Assessment of Athletes with Groin Pain: Difference between revisions

No edit summary
(added the references)
Line 5: Line 5:
</div>  
</div>  
== Introduction ==
== Introduction ==
Groin pain including Groin strains are common among athletes who participate in sports with repetitive and forceful hip movement [ref] Ice hockey and various football codes have been identified as sports with high prevalence of groin injuries due to the high intensity nature [ref]. Groin injuries accounts for 14 - 19% of all injuries in male football clubs and 2 - 14% in women. [ref]
Groin pain including [[Groin Strain|groin strains]] are common among athletes who participate in sports with repetitive and forceful hip movement.<ref>Serner A, Mosler AB, Tol JL, Bahr R, Weir A. [https://pubmed.ncbi.nlm.nih.gov/30006458/ Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis. British journal of sports medicine.] 2019 Feb 1;53(3):158-64.</ref> Ice hockey and various football codes have been identified as sports with high prevalence of groin injuries due to the high intensity nature.<ref>Eckard TG, Padua DA, Dompier TP, Dalton SL, Thorborg K, Kerr ZY. [https://pubmed.ncbi.nlm.nih.gov/28745561/ Epidemiology of hip flexor and hip adductor strains in National Collegiate Athletic Association athletes, 2009/2010-2014/2015]. The American journal of sports medicine. 2017 Oct;45(12):2713-22.</ref> Groin injuries accounts for 14 - 19% of all injuries in male football clubs and 2 - 14% in women. <ref>Waldén M, Hägglund M, Ekstrand J. [https://pubmed.ncbi.nlm.nih.gov/25833901/ The epidemiology of groin injury in senior football: a systematic review of prospective studies]. British journal of sports medicine. 2015 Jun 1;49(12):792-7.</ref>


Groin pain is typically thought of as difficult to diagnose and manage[ref]. In a systematic review on the treatment of groin pain, 33 different diagnostic terms were used to describe groin pain.[ref] The poor understanding of underlying pathology and structural attachment has created confusion regarding diagnosis and terminologies [ref]. The current understanding of hip joint pathologies which causes groin pain adds up to the complexities surrounding the diagnosis of groin pain.[ref]
Groin pain is typically thought of as difficult to diagnose and manage.<ref>Hölmich P. [https://www.sciencedirect.com/science/article/abs/pii/S0949328X17301175?via%3Dihub Groin injuries in athletes–new stepping stones. Sports Orthopaedics and Traumatology]. 2017 Jun 1;33(2):106-12.</ref> In a systematic review on the treatment of groin pain, 33 different diagnostic terms were used to describe groin pain.<ref>Serner A, van Eijck CH, Beumer BR, Hölmich P, Weir A, de Vos RJ. [https://pubmed.ncbi.nlm.nih.gov/25633830/ Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes.] British journal of sports medicine. 2015 Jun 1;49(12):813-.</ref> The poor understanding of underlying pathology and structural attachment has created confusion regarding diagnosis and terminologies.<ref name=":0">Thorborg K, Hölmich P. [https://pubmed.ncbi.nlm.nih.gov/23407439/ Advancing hip and groin injury management: from eminence to evidence]. 2013</ref> The current understanding of [[Hip Anatomy|hip joint]] pathologies which causes groin pain adds up to the complexities surrounding the diagnosis of groin pain.<ref name=":0" />


However, in November 2014, an agreement meeting was held in Doha, Qatar involving experts in sports medicine. The Doha agreement meeting on terminology and definitions of  Groin pain in athletes was held to address the problem. [ref]
However, in November 2014, an agreement meeting was held in Doha, Qatar involving experts in sports medicine. The Doha agreement meeting on terminology and definitions of  Groin pain in athletes was held to address the problem. <ref name=":1">Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, Lovell G, Meyers WC, Muschaweck U, Orchard J, Paajanen H. [https://bjsm.bmj.com/content/49/12/768.short Doha agreement meeting on terminology and definitions in groin pain in athletes.] British journal of sports medicine. 2015 Jun 1;49(12):768-74.</ref>


== Assessment  ==
== Assessment  ==
The Doha agreement agreed on three (3) subheadings for classifying groin pain of athletes. [ref]
The Doha agreement agreed on three (3) subheadings for classifying groin pain of athletes. <ref name=":1" />


# Defined clinical entities for groin pain:
# Defined clinical entities for groin pain:
Line 23: Line 23:




Thorborg et al. (2018) provided a clinical framework for examination of athletes with Groin pain. The framework provides a comprehensive examination of the entire groin and hip joint region of an athlete with Groin pain. When serious pathology has been ruled out, the diagnosis can be made with focal findings on examination using the guidelines from the Doha agreement to classify the injury into 1 of the 4 clinical entities[ref]
Thorborg et al. (2018) provided a clinical framework for examination of athletes with Groin pain which is illustrated in the figure below. The framework provides a comprehensive examination of the entire groin and [[Hip Anatomy|hip joint]] region of an athlete with Groin pain. When serious pathology has been ruled out, the diagnosis can be made with focal findings on examination using the guidelines from the Doha agreement to classify the injury into 1 of the 4 clinical entities.<ref name=":2">Thorborg K, Reiman MP, Weir A, Kemp JL, Serner A, Mosler AB, Hölmich P. [https://www.jospt.org/doi/10.2519/jospt.2018.7850 Clinical examination, diagnostic imaging, and testing of athletes with groin pain: an evidence-based approach to effective management]. journal of orthopaedic & sports physical therapy. 2018 Apr;48(4):239-49.</ref>
[[File:Clinical framework for assessing groin pain.png|thumb|[[:File:Clinical framework for assessing groin pain.png|File:Clinical framework for assessing groin pain.png]]|alt=|center|600x600px]]
[[File:Clinical framework for assessing groin pain.png|thumb|[[:File:Clinical framework for assessing groin pain.png|File:Clinical framework for assessing groin pain.png]]|alt=|center|600x600px]]


==  Subjective Assessment ==
==  Subjective Assessment ==
* '''Location of pain:''' The location of pain is essential in identifying the structures involved and should be enquired from the patient. Groin pain felt more anteriorly is the thigh region indicative of the iliopsoas related groin pain. Pain located more to the proximal inner thigh is indicative of adductor related groin pain.
* '''Location of pain:''' The location of pain is essential in identifying the structures involved and should be enquired from the patient. Groin pain felt more anteriorly is the thigh region indicative of the [[Iliopsoas Tendinopathy|iliopsoas]] related groin pain. Pain located more to the proximal inner thigh is indicative of adductor related groin pain.
* '''Injury mechanism:''' change of direction, kicking,  reaching  and jumping are the common actions associated with groin injuries. [ref]
* '''Injury mechanism:''' change of direction, kicking,  reaching  and jumping are the common actions associated with groin injuries. <ref>Serner A, Mosler AB, Tol JL, Bahr R, Weir A. [https://pubmed.ncbi.nlm.nih.gov/30006458/ Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis.] British journal of sports medicine. 2019 Feb 1;53(3):158-64.</ref>
* '''Acute or gradual onset:''' Groin pain can either be of an acute onset or gradual onset and knowing how the pain developed is important in both examination and management.  
* '''Acute or gradual onset:''' Groin pain can either be of an acute onset or gradual onset and knowing how the pain developed is important in both examination and management.  
* '''Systemic symptoms:''' unexplained weight loss, fatigue, fever, painful urination and night pain should be treated with urgency and referred for further investigations.[ref]
* '''Systemic symptoms:''' unexplained weight loss, fatigue, fever, painful urination and night pain should be treated with urgency and referred for further investigations.<ref>Gabbe BJ, Bailey M, Cook JL, Makdissi M, Scase E, Ames N, Wood T, McNeil JJ, Orchard JW. T[https://pubmed.ncbi.nlm.nih.gov/19955159/ he association between hip and groin injuries in the elite junior football years and injuries sustained during elite senior competition.] British journal of sports medicine. 2010 Sep 1;44(11):799-802.</ref>


== Objective Assessment ==
== Objective Assessment ==
A groin examination classification system adapted using both the Warwick Agreement[ref] and the Doha meeting [ref] taken from Thorborg et al.(2018)
A groin examination classification system adapted using both the Warwick Agreement<ref>Griffin DR, Dickenson EJ, O'donnell J, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P. [https://bjsm.bmj.com/content/50/19/1169.short The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement.] British journal of sports medicine. 2016 Oct 1;50(19):1169-76.</ref> and the Doha meeting<ref name=":1" />  taken from Thorborg et al.(2018)<ref name=":2" />
[[File:Groin pain examination classification.png|thumb|[[:File:Groin pain examination classification.png|File:Groin pain examination classification.png]]|alt=|center|600x600px]]
[[File:Groin pain examination classification.png|thumb|[[:File:Groin pain examination classification.png|File:Groin pain examination classification.png]]|alt=|center|600x600px]]


===== '''Adductor related groin pain''' =====
===== '''Adductor related groin pain''' =====
Palpation of the adductor muscle group:
Palpation of the adductor muscle group in particular the [[Adductor Longus]]:


{{#ev:youtube|IB_zBC3Hru0|300}}
{{#ev:youtube|IB_zBC3Hru0|300}}
Line 43: Line 43:
<ref>Accessed from https://www.youtube.com/watch?v=IB_zBC3Hru0 on 18/11/2021</ref>
<ref>Accessed from https://www.youtube.com/watch?v=IB_zBC3Hru0 on 18/11/2021</ref>


Adductor groin squeeze testing :
[[Adductor Squeeze Test|Adductor groin squeeze testing ]]:


{{#ev:youtube|GwxrgZ_XgOU|300}}<ref>Accessed from https://www.youtube.com/watch?v=GwxrgZ_XgOU on 18/11/2021</ref>
{{#ev:youtube|GwxrgZ_XgOU|300}}<ref>Accessed from https://www.youtube.com/watch?v=GwxrgZ_XgOU on 18/11/2021</ref>
Line 61: Line 61:


===== '''Inguinal related groin pain''' =====
===== '''Inguinal related groin pain''' =====
Palpation of the inguinal ligament:
Palpation of the [[Inguinal Ligament|inguinal ligament]]:
{{#ev:youtube|l9th0hSBeU0|300}}
{{#ev:youtube|l9th0hSBeU0|300}}


Line 72: Line 72:


===== '''Pubic related groin pain''' =====
===== '''Pubic related groin pain''' =====
No resisted testing is described for pubis related pain and maybe be reproduced on adductor abdominal testing, how ever there may be local tenderness on the pubis symphysis and surrounding bones.  
No resisted testing is described for [[pubis]] related pain and maybe be reproduced on adductor abdominal testing, how ever there may be local tenderness on the pubis symphysis and surrounding bones.  
{{#ev:youtube|JKuBjqbzpc8|300}}
{{#ev:youtube|JKuBjqbzpc8|300}}


Revision as of 21:56, 18 November 2021

Original Editor - User Name

Top Contributors - Prince Wilson  

Introduction[edit | edit source]

Groin pain including groin strains are common among athletes who participate in sports with repetitive and forceful hip movement.[1] Ice hockey and various football codes have been identified as sports with high prevalence of groin injuries due to the high intensity nature.[2] Groin injuries accounts for 14 - 19% of all injuries in male football clubs and 2 - 14% in women. [3]

Groin pain is typically thought of as difficult to diagnose and manage.[4] In a systematic review on the treatment of groin pain, 33 different diagnostic terms were used to describe groin pain.[5] The poor understanding of underlying pathology and structural attachment has created confusion regarding diagnosis and terminologies.[6] The current understanding of hip joint pathologies which causes groin pain adds up to the complexities surrounding the diagnosis of groin pain.[6]

However, in November 2014, an agreement meeting was held in Doha, Qatar involving experts in sports medicine. The Doha agreement meeting on terminology and definitions of Groin pain in athletes was held to address the problem. [7]

Assessment[edit | edit source]

The Doha agreement agreed on three (3) subheadings for classifying groin pain of athletes. [7]

  1. Defined clinical entities for groin pain:
    1. Adductor-related
    2. Iliopsoas-related
    3. Inguinal-related
    4. Pubic-related groin pain
  2. Hip-related groin pain
  3. Other causes of groin pain in athletes


Thorborg et al. (2018) provided a clinical framework for examination of athletes with Groin pain which is illustrated in the figure below. The framework provides a comprehensive examination of the entire groin and hip joint region of an athlete with Groin pain. When serious pathology has been ruled out, the diagnosis can be made with focal findings on examination using the guidelines from the Doha agreement to classify the injury into 1 of the 4 clinical entities.[8]

File:Clinical framework for assessing groin pain.png

Subjective Assessment[edit | edit source]

  • Location of pain: The location of pain is essential in identifying the structures involved and should be enquired from the patient. Groin pain felt more anteriorly is the thigh region indicative of the iliopsoas related groin pain. Pain located more to the proximal inner thigh is indicative of adductor related groin pain.
  • Injury mechanism: change of direction, kicking, reaching and jumping are the common actions associated with groin injuries. [9]
  • Acute or gradual onset: Groin pain can either be of an acute onset or gradual onset and knowing how the pain developed is important in both examination and management.
  • Systemic symptoms: unexplained weight loss, fatigue, fever, painful urination and night pain should be treated with urgency and referred for further investigations.[10]

Objective Assessment[edit | edit source]

A groin examination classification system adapted using both the Warwick Agreement[11] and the Doha meeting[7] taken from Thorborg et al.(2018)[8]

File:Groin pain examination classification.png
Adductor related groin pain[edit | edit source]

Palpation of the adductor muscle group in particular the Adductor Longus:

[12]

Adductor groin squeeze testing :

[13]

iliopsoas related groin pain[edit | edit source]

Palpation of the iliopsoas muscle:

[14]

Resisted hip flexion test:

[15]

Inguinal related groin pain[edit | edit source]

Palpation of the inguinal ligament:

[16]

Abdominal resisted testing:

[17]

Pubic related groin pain[edit | edit source]

No resisted testing is described for pubis related pain and maybe be reproduced on adductor abdominal testing, how ever there may be local tenderness on the pubis symphysis and surrounding bones.

[18]


References[edit | edit source]

  1. ↑ Serner A, Mosler AB, Tol JL, Bahr R, Weir A. Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis. British journal of sports medicine. 2019 Feb 1;53(3):158-64.
  2. ↑ Eckard TG, Padua DA, Dompier TP, Dalton SL, Thorborg K, Kerr ZY. Epidemiology of hip flexor and hip adductor strains in National Collegiate Athletic Association athletes, 2009/2010-2014/2015. The American journal of sports medicine. 2017 Oct;45(12):2713-22.
  3. ↑ Waldén M, Hägglund M, Ekstrand J. The epidemiology of groin injury in senior football: a systematic review of prospective studies. British journal of sports medicine. 2015 Jun 1;49(12):792-7.
  4. ↑ Hölmich P. Groin injuries in athletes–new stepping stones. Sports Orthopaedics and Traumatology. 2017 Jun 1;33(2):106-12.
  5. ↑ Serner A, van Eijck CH, Beumer BR, Hölmich P, Weir A, de Vos RJ. Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. British journal of sports medicine. 2015 Jun 1;49(12):813-.
  6. ↑ 6.0 6.1 Thorborg K, Hölmich P. Advancing hip and groin injury management: from eminence to evidence. 2013
  7. ↑ 7.0 7.1 7.2 Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, Lovell G, Meyers WC, Muschaweck U, Orchard J, Paajanen H. Doha agreement meeting on terminology and definitions in groin pain in athletes. British journal of sports medicine. 2015 Jun 1;49(12):768-74.
  8. ↑ 8.0 8.1 Thorborg K, Reiman MP, Weir A, Kemp JL, Serner A, Mosler AB, Hölmich P. Clinical examination, diagnostic imaging, and testing of athletes with groin pain: an evidence-based approach to effective management. journal of orthopaedic & sports physical therapy. 2018 Apr;48(4):239-49.
  9. ↑ Serner A, Mosler AB, Tol JL, Bahr R, Weir A. Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis. British journal of sports medicine. 2019 Feb 1;53(3):158-64.
  10. ↑ Gabbe BJ, Bailey M, Cook JL, Makdissi M, Scase E, Ames N, Wood T, McNeil JJ, Orchard JW. The association between hip and groin injuries in the elite junior football years and injuries sustained during elite senior competition. British journal of sports medicine. 2010 Sep 1;44(11):799-802.
  11. ↑ Griffin DR, Dickenson EJ, O'donnell J, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British journal of sports medicine. 2016 Oct 1;50(19):1169-76.
  12. ↑ Accessed from https://www.youtube.com/watch?v=IB_zBC3Hru0 on 18/11/2021
  13. ↑ Accessed from https://www.youtube.com/watch?v=GwxrgZ_XgOU on 18/11/2021
  14. ↑ Accessed from https://www.youtube.com/watch?v=dpQhV-pCG3Q on 18/11/2021
  15. ↑ Accessed from https://www.youtube.com/watch?v=O_-Oi5uGU6I on 18/11/2021
  16. ↑ Accessed from https://www.youtube.com/watch?v=n54G5-OySKA on 18/11/2021
  17. ↑ Accessed from https://www.youtube.com/watch?v=n54G5-OySKA 0n 18/11/2021
  18. ↑ Accessed from https://www.youtube.com/watch?v=JKuBjqbzpc8 on 18/11/2021
Retrieved from "https://www.physio-pedia.com/index.php?title=Assessment_of_Athletes_with_Groin_Pain&oldid=286710"