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Groin symptoms in athletes have been likened to the Bermuda Triangle as sports physicians, orthopaedists, surgeons and therapists alike are easily sucked into a sea of confusing suppositions and assumptions.1 Possibly the greatest advance in the understanding and appreciation of ‘sports hernia’ has been the recent acknowledgment by a multidisciplinary panel of experts that there is in fact no hernia associated with the condition and they have coined the term ‘inguinal disruption’.2 Unfortunately, although the authors describe a constellation of symptoms, the label again suggests a localised pathology rather than a syndrome.
A broader focus required
As much as we concentrate our collective efforts on repairing a defect in an anatomical area or treating what we consider to be the primary area of injury, perhaps we should explore and investigate the concept that symptoms are a result of a structural failure of tissue to compensate for abnormal loads created by an imbalance of forces across the groin area. Single or multiple areas of groin injury may represent a failure of the same functional unit. The proposal of a ‘pubic joint’, distinct from the symphysis pubis, which involves numerous anatomical structures and their resultant forces at different contact sites can explain the multiple pathologies that exist in this condition. …
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