Groin Injuries
All kinds of athletic activity carry the risk of suffering from a groin strain, being more usual in sporting activities which include common and forceful hip motion towards the centre of the body (hip adduction). Ice skating, hockey, swimming and soccer (football) are sports with higher incidences of groin injuries. Groin injuries may account for up to 5% of all muscular and tendinous injuries in soccer. If hip and groin pain presents in women, adolescents or children then particular and potentially more serious diagnoses should be considered.
Children with hip pain and a limp should be thoroughly investigated as the possible diagnoses include septic arthritis, a slipped epiphysis of the upper femur, Perthe’s disease and avascular necrosis of the femoral head. Such conditions require the urgent attention of an orthopaedic surgical specialist. As pain can be referred from the hip to the knee region it is important for the surrounding joints to be assessed in the examination. In adolescent athletes the growth plate at the hip is a weaker area and may be involved in traumatic injuries.
The hip is the largest joint in the body and has an extensive range of motion. It is vulnerable to damage due to its weight bearing function and repetitive activities performed. Stiffness of the hip joint may be present some time before the incidence of a groin strain and a strain may occur more readily in the presence of reduced range. Acute groin injuries such as tears, strains or sprains of the muscles and tendons occur with forceful adduction of the hip, a movement towards the midline, or if the splits occurs accidentally. Chronic groin injuries present in activities which typically overuse the muscles, such as breaststroke and running.
Examining a person with a groin strain can be complicated as the area of pain and its nature can be vaguely described. A wide variety of conditions can present as groin pain and the physician must be aware of these. A groin strain is the most common type of acute injury to this area. There are a large number of muscles which attach to the pelvis or thigh bone in the groin area and function to hold the legs in the midline under movement. Running and changing direction quickly, kicking or doing the splits can cause this kind of injury. Sharp pain in the groin is a typical symptom and the pain can radiate down the thigh on the inside.
The typical area for a groin strain is where the muscle grades into the tendon, with fibre rupture and bleeding in the damaged area. The area heals with the formation of fibrous tissue and scar but the injured area has increased likelihood of being re-injured, with the common occurrence of repetitive injury and more injuries in older athletes. Avulsion injuries with small parts of the bone pulled away can occur in more violent injuries, with surgical fixation necessary in some severe cases. Groin strains mostly recover with conservative management and physiotherapists use ice, rest and exercise therapy.
The most commonly affected muscle in groin strains is one of the inner thigh muscles, the adductor longus. The injury can be in the belly of the muscle or at the junction of the tendon and the bone. Muscle belly injuries can be treated with gentle stretches once the acute period has settled, strengthening and getting back to activity as able. Tendon and bone injuries need a slower management programme with rest until the pain settles, gentle muscle work progressing to stretching and strengthening over a period of time and a gradual return to more stressful activities.
Other possibilities for the diagnosis of pain in the groin region include abdominal hernias, often not diagnosable by physical examination, managed conservatively to start with and then if necessary with surgical care. High energy physical events may cause fractures around the hip although older people may fracture with relatively trivial force. Severe pain and limitation of hip movements and gait should be noted and referral made if needed. Sporting activities which involve repeated impacts such as running can cause stress fractures of the pubic rami or the neck of the femur. Other conditions to consider are avulsion fractures if pain onset is quick and inflammation of a bursa.
Jonathan Blood Smyth is the Superintendent of Physiotherapy at an NHS hospital in the South-West of the UK. He writes articles about back pain, neck pain, and injury management. If you are looking for physiotherapists in Sheffield visit his website.
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