Abstract
Groin injury is among the most common cited injuries in the sports of ice hockey, soccer, Australian Rules football, calisthenics and cricket. There are very few prospective studies examining risk factors for groin strain injury in sport. There is support for an association of previous injury and greater abductor to adductor strength ratios as well as sport specificity of training and pre-season sport-specific training, as individual risk factors in groin strain injury in athletes. Core muscle weakness or delayed onset of transversus abdominal muscle recruitment may increase the risk of groin strain injury. Debate exists in the literature regarding the role of adductor strength and length as well as age and/or sport experience as risk factors for groin injury. There is no strong evidence to support a causal association for any of these risk factors and groin injury.
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References
Janda D. Prevention has everything to do with sports medicine. Clin J Sport Med 1992; 2: 159–60
van Mechelen W. Sports injury surveillance systems: one size fits all? Sports Med 1997; 24 (3): 164–8
Emery CA. Risk factors for injury in child and adolescent sport: a systematic review of the literature. Clin J Sport Med 2003; 13: 256–68
Lysens R, Steverlynk A, van den Auweele Y, et al. The predictability of sports injuries. Sports Med 1984; 12: 6–10
Meeuwisse W. Predicitability of sports injuries: what is the epidemiological evidence? Sports Med 1991; 12: 8–15
Cahill B, Griffith E. Effect of preseason conditioning on the incidence and severity of highschool football knee injuries. Am J Sports Med 1978; 6: 180–4
Dryden D, Francescutti L, Rowe B, et al. Personal risk factors associated with injury among female recreational ice hockey playplayers. J Sci Med Sport 2000; 3 (2): 140–9
Emery CA. Does decreased muscle strength cause acute muscle strain injury in sport? A systematic review of the evidence. Phys Ther Rev 1999; 4: 79–85
Pinto M, Kuhn J, Greenfield M, et al. Prospective analysis of ice hockey injuries at the Junior A level over the course of a season. Clin J Sports Med 1999; 9: 70–4
Tropp H, Ekstrand J, Gillquist J. Factors affecting stabilometry recordings of single leg stance. Am J Sports Med 1984; 12: 185–8
Tropp H, Ekstrand J, Gillquist J. Stabilometry in functional instability of the ankle and it’s value in predicting injury. Med Sci Sports Exerc 1984; 16: 64–6
Jones B, Bovee M, Harris J, et al. Intrinsic risk factors for exercise related injuries among male and female army trainees. Am J Sports Med 1993; 21: 705–10
Schick D, Meeuwisse W. Injury rates and profiles in female ice hockey players. Am J Sports Med 2003; 31 (1): 47–52
Lorentzon R, Wedren H, Pietila T. Incidences, nature, and causes of ice hockey injuries: a three year prospective study of a Swedish elite ice hockey team. Am J Sports Med 1988; 16: 392–6
Arnason A, Sigurdsson S, Gudmundsson A, et al. Risk factors for injuries in football. Am J Sports Med 2004; 32 (1 Suppl.): 5S–16
Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med (Lond) 2002; 36 (1): 39–44
Orchard J, Verrall GM. Groin injuries in the Australian Football League [online]. Available from URL: (http://www.injury-update.com.au/ISMJGroinAFL.htm) [Accessed 2006 Apr 4]
Leaf J, Keating J, Kolt G. Injury in the Australian sport of calisthenics: a prospective study. Aust J Physiother 2003; 49 (2): 123–30
Orchard J, James T, Alcott E, et al. Injuries in Australian cricket at first class level 1995/1996 to 2000/2001. Br J Sports Med 2002; 36 (4): 270–4
Leetun D, Ireland M, Willson J, et al. Core stability measures as risk factors for lower extremity injury in athletes. Med Sci Sports Exerc 2004; 36 (6): 926–34
Estwanik J, Sloane B, Rosenberg M. Causes of groin strain. Phys Sportsmed 1990; 18: 55–60
Merrifield H, Cowan R. Groin strain injuries in ice hockey. J Sports Med 1973; 1: 41–2
Smodlaka V. Groin pain in soccer players. Phys Sportsmed 1980; 8: 57–61
Parkkari J, Kujala U, Kannus P. Is it possible to prevent sports injuries? Review of controlled clinical trials and recommendations for future work. Sports Med 2001; 31 (14): 985–95
MacKay M, Scanlan A, Olsen L. Sports and recreational injury prevention strategies: systematic review and best practices executive summary. Vancouver (BC): BC Injury Research and Prevention Unit, 2001
Rothman K, Greenland S, editors. Modern epidemiology. 2nd ed. Philadelphia (PA): Lippincott–Raven Publishers, 1998: 14
Cowan S, Schache A, Brukner P, et al. Delayed onset of transversus abdominus in long-standing groin pain. Med Sci Sports Exerc 2004; 36 (12): 2040–5
Cusi MF, Juska-Butel CJ, Garlick D, et al. Lumbopelvic stability and injury profile in rugby union players. NZ J Sports Med 2001; 29 (1): 14–8
Emery C, Meeuwisse W. Risk factors for groin injuries in hockey. Med Sci Sports Exerc 2001; 33 (9): 1423–33
Grote K, Lincoln T, Gamble J. Hip adductor injury in competitive swimmers. Am J Sports Med 2004; 32 (1): 104–8
O’Connor D. Groin injuries in professional rugby league players: a prospective study. J Sports Sci 2004; 22 (7): 629–36
Orchard J, Wood T, Seward H, et al. Comparison of injuries in elite senior and junior Australian football. J Sci Med Sport 1998; 1 (2): 83–8
Tyler T, Nicholas S, Campbell R, et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med 2001; 29 (2): 124–8
Tyler T, Nicholas S, Campbell R, et al. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med 2002; 30 (5): 680–3
Witvrouw E, Danneels L, Asselman P, et al. Muscle flexibility as a risk factor for developing muscle injuries in male professional soccer players: a prospective study. Am J Sports Med 2003; 31 (1): 41–6
Hides J, Jull G, Richardson C, et al. Long-term effects of specific stabilizing exercises for first-episode low back pain. Spine 2001; 26 (11): E243–8
O’Sullivan P, Twomey L, Allison G. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolis thesis. Spine 1997; 22 (24): 2959–67
Stuge B, Laerum E, Kirkesola G, et al. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a two-year follow-up of a randomized clinical trial. Spine 2004; 29 (4): 351–9
Sim FH, Simonet WT, Melton LJ, et al. Ice hockey injuries. Am J Sports Med 1987; 15: 30–40
Shrier I. Does stretching improve performance? A systematic and critical review of the literature. Clin J Sport Med 2004; 14 (5): 267–73
Niemuth P, Johnson R, Myers M, et al. Hip muscle weakness and overuse injuries in recreational runners. Clin J Sport Med 2005; 15 (1): 14–21
Nadler S, Malanga G, Bartoli L, et al. Hip muscle imbalance and low back pain in athletes: influence of core strengthening. Med Sci Sports Exerc 2002; 34 (1): 9–16
Nadler S, Malanga G, Solomon J, et al. The relationship between lower extremity injury and the hip abductor to extensor strength ratio in collegiate athletes. J Back Musculoskeletal Rehab 2002; 16 (4): 153–8
Garrett WE, Safran MR, Seaber AV, et al. Biomechanical comparison of stimulated and nonstimulated skeletal muscle pulled to failure. Am J Sports Med 1987; 15: 448–54
Ekberg O, Persson N, Abrahamsson P. Longstanding groin pain in athletes: a multidisciplinary approach. Sports Med 1988; 6: 56–61
Meyers W, Foley D, Garrett W. Management of severe lower abdominal or inguinal pain in high-performance athletes. Am J Sports Med 2000; 28: 2–8
Williams P, Thomas D, Downes E. Osteitis pubis and instability of the pubic symphysis. Am J Sports Med 2000; 28: 350–5
Sherry M, Best T. A comparison of 2 rehabilitation programs in the treatment of acute hamstring strains. J Orthop Sports Phys Ther 2004; 34: 116–25
Holmich P, Uhskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for longstanding adductor-related groin pain in athletes: randomised trial. Lancet 1999; 353: 439–43
Worrell T. Factors associated with hamstring injuries: an approach to treatment and preventative measures. Sports Med 1994; 17: 338–45
Garrett W. Muscle strain injuries. Am J Sports Med 1996; 24: S2–8
Thacker S, Gilchrist J, Stroup D, et al. The impact of stretching on sports injury risk: a systematic review of the literature. Med Sci Sports Exerc 2004; 36 (3): 371–8
Hunter J, Marshall R. Effects of power and flexibility training on vertical jump technique. Med Sci Sports Exerc 2002; 34: 478–86
Gabbe B, Finch C, Bennell K, et al. Risk factors for hamstring injuries in community level Australian football. Br J Sports Med 2005; 39: 106–10
Verrall GM, Hamilton IA, Slavotinek JP, et al. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport 2005; 8 (1): 77–84
Mays P, McAnulty R, Campa J, et al. Age-related changes in collagen synthesis and degradation in rat tissues: importance of degradation of newly synthesized collagen in regulating collagen production. Biochem J 1991; 276 (Pt 2): 307–13
Wang X, Shen X, Li X, et al. Age-related changes in the collagen network and toughness of bone. Bone 2003; 32 (1): 107
Wang X, Li X, Shen X, et al. Age-related changes of noncalcified collagen in human cortical bone. Ann Biomed Eng 2003; 31 (11): 1365–71
Johnson M, Mille M-L, Martinez K, et al. Age-related changes in hip abductor and adductor joint torques. Arch Phys Med Rehabil 2004; 85: 593–7
Verrall G, Slavotinek J, Barnes P, et al. Clinical risk factors for hamstring muscle strain injury: a prospective study with correlation of injury by magnetic resonance imaging. Br J Sports Med (Lond) 2001; 35 (6): 435–9
Ross JJ, Hu LT. Septic arthritis of the pubic symphysis: review of 100 cases. Medicine 2003; 82 (5): 340–5
Fuller C, Ekstrand J, Junge A, et al. Consensus statement on injury definitions and data collection procedures in studies of football (soccer) injuries. Br J Sports Med 2006; 40 (3): 193–201
Acknowledgements
The authors would like to thank the University of Calgary Sport Medicine Centre for their ongoing support to do research. They also thank Diana Jorgensen and Dennis Jorgensen for all their assistance in this research. Lorrie Maffey is funded by Speed Skating Canada. Carolyn Emery is funded by the Canadian Institutes of Health Research and the Alberta Heritage Foundation for Medical Research. The authors acknowledge that they have no conflicts of interest that are directly relevant to the contents of this article.
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Maffey, L., Emery, C. What are the Risk Factors for Groin Strain Injury in Sport?. Sports Med 37, 881–894 (2007). https://doi.org/10.2165/00007256-200737100-00004
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DOI: https://doi.org/10.2165/00007256-200737100-00004