ORIGINAL ARTICLE

Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study

P Hölmich¹, L R Hölmich¹, A M Bjerg²

¹ Amager University Hospital, Copenhagen, Denmark
² Institute of Preventive Medicine, Copenhagen

Correspondence to:
Correspondence to:
Associate Professor P Hölmich
Amager University Hospital, Orthopaedic Surgery Department, Italiensvej 1, Copenhagen DK-2300 S, Denmark; per.holmich{at}ah.hosp.dk

Background: Groin pain is a diagnostic and therapeutic challenge to sports medicine. The literature provides no consensus on definitions of or diagnostic criteria for groin pain in athletes. To compare the results of research and treatments, the methods used to diagnose and evaluate the degree of groin pain must be clearly defined and reproducible.

Objectives: To describe clinical examination techniques for groin pain in athletes and evaluate the intraobserver and interobserver reliability of these.

Methods: Eighteen athletes, nine with sports related groin pain and nine without groin pain, were examined by two doctors and two physiotherapists. The examiners were trained in the examination techniques before the study. The examiners were blinded to the symptoms and identity of the subjects. The subjects were examined twice by each examiner in random order. The examinations included evaluation of adductor muscle related pain and strength, iliopsoas muscle related pain, strength, and flexibility, abdominal muscle related pain, and strength and pain at the symphysis joint. Kappa statistics and percentage of agreement were used to evaluate the data.

Results: Overall, the values and percentage of agreement were in accordance and showed good reliability of the examinations. The values for the intraobserver agreement were above 0.60 in 11 of 14 tests, and those for the interobserver agreement of the pain tests were above 0.60 in eight of 10 tests. The only test without acceptable interobserver reliability was the strength test for iliopsoas muscle.

Conclusion: All but one of the tests investigated were reproducible and subject only to limited intraobserver and interobserver variation.

Keywords: groin pain; examination; reliability; adductor muscles; iliopsoas muscle

CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

• Schilders, E., Talbot, J. C., Robinson, P., Dimitrakopoulou, A., Gibbon, W. W., Bismil, Q. (2009). Adductor-Related Groin Pain in Recreational Athletes. Role of the Adductor Enthesis, Magnetic Resonance Imaging, and Entheseal Pubic Cleft Injections. JBJS 91: 2455-2460 [Abstract] [Full Text]  
• Malliaras, P, Hogan, A, Nawrocki, A, Crossley, K, Schache, A (2009). Hip flexibility and strength measures: reliability and association with athletic groin pain. Br. J. Sports. Med. 43: 739-744 [Abstract] [Full Text]  
• Khan, K. M (2009). Another major win for physiotherapy -- curing patellofemoral pain. Br. J. Sports. Med. 43: 157-158 [Full Text]  
• Falvey, E C, Franklyn-Miller, A, McCrory, P R (2009). The groin triangle: a patho-anatomical approach to the diagnosis of chronic groin pain in athletes. Br. J. Sports. Med. 43: 213-220 [Abstract] [Full Text]  
• Caudill, P, Nyland, J, Smith, C, Yerasimides, J, Lach, J (2008). Sports hernias: a systematic literature review. Br. J. Sports. Med. 42: 954-964 [Abstract] [Full Text]  
• Schilders, E., Bismil, Q., Robinson, P., O'Connor, P. J., Gibbon, W. W., Talbot, J. C. (2007). Adductor-Related Groin Pain in Competitive Athletes. Role of Adductor Enthesis, Magnetic Resonance Imaging, and Entheseal Pubic Cleft Injections. JBJS 89: 2173-2178 [Abstract] [Full Text]  
• Holmich, P., Renstrom, P. A (2007). Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients * COMMENTARY. Br. J. Sports. Med. 41: 247-252 [Full Text]  
• (2005). Evidence based journal watch. Br. J. Sports. Med. 39: 50-51 [Full Text]