the Cohen's κ was 0.06 and 0.002 for case 1 and 2, respectively. This heterogeneous taxonomy reflects only a slight agreement between the various diagnostic terms provided by the selected experts. Conclusions This short Delphi survey of two 'typical, straightforward' cases demonstrated major inconsistencies in the diagnostic terminology used by experts for groin pain in athletes. These results underscore the need for consensus on definitions and terminology on groin pain in athletes. [ABSTRACT FROM AUTHOR] more...

Background: Groin injuries are troublesome in men's and women's football.Aim: To review the literature on the epidemiology of groin injury in senior football and compare injury occurrence between sexes.Methods: Studies were identified through a search of PubMed, EMBASE, CINAHL and Web of Science, in the reference lists of the selected articles and the authors' bibliographies. The number of injuries, percentage of groin injury from all injuries and rate of groin injury per 1000 h were extracted. Exposure and injury data were aggregated across included studies and the absolute differences in groin injury proportion and rate of groin injury were compared between sexes. Risk of bias was assessed using a 5-item checklist.Results: 34 articles met the study criteria and were included. The proportion of groin injury in club-seasonal football was 4-19% in men and 2-14% in women. Aggregated data analysis (29 studies) showed a higher relative proportion of groin injury in men than in women (12.8% vs 6.9%, absolute difference 5.9%, 95% CI 4.6% to 7.1%). The rate of groin injury varied from 0.2 to 2.1/1000 h in men and 0.1 to 0.6/1000 h in women's club football, and aggregated analysis (23 studies) showed a more than two-fold higher rate in men (0.83/1000 h vs 0.35/1000 h, rate ratio 2.4, 95% CI 2.0 to 2.9). High risk of bias was identified for participant selection (18 studies), exposure (17 studies) and precision estimate (16 studies).Conclusions: Groin injuries are frequent in senior football and are more common in men than women. Future research needs to be of higher quality. [ABSTRACT FROM AUTHOR] more...

Background Hip and groin injuries are common in many sports. Understanding the factors differentiating athletes with hip/groin pain from those without these injuries could facilitate management and prevention. Objective Conduct a systematic review and meta-analysis of the literature on factors differentiating athletes with and without hip/groin pain. Methods The review was registered as PROSPERO CRD42014007416 and a comprehensive, systematic search was conducted in June 2014. Inclusion criteria were: cross-sectional, cohort or case-control study designs of n>10 that examined outcome measures differentiating athletes with and without hip/groin pain. Two authors independently screened search results, assessed study quality, and performed data extraction. Methodological heterogeneity was determined and data pooled for meta-analysis when appropriate. A best evidence synthesis was performed on the remaining outcome measures. Results Of 2251 titles identified, 17 articles were included of which 10 were high quality. Sixty two different outcome measures were examined, 8 underwent meta-analysis. Pooled data showed strong evidence that athletes with hip/groin pain demonstrated: pain and lower strength on the adductor squeeze test, reduced range of motion in hip internal rotation and bent knee fall out; however, hip external rotation range was equivalent to controls. Strong evidence was found that lower patient-reported outcome (PRO) scores, altered trunk muscle function, and moderate evidence of bone oedema and secondary cleft sign were associated with hip/groin pain. Conclusions PROs, pain and reduced strength on the adductor squeeze test, reduced range of motion in internal rotation and bent knee fall out are the outcome measures that best differentiate athletes with hip/groin pain from those without this pain. [ABSTRACT FROM AUTHOR] more...

Objectives: No single aetiological factor has been proven to cause long-standing groin pain in athletes and no sole operative technique (either open or laparoscopic) has been shown to be the preferred method of repair. The aim of this systematic review was to determine whether there are any differences in the return to full sporting activity following laparoscopic repair of groin pain in athletes.Data Sources: The minimal access approaches include laparoscopic transabdominal pre-peritoneal (TAPP) or endoscopic total extraperitoneal (TEP) techniques. A systematic literature search was performed in PubMed, SCOPUS, UpToDate and the Cochrane Library databases. Series reporting laparoscopic repair (TAPP/TEP) of groin pain in adult (>18 years) athletes were included. The primary outcome was return to full sporting activity and secondary outcomes included percentage success rates and complications of operations.Results: Only 18 studies fulfilled the search criteria with both laparoscopic and sports hernia repairs. The studies were mainly observational with some reporting comparative data, but no large randomised controlled trials were detected. The median return to sporting activity of 4 weeks (28 days) was the same for the TAPP as well as TEP techniques. No real difference in secondary outcome measures was shown. More reported cases to date in the literature used the TAPP technique compared with TEP repair (n=605 vs n=266).Conclusions: Laparoscopic surgery for elite athlete groin pain is increasingly becoming more common with almost 1000 patients reported since 1997. No particular laparoscopic technique appears to offer any advantage over the other. [ABSTRACT FROM AUTHOR] more...

Introduction The aim was to produce a multidisciplinary consensus to determine the current position on the nomenclature, definition, diagnosis, imaging modalities and management of Sportsman's groin (SG). Methods Experts in the diagnosis and management of SG were invited to participate in a consensus conference held by the British Hernia Society in Manchester, UK on 11-12 October 2012. Experts included a physiotherapist, a musculoskeletal radiologist and surgeons with a proven track record of expertise in this field. Presentations detailing scientific as well as outcome data from their own experiences were given. Records were made of the presentations with specific areas debated openly. Results The term 'inguinal disruption' (ID) was agreed as the preferred nomenclature with the term 'Sportsman's hernia' or 'groin' rejected, as no true hernia exists. There was an overwhelming agreement of opinion that there was abnormal tension in the groin, particularly around the inguinal ligament attachment. Other common findings included the possibility of external oblique disruption with consequent small tears noted as well as some oedema of the tissues. A multidisciplinary approach with tailored physiotherapy as the initial treatment was recommended with any surgery involving releasing the tension in the inguinal canal by various techniques and reinforcing it with a mesh or suture repair. A national registry should be developed for all athletes undergoing surgery. Conclusions ID is a common condition where no true hernia exists. It should be managed through a multidisciplinary approach to ensure consistent standards and outcomes are achieved. [ABSTRACT FROM AUTHOR] more...

Introduction Exercise programmes are used in the prevention and treatment of adductor-related groin injuries in soccer; however, there is a lack of knowledge concerning the intensity of frequently used exercises. Objective Primarily to investigate muscle activity of adductor longus during six traditional and two new hip adduction exercises. Additionally, to analyse muscle activation of gluteals and abdominals. Materials and methods 40 healthy male elite soccer players, training >5 h a week, participated in the study. Muscle activity using surface electromyography (sEMG) was measured bilaterally for the adductor longus during eight hip adduction strengthening exercises and peak EMG was normalised (nEMG) using an isometric maximal voluntary contraction (MVC) as reference. Furthermore, muscle activation of the gluteus medius, rectus abdominis and the external abdominal obliques was analysed during the exercises. Results There were large differences in peak nEMG of the adductor longus between the exercises, with values ranging from 14% to 108% nEMG (p<0.0001). There was a significant difference between legs in three of the eight exercises (35-48%, p<0.0001). The peak nEMG results for the gluteals and the abdominals showed relatively low values (5-48% nEMG, p<0.001). Conclusions Specific hip adduction exercises can be graded by exercise intensity providing athletes and therapists with the knowledge to select appropriate exercises during different phases of prevention and treatment of groin injuries. The Copenhagen Adduction and the hip adduction with an elastic band are dynamic high-intensity exercises, which can easily be performed at any training facility and could therefore be relevant to include in future prevention and treatment programmes. [ABSTRACT FROM AUTHOR] more...

The article discusses a study which compared the clinical outcomes of the minimal repair technique with the traditional modified Bassini repair for sports hernia. The study involved 14 patients who underwent the modified Bassini repair and a second group of patients who underwent the minimal repair technique. The researchers concluded that the minimal repair technique was superior to the modified Bassini repair. more...

Purpose: Groin injuries and chronic pain are relatively common in soccer and other contact sports. Our aim was to define the gender-related frequency of both acute and chronic groin injuries in soccer compared to non-contact endurance sports. Methods: A 12-month study of 613 professional athletes was conducted in 2006. Premier league soccer players (77 males and 90 females) answered retrospectively 70 multi-choice questions of sport injuries. Factors related to groin injuries were compared with corresponding data of elite-level swimmers ( n = 154), long-distance runners ( n = 143) and cross-country skiers ( n = 149). Results: In soccer, 125/167 players had 375 injuries (274 acute and 101 overuse injuries) and the number of acute injuries were 146/274 (53%) in males and 128/274 (47%) in females ( p = 0.368). Acute groin injury was reported in 15/167 (9.0%) of elite soccer players compared to 3/154 (2.0%) in swimmers ( p = 0.006) and 1.4% in both long-distance running ( n = 2) and skiing ( n = 2, p = 0.003). Male soccer players had acute groin injuries nearly three times more frequently than females. Chronic persistent groin pain was found in only one male and two female soccer players and no athletes in endurance sports. Conclusions: Almost every tenth soccer player had an acute groin injury. Long-standing groin pain was not frequent in soccer and it was not found in non-contact endurance sport at the elite-level. [ABSTRACT FROM AUTHOR] more...

Objective A decreased range of motion (ROM) of the hip joint is known to predispose to athletic groin injury. Femoroacetabular impingement (FAI) of the hip leads to a reduced ROM. This study examined the prevalence of radiological signs of FAI in patients presenting with long-standing adductor-related groin pain (LSARGP). Design Prospective case series. Setting Outpatient Sports Medicine Department. Patients 34 athletes with LSARGP defined as pain on palpation of the proximal insertion of adductor muscle and a painful, resisted adduction test. Assessment A clinician blinded to the results of the radiological assessment performed a physical examination: iliopsoas length, hip ROM and anterior hip impingement test. Anteroposterior pelvic radiographs were examined by a second blinded clinician for the presence of: pistol grip deformity, centrum-collum-diaphyseal angle, femoral head neck ratio, coxa profunda, protrusio acetabuli, lateral centre edge angle, acetabular index and cross-over sign. Results The prevalence of radiological signs of FAI was 94% (64/68). The mean number of radiological signs in hips with LSARGP was 1.84 (range 0–4, SD 1.05) and 1.96 (range 0–5, SD 1.12) in asymptomatic groins (p=0.95). The anterior hip impingement test was positive in nine cases. There was no relationship with the number of radiological signs (p=0.95). There was no correlation between hip ROM and the number of radiological signs (p=0.37). Conclusion Radiological signs of FAI are frequently observed in patients presenting with LSARGP. Clinicians should be aware of this fact and the possible lack of correlation when assessing athletes with groin pain. [ABSTRACT FROM PUBLISHER] more...

The article examines the magnetic resonance imaging results of the most common causes of groin pain or athletic pubalgia in professional hockey players in the National Hockey League (NHL). It involves the imaging of adductor muscle injury, osteitis pubis, and prehernia complex. It concludes that groin pain or athletic pubalgia in hockey players needs a large differential diagnosis which can be difficult to differentiate clinically. more...

The purpose of this study was to identify subjective complaints and objective findings in patients treated for femoroacetabular impingement (FAI). Three hundred and one arthroscopic hip surgeries were performed to treat FAI. The most frequent presenting complaint was pain, with 85% of patients reporting moderate or marked pain. The most common location of pain was the groin (81%). The average modified Harris Hip score was 58.5(range 14–100). The average sports hip outcome score was 44.0 (range 0–100). The anterior impingement test was positive in 99% of the patients. Range of motion was reduced in the injured hip. Patients who had degenerative changes in the hip had a greater reduction in range of motion. The most common symptom reported in patients with FAI was groin pain. Patient showed decreased ability to perform activities of daily living and sports. Significant decreases in hip motion were observed in operative hips compared to non-operative hips. [ABSTRACT FROM AUTHOR] more...

Background: Little data exist on the results of treatment for sports-related chronic groin injury. Hypothesis: Sports-related chronic groin injury treated with a conservative (rest) program results in a satisfactory outcome. Study Design: Case series; Level of evidence, 4. Methods: Professional Australian male football players, at the end of the playing season, had their groin injury diagnosed using specific clinical and magnetic resonance imaging (MRI) criteria. Those assessed as having a non-hip-related cause for their chronic groin injury were treated principally by 12 weeks of complete rest from active weightbearing activities. Response to treatment was assessed at different stages of rehabilitation by recording the number of athletes who had returned to playing football and the number of athletes without symptoms. Results: Twenty-seven athletes were considered to have chronic groin injury. Clinical and MRI (pubic bone marrow edema N = 26 [96%]), hyperintense line N = 25 [93%]) criteria suggested a pubic bone stress injury as diagnosis for the chronic groin injury. Eighty-nine percent of athletes returned to sport in the subsequent playing season, with 100% having returned by the second playing season after diagnosis. Forty-one percent of the athletes were without symptoms at the commencement of the following playing season, rising to 67% by the end of that playing season. Conclusions: Conservative management of athletic chronic groin injury resulted in an excellent outcome when assessed by the return to sport criterion. However, the results were only satisfactory if the criterion of ongoing symptoms after treatment was used. More research is needed to compare the efficacy of all treatments that are used in this troublesome condition. [ABSTRACT FROM AUTHOR] more...

Groin pain in athletes is not infrequently a cause of frustration and aggravation to both doctor and patient. Complaints in the groin region can prove difficult to diagnose, particularly when they are of a chronic nature. These injuries are seen more commonly in sports that require specific use (or overuse) of the proximal musculature of the thigh and lower abdominal muscles. Some of the more common sports would be soccer, skiing, hurdling, and hockey. The differential diagnosis can cover a rather broad area of possibilities. Most common groin injuries are soft-tissue injuries, such as muscular strains, tendinitis, or contusions. More difficult areas to pinpoint are such entities as osteitis pubis, nerve entrapment, the so-called "sports hernia," or avulsion fractures, to name but a few. The evaluation of such patients includes a familiarity with the sport and possible mechanism of injury (i.e., taking a careful history), meticulous physical examination of the groin, abdomen, hips, spine, and lower extremities. Diagnostic examinations may or may not prove helpful in formulating a final diagnosis. Some patients may be required to undergo procedures, such as laparoscopic evaluation of the region to obtain adequate information that allows a proper diagnosis and treatment plan. This article describes many of the possible causes of groin pain in athletes. The list is quite lengthy, and only the more common problems will be discussed in detail. [ABSTRACT FROM AUTHOR] more...

The article presents insights on groin injuries or inguinal disruption (ID). Topics discussed include the signs and symptoms of ID, the use of magnetic resonance imaging in diagnosis ID and studies that investigated the outcome of rehabilitation and physiotherapy for pain in the inguinal region in athletes. more...

Introduction: The Lichtenstein technique is currently one of the popular methods in practice as it provides very good results consistently. However many patients suffer from wound indurations' and chronic wound pain which are often underreported. The transinguinal preperitoneal technique (TPT) avoids these complications by placing the mesh in preperitoneal plane by open approach. Materials and Methods: In this study, 71 patients were randomized into two groups one, of which one underwent the Lichtenstein repair and the other preperitoneal repair by TPT. All the patients were followed up for two years. Results: Patients in TPT group had less pain in immediate postoperative period (p - .005), less wound induration and chronic pain on follow-up. Patients were also able to return to work early (p =0.036). Average duration of operation was slightly longer compared to Lichtenstein technique (p < .0061). There was no recurrence in either group on 2 year follow-up. Conclusion: This study shows that TPT provides a better alternative to Lichtenstein technique with decreased incidence of wound complications and chronic groin pain, while having a similar recurrence rate. Preperitoneal mesh placement by open approach in TPT is also easier and eliminates the need for laparoscopy. [ABSTRACT FROM AUTHOR] more...

The authors reflect on a study by A. Serner and colleagues on treatment of groin in athletes. Topics discussed include the controversy in the etiology of groin, an argument on the use of a single-specified surgical technique, and the importance of physiotherapy in preoperative and postoperative rehabilitation of athletes. more...