Let’s be upfront here, groin pain can be a confusing – and sometimes embarrassing – problem for patients and therapist alike; its the one area you can guarantee people will tell you about early in their enquiry, almost as if they are ‘warning’ you. I mean, who wants to be poked in their groin?! (put your hand down).
There are numerous reasons why it is a particularly difficult area to unpick. Firstly, when we examine people with groin pain, the area that is painful or tender isn’t necessarily the area that is causing the problem. There may be pain referring from other structures; areas creating compensations which overload other tissues, making the groin area the fall guy, or symptom. Also, there is often more than one pathology at play – the groin/hip area is incredibly complex anatomically and biomechanically, with nothing working in isolation. Finally, there is huge amount of confusion about hip/groin pathologies.
So what are the common pathologies, and where do we start?
The most common self diagnosis (thanks, Dr Google) is a ‘Sportsman’s Hernia’. A hernia implies a lump, but actually in the case of the sportsman’s groin, it’s actually a disruption of soft tissue structures – and there is no lump. There are of course “true” hernias, such as an inguinal hernia, which typically occur in an older population as an obvious swelling in the groin. These don’t necessarily hurt unless a loop of bowel becomes entangled in it. Sportsman’s groin problems are typically over diagnosed, and tend to occur mostly in elite level, professional male footballers. These are much rarer than the general population would think.
Muscle strains to the adductor muscles (what we are brought up to call our groin muscles) are not uncommon in sports with diagonal changes of direction, such as football, rugby, hockey. Studies suggest that they for account for nearly 66% of acute groin injuries (Ref 1). The adductors are strong muscles (as strong as the glutes, according to some) and can play various roles, including hip extension. If they become fatigued, they can become tight and irritable. Something that can be easily missed or overlooked is that the longest adductor, Adductor Longus has a common insertion with Rectus Abdominus (Ref 2) which can lead to painful areas replicating hernias etc.
You may have a hip condition called femoroacetabular impingement (F.A.I.) and /or a condition that overloads the bony and soft-tissue structures at the front of the pelvis called ‘osteitis pubis’ (O.P.). There are a few symptoms that are fairly standard for these two, and they are often seen together. F.A.I. is a hip condition that will often give you pain deep in your groin, and it’s typically made achy after activity. You might also feel a pinching/clicking sensation in your groin, and it can be uncomfortable getting up from a seat – an almost ever-present complaint seems to be moving the leg out of a car. O.P. tends to give you a more central ache, in the bony part of the pelvis (pubic bone region), and it may make your adductors on the inside of your thighs feel tight or irritable. Using special tests, F.A.I. and O.P. problems can be detected and sorted out with the correct assessment (sometimes inc. scans), and can often be managed without surgery.
If you are suffering with unidentified pain in the groin, it is vital to get it checked out by an experienced therapist. Most pathologies can be managed with a structured, graded rehabilitation protocol, without the need for scans and/or surgery.
REFERENCES
Ref 2. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3666502/
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldn’t be seen as such. They are merely guides to a better understanding of how our bodies work.
For more information please visit www.dc-injuryclinic.co.uk