Groin and Hip Pain

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Groin Pain

Groin pain can be a frustrating and troublesome problem in some exercising individuals, particularly football players and those who change direction quickly whilst exercising. There are very many different diagnoses to account for it, from simple muscle strains, hip joint problems and hernias, to referred pain from the back or abdomen. The problem does not fit into a neat category or medical care such as general surgery, gynaecology or orthopaedics and your GP may lack the time or expertise to really get to the bottom of the problem. I have developed an interest over the years in order to manage these problems and through careful examination and investigation can hopefully improve the pathways of care to restore function and get you back playing as soon as possible.

A lot of money is spent in professional sport, trying to manage groin pain. There are many practitioners with a variety of treatments all trying to get expensive, well-paid professional sports players back on the field. The fact that there are so many treatments suggests that it is either not one condition or that no one treatment is effective. It is probably a combination of both.

The condition is described as  ‘a pain of insidious or acute onset, which occurs predominantly in the anterior groin area near the pubic tubercle localising to the common point of origin of the rectus abdominis muscle and the adductor longus tendon and the insertion of the inguinal ligament where no obvious other pathology, such as a hernia, exists to explain the symptoms’.

Indeed even the confusion of names given to the condition – Sportsman’s hernia, Gilmore’s groin, groin insufficiency , groin disruption – alludes to the lack of clarity surrounding the underlying cause.

The underlying reason for the condition is almost certainly a failure of some of the structures around a very complex area of load transfer when twisting and turning which is very slow to heal due to a disruption of the normal load distribution pathways.

The cause of the injury may be a combination of overuse, an acute overstretching injury and poor pelvic balance strength and stability.

The key to solving the problem lies hugely in getting the diagnosis right and looking for alternative treatable causes such as an adductor muscle strain, hip problems, hernias, nerve entrapment or a myriad of other causes.

Once established as groin disruption, the athlete may respond well to physio but surgery may be resorted to in cases where rapid return to sport is demanded. This is not without risk and needs careful consideration

Adductor muscle strain

It is important to mention this condition here as an important diagnosis of groin pain. Commonly injured through overstretching, the muscles of the inner thigh can be damaged and lead to a prolonged and protracted injury. Prompt and effective diagnosis and treatment is key to recovery.

Hip Pain

The hip joint itself can be an important cause of pain around the hip and groin and indeed is often mistaken for a groin strain as the pattern of pain commonly localises to the groin. Common causes for hip pain can include:

  • Osteoarthritis
    More commonly seen in older athletes or those who have had a problem with the structure of the hip from birth or an early age. It causes stiffness, a reduction in the range of movement and pain. Effective treatment may involve physiotherapy, injections into the joint or, as the condition progresses, surgery.
  • Labral pathology and hip impingement
    The hip joint, like the shoulder, has a rim of cartilage around it to deepen the cup. Sometimes the structure of the neck of the thigh bone (femur), the femoral head or the lip of the cup (acetabulum ) leads to a pinching or levering of the joint picner or cam deformities, which can lead to a tearing of the rim – an acetabular labral tear or damage to the joint surface.
  • Occasional isolated labral injures occur through the overstretching of the joint in the end range of movement as in a slip or fall or in sport movement involving overstretching of the joint such as martial arts or gymnastics and dance.
  • Hip stress fracture
    It is vital to identify this important condition to prevent potential disability and full blown hip fracture. Bone is constantly remodeling during exercise and there is a balance between tiny bone tissue failure and regrowth that keeps our bones healthy. If the stresses on the bone are excessive such as occurs in runners who push themselves beyond the ability of the bones to repair themselves, or whose nutrition leads to poor bone health, this can lead to the development of this condition. Offloading rest is vital to repair this condition.
  • Hamstring injuries
    Injuries to the hamstrings are common in sprinters, hurdlers, runners in general and general sports players. It can involve a prolonged rehabilitation and is prone to recurrence.  Prevention through a proper warm up,  altering sport technique and proper rehabilitation after initial injury can help prevent recurrence.
  • Quadriceps injury
    The large muscle at the front of the thigh is relatively protected from injury although there are areas where injury is more common. Part of the muscle crosses the hip, known as rectus femoris. It can get overstretched and injured and its insertion is a relatively common site of injury particularly in growing adolescent children who play a lot of sport involving explosive kicking routines.
  • Local injury to the muscle can occur in contact sports such as rugby, causing bruising to the muscle. Under certain conditions, particularly if massage has been introduced too early, an unusual transformation can occur when part of the muscle becomes bony hard – myositis ossificans. This troublesome condition eventually resolves but can be a nuisance for many months.
  • The quadriceps tendon close to the knee can occasionally become inflamed. Rest rather than injecting it is far more likely to produce favorable results in the long term.
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