Traditionally groin injuries have been the nemesis of many sportspeople causing debilitating pain and limiting performance. Sports that are particularly vulnerable to this subcategory of injury are sports that involve multi-directional movements such as cutting, change of direction, lunging and kicking. This is concerning with the football and netball season around the corner.
But do you know the great news?
Do you know that the incidence of groin pain has fallen significantly over the last ten years?
Injury surveillance statistics conducted by the AFL reports Groin strains and osteitis pubis was previously the second-most common injury, with a prevalence of 17.5 (games/club/season) in 2007; however, this had fallen to 7.1 (games/club/season) in 2015.
How are we changing the trend?
There are several reasons but ultimately it comes from a greater collective understanding of the pathology involved and how to manage it. Specifically, we are getting better at diagnosing and type-casting the anatomical sub-categories of pain and managing them accordingly. We also have a better understanding of risk factors, treatments and preventative exercises.
Anatomical Sub-categorisation of Hip and pelvic pain
In 2014, 24 of the worlds experts in groin pain met. Their discussions were to reach a consensus statement and decide where future research should be directed. As a result, one of the main outcomes was that clinical entities of pain can now be divided into specific groups (see Figure 1.).
Can you imagine how powerful it is now that clinicians and academics from all around the world can now collaborate with less confusion? This has certainly been a game-changer.
There are many factors that increase the risk of developing groin injuries in athletes. The main risk factors are:
Previous groin injury
Decreased hip and core strength – especially imbalances in strength. Physiotherapists can take objective markers to highlight strength deficits and then show you how to correct them.
Figure 2. Hip Adductor strength testing Reference: Active Force Manual
Imbalances in lower limb range of movement. Research has shown lack of hip extension and internal rotation is less favourable.
Quality of running, jumping, change of direction. Feedback through visual cues and video analysis can help you correct faulty movements.
Training loads – whether that be a sudden increase in load or lack of training. We can help with programming errors.
Load management: avoiding spikes in load, focusing on graded return to sport
Strength training: very important that there is adequate strength to match the sport-specific demands
Running/change of direction retraining: increases quality of the movement
Manual therapy: increasing range of movement and decreasing pain responses
Exercises are individualised and structured depending on the individual and the physiotherapist’s findings of their assessment (see photos below)
Examples of exercises include:
Compound exercises to build overall strength
Neuromuscular control to improve the control during running or change of direction
Accessory running drills for better efficiency
Mobility exercises to ensure that range of movement and control are improved
Just like the Nordic exercises for the hamstring, Copenhagen bridges are a very effective way of decreasing the risk of groin injuries. Like Nordics they focus on the eccentric component of exercise loading. This makes it a great exercise to target the athlete’s muscle-tendon component.
What can you do?
As American Civil Rights Activist, Maya Angelou famously quoted ‘when you know better you do better’, the same applies to managing groin pain. A skilled physiotherapist can help you know the diagnosis of your groin pain and to ensure that all of the steps of treatment are met. You will also have the correct information and guidance to progress you back to full recovery.
Jesse is a physiotherapist who also treats groin injuries particularly with his involvement with the Leopold Football Club.
Weir, A., Brukner, P., Delahunt, E., Ekstrand, J., Griffin, D., Khan, K. M., … & Paajanen, H. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British journal of sports medicine, 49(12), 768-774
Saw,R., Finch,C., Samra,D., Hope, D., and Orchard, J. (2017). Injuries in Australian Rules Football: An Overview of Injury rates, Patterns, and Mechanisms Across All Levels of Play. Sports Health, May-Jun; 10(3): 208-216