ORIGINAL ARTICLE

Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients

Per Hölmich

Correspondence to:
P Hölmich
Department of Orthopaedic Surgery, Amager University Hospital, Copenhagen DK-2300 S, Denmark; per.holmich@ah.hosp.dk

Accepted 15 January 2007

ABSTRACT

Background: Groin pain remains a major challenge in sports medicine.

Aim: To examine 207 consecutive athletes (196 men, 11 women) with groin pain using a standardised and reliable clinical examination programme that focused on signs that suggest pathology in (1) the adductors, (2) the ilopsoas and (3) the rectus abdominis.

Patients and methods: Most patients were football players (66%) and runners (18%). In this cohort, the clinical pattern consistent with adductor-related dysfunction, was the primary clinical entity in 58% of the patients and in 69% of the football players. Iliopsoas-related dysfunction was the primary clinical entity in 36% of the patients. Rectus abdominis-related dysfunction was found in 20 (10%) patients but it was associated with adductor-related pain in 18 of these patients. Multiple clinical entities were found in 69 (33%) patients; of these, 16 patients had three clinical entities.

Conclusions: These descriptive data extend previous findings that physical examination for groin pain can be reliable. While underscoring the prevalence of adductor-related physical examination abnormality in football players, the data highlight the prevalence of examination findings localising to the iliopsoas among this cohort. Also, the fact that combinations of clinical entities were present has important implications for treatment. The finding of multiple abnormal clinical entities also raises the possibility that earlier presentation may be prudent; it is tempting to speculate that one clinical entity likely precedes other developing entities. These data argue for the need for a trial where clinical entities are correlated with systematic investigation including MRI and ultrasonography.

The first 150 words of the full text of this article appear below.

Although groin pain was reported as an important athletic injury at least as early as 1980 by Renström and Peterson,¹ it remains a major challenge in contemporary sports medicine. In a prospective 2-year study of injuries among 17 male football teams,² groin injuries comprised 5% of all injuries. Ekstrand and Gillquist³ found in a study of 12 football teams over a 1-year period that 13% of all injuries were localised in the groin. The injury incidence rate was 18 groin injuries per 100 football players per year. Engström et al⁴ reported 12% groin injuries and a groin injury incidence rate of 16% in a 1-year study of 64 elite football players. Among elite female football players, Engström et al⁵ observed a groin injury incidence rate of 12%. Groin injuries are also known from other sports such as ice hockey, running, tennis, rugby, American football, basketball and others.^{6,7,8,9,10,11,12,13,14,15,16,17,18,19} No comparative prospective . . . [Full text of this article]

Per A Renström

Stockholm Center for Sports Trauma Research, Karolinksa Institute, Stockholm, Sweden; per.renstrom@ki.se

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