Groin pain remains a major challenge in sports medicine. The author examined 207 consecutive athletes (196 M, 11F) with groin pain using a standardised and reliable clinical examination program that focused on signs that suggest pathology in (i) the adductors, (ii) the ilipsoas, and (iii) rectus abdominis. The majority of 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 patients (10%) but it was associated with adductor related pain in 18 of these patients. Multiple clinical entities were found in 69 patients (33%); of these, 16 patients had 3 clinical entities. 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 localizing 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 possility that earlier presentation may be prudent; it is tempting to speculate that one clinical entity likely precedes others developing. These data argue for the need for a trial where clinical entities are correlated with systematic investigation including MRI and ultrasonography.
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