The diagnosis of long-standing groin pain – a prospective clinical cohort study

Christopher J Bradshaw ^1*, Michael Bundy ¹ and Eanna Falvey ²

¹ Pure Sports Medicine, United Kingdom
² Centre for Health, Exercise and Sports Medicine, University of Melbourne, Australia

^* To whom correspondence should be addressed. E-mail: candsbradshaw{at}bigpond.com.

Accepted 22 January 2008

Abstract

Background: Longstanding groin pain is a difficult diagnostic challenge for sports physicians and the lack of consensus on diagnostic criteria and taxonomy makes comparison of published studies difficult.

Aim: To determine the usefulness and validity of the clinical classification proposed by Holmich et al in a primary care sports medicine population

Design: Prospective cohort study

Setting: Private sports medicine clinic in London, England

Participants: 218 consecutive cases presenting with longstanding groin pain

Interventions: Clinical assessment, diagnostic investigations and follow up

Results: Groin pain patients (173 men, 45 women) presented from 23 sporting codes from professional athletes to the recreational exerciser. Men most commonly played soccer (22%) and rugby (21%), while women were most often runners (40%). 12 month follow-up was successful in 65% of cases; an accurate diagnosis was made in 89% of cases. Hip Pathology (50.4%) was the most common form of injury, with pubic pathology seen in 21% of cases. Pubic pathology was most often seen in kicking sports (58%), and straight-line activities most often resulted in hip pathology (39%). Those patients diagnosed with hip pathology were less likely to return to pre-morbid levels of activity than those diagnosed with pubic pathology (28% Vs 15%).

Conclusion: This series shows a different breakdown of injuries in a sporting population presenting with groin pain than previously reported. This reflects diagnostic difficulties in the area. The high incidence of hip pathology and the poor prognosis this confers are worthy of note.