Injuries to the Groin
Injuries to the groin are very frequent in many different sports, typically those where an inward movement of the hip with some force is a common action. This injury is more common in sports such as football (soccer), ice skating and hockey. Up to 5 percent of all musculoskeletal injuries in football may be of the groin area. If children, adolescents or women present with hip and groin related pain then the possibility of a more serious diagnosis rather than a muscle or tendon strain should be considered and checked for accordingly.
If children present with a limp and hip pain then particular attention should be paid to their history and examination as serious diagnoses such as slipped femoral epiphysis, Perthe’s disease, avascular necrosis of the head of the femur and septic arthritis are possible. Urgent referral to an orthopaedic specialist is required in these cases. Knee pain can be referred from the hip area so the joints around the painful areas should be examined in the consultation. Athletic adolescents who have traumatic injuries around the hip may have involvement of the hip growth plate.
The biggest joint of the body is the hip joint and it has a wide range of motion. Due to its function bearing the weight of the body and undergoing repeated activities, the hip is likely to suffer injury. Even before a groin strain occurs there may be some limitation of movement of the hip, which itself may increase the likelihood of the injury occurring. In activities where the hips are moved with some force towards the central axis of the body (hip adduction), or the splits can occur, there is an incidence of acute groin strain of the tendons or muscles. In breaststroke or running, which are potentially overuse activities, chronic strains are more common.
A groin injury can be difficult to assess as the pain areas and the type of pain described vary and can be vague. There are many medical diagnoses which can be responsible for the symptom presentation of groin pain and these need to be kept in mind. Acute injuries are common and the most prevalent is the typical groin strain, a strain of one of the many muscles running from the pelvis to the femur, maintaining the femur in the centre line under movement. Likely injuring activities include sprinting, kicking, doing the splits, running and changing direction. Sharp groin pain with some thigh radiation is typical.
The junction of where the tendon and the muscle meet is the main region of injury with bleeding from the locally ruptured muscle fibres. The formation of fibrous tissue followed by scar is the method of healing, leaving the area vulnerable to repetitive injuries, with older sports people being at higher risk than younger athletes. If the injury is severe, part of the bone can come off with the tendon, causing an avulsion injury with surgical repair being required at times. Conservative treatment is the standard management with physiotherapists employing exercise, rest and ice.
Of the inner thigh muscles which are vulnerable to groin strain the main muscle mostly affected is the adductor longus. The injury site can be where the bone and tendon join or inside the belly of the muscle. Injuries to the muscle bellies, once acute pain has settled, can be managed with gentle stretching, strengthening and returning to normal as soon as possible. Bone-tendon injuries require a slower pace of rehabilitation with resting until pain has eased, gentle exercise leading to stretching and slowly strengthening with functional activity practice in a graded programme.
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.