MANAGING GROIN PAIN IN ATHLETES

Background: Injuries and pain in the groin area are very common in athletes, especially in sports that involve running, cutting, change of direction or kicking. Up to 45% of athletes who compete in Australian Football have had pain in the groin at least once in their career. (Charlton et al., 2017, p. 2) Male athletes have higher prevalence of groin injuries than females.(Thorborg et al., 2018, p. 7)Groin pain can be due to acute or overuse injuries.

Purpose: Groin injuries in athletes are highly prevalent and common injuries in football. Pain can be long-lasting and chronic and therefore hard to manage. (HÖlmich et al., 2014, p. 1245) In addition sport injuries have relevant impact on the health care system in conjunction with medical costs. (Cumps et al., 2008, p. 9).The purpose of this thesis is to discover nonsurgical treatments for groin pain in athletes. What are therapeutic strategies for managing groin pain in athletes?

Methods: With the help of the PICO-scheme a topic and question were formed. A systematic literature search was done in Medline via PubMed, PEDRO and Cochrane library. 5 randomized controlled trials (RCT) and 1 before and after study were selected. Exclusion criteria involved operation and injection to the groin area. Studies included needed to have interventions that a physiotherapist can do or provide to patients. RCT's were critically appraised with the PEDro Scale.

Results: Exercise-based therapy that focused on strengthening of the muscles surrounding the hip, especially the adductor and abductor muscles was mainly performed in the studies. Compression shorts and orthosis with high targeted compression were also incorporated in 2 studies. This intervention was found to decrease overall pain in athletes. Another treatment option was shock wave therapy in combination with exercise-based therapy. Overall, most athletes had lower levels of pain and could return to sport on their prior athletic level.

Conclusion(s): In conclusion groin pain that is inguinal-, adductor-, iliopsoas, or pubic-related can be treated conservatively in men aged between 18 and 50 years old. Treatment revolved around exercise-based therapy, compression shorts and orthoses and passive modalities such as shock wave therapy and myofascial techniques. The main outcome parameter looked at was overall pain. In the studies the population that received the intervention were mostly male football athletes. 

Implications: A combination of all modalities used might be beneficial in optimizing the recovery of groin injuries in athletes. Exercise-based therapy can be done in a group session 2 to 3 times a week. Thus, sessions in the studies lasted for at least 90 minutes a reduction to 60 minutes might be favorable for non-elite level athletes if therapists do not neglect progressive overload. Exercises should focus on strengthening the hip and abdominal muscles, especially adductors and abductors. A great way to ensure progressive overload of the adductor muscles would be the Copenhagen adductor exercise. If possible, athletes should get an individualized compression short with high targeted compression. These shorts can be worn in the group session and at the beginning of return to sport to alleviate symptoms and increase pelvic stability.

Funding, acknowledgements: This review was unfunded.

Keywords: Groin Pain, Athletes, Treatment

Topic: Sport & sports injuries

Did this work require ethics approval? No

Institution: University of Applied Sciences for Health Professions Upper Austria

Committee: University of Applied Sciences for Health Professions Upper Austria

Reason: Systematic Review