Groin Injuries

Groin injuries are common in all forms of sporting endeavour, especially those in which a forceful inward movement of the hip occurs, known as hip adduction. Typical sports where this injury is more common are swimming, football, skating and hockey. Groin injuries may make up five percent of all injuries in football (soccer). Groin pain in younger people such as children and adolescents and in women can be due to more serious conditions than a simple groin sprain and should be investigated and referred on appropriately.

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 hip is the biggest of the body’s joints and it has a large range of movement. As it is exposed to the repetitive stresses of the body weight it is vulnerable to injury. There may be some stiffness of the hip which develops before a groin injury presents itself, and a limited range of motion may make a groin strain more likely. Acute groin injuries, typically muscle or tendon strains or tears, occur in conditions where the hips are moved forcefully inwards against resistance, or where a sudden splits movement could occur. More chronic injuries happen in activities where overuse of the groin muscles occurs such as running and breaststroke.

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 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 Harpenden visit his website.

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Filed under back pain by Jonathan Blood Smyth on Dec 25th, 2009.

Groin Injuries

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