What causes Groin Pain?
Groin pain is very common in athletes participating in multidirectional sports, especially prevalent in football, where repetitive and forceful hip movements such as high intensity kicking and change of direction are involved. Traditionally, groin pain has been considered a difficult problem to understand, diagnose and manage because of lack of detailed scientific understanding of the underlying pathology of pain that can originate from many surrounding structures around the hip and the groin.
We commonly see either acute strains or overuse injuries related to the groin region.
Acute muscle strains occur at the junction of the muscle and the tendon whereas groin overuse injuries involve bone and tendons and their insertions of the adductor longus, rectus femoris and iliopsoas muscles.
Runners and dancers can also present with hip and groin pain often due to overuse often related to repetitive and accumulated overload.
Groin pain can be classified as: adductor-related, iliopsoas-related, inguinal-related, pubic-related related. Based on our palpation findings, response to stretching and resistance testing, we try to identify the source of pain related to these anatomical structures.
Hip-related intra-articular pathology such as femoroacetabular (FAI) syndrome can also be a possible cause of groin pain in athletes.
What causes Hip Pain?
Hip pain affects people who play sports, spend a lot of time standing and other weight-bearing activities, or sometimes spend too much time sitting down. These episodes can be acute or chronic in nature causing irritation to the soft tissue structures surrounding hip with pain referring into the pelvis and the thigh. Hip pain affects up to 23.5% of women and 8% of men between 50 and 75 years of age. The most common complaint reported is difficulty in sleeping, pain and disability affecting quality of life.
The common causes of hip pain include:
- Trochanteric bursitis
- Gluteus medius and minimus tendinopathy
- Hip osteoarthritis
Assessment of the Hip and Groin Pain
At Praxis Rehab Physiotherapy, we ensure a thorough assessment to rule out any red flags i.e. any signs and symptoms that might indicate a more serious condition. If needed, you will be referred for scans (x-ray, ultrasound and MRI) to rule out avascular necrosis, femoral neck fracture, or femoral shaft stress fracture.
A proper history-taking of your problem will help us to identify – the barriers limiting your ability to move at home/work/socially, nature and behaviour of pain, coping strategies, your concerns regarding pain, beliefs and attitudes developed over time to manage the pain, and short & long-term goals.
A detailed assessment will aim to look for any pain orsoreness in the groin, weakness, stiffness, clicking, locking, restricted hip ROM in the hip movements, functional movements, work-related and sports-specific activities such as stair-climbing, squatting, lunges, running, kicking, twisting, sudden stop-start and change of directions. We also want to screen your back and pelvis to ensure it is not the source of pain.
Most athletes with groin pain are able to continue training for several months prior to pain forcing them to discontinue their sport. Continuing to train and play with groin pain, can result in movement compensation strategies, resulting in decreased function and person. Therefore, a systematic assessment of muscle strength, joint range of motion, function, and physical performance is necessary. We also use patient-reported outcome measures to score pain, function, participation/performance, and quality of life to evaluate progress and guide the treatment plan.
Management of Hip and Groin Pain
Research has shown that exercise therapy is most effective as first-line treatment to improve pain, mobility, strength, function, neuromuscular coordination and balance. Hands-on/manual therapy such as soft tissue massage, joint mobilization, dry needling and use of therapeutic ultrasound may be integrated as additional therapy to help in the initial treatment phase. We would like to take you till the end-stage rehab and challenge you with strengthening exercises targeting different muscle groups, plyometrics and agility drills specially if it is a sports-related demand.
At Praxis Rehab Physiotherapy, we aim to derive considerable comfort and results from research that consistently demonstrates improvements in symptoms with a well-structured and graduated exercise program. We will advise you on the type, duration and dosage of exercise, modify activities if painful, calm the load down before reintroducing controlled loading and gradual progression from simple to complex hip movements.
We put great emphasis on education as an essential component of rehabilitation, and attention to lifestyle factors (smoking cessation, nutrition, stress, and sleep management) to enhance outcomes.