Groin & Hip Quandries in Sport

(Photo credit: niallkennedy)

“This article has been adapted from a handbook, Groin & Hips: the latest international evidence, 2012, written by the author of this article, primarily for premier league football medical personnel, but also for those involved in other elite sports, in response to the controversy and lack of consensus among clinicians working in this area.

On reviewing the literature, it became clear that the best answer to these problems is prevention/pre-habilitation. An in-depth knowledge of the basic and functional anatomy of this area is critical and this encompasses the entire kinetic chain above and below the groin.

In particular, the adductor muscles are mostly neglected and are invaluable in the prevention strategy. Thus the most pertinent point is that many of the groin/hip pathologies can be averted by thorough and specific pre- habilitation. That is … treat the cause, not the symptom!

Did you know? There are:

  • 82 differential diagnoses relating to the groin; and
  • Another 41 related to the hip.

The literature review that was undertaken for the handbook, Groin & Hips: the latest international evidence was based on 240 studies and confirmed that the groin, an anatomical region where diagnosis and symptoms are often confusing, and may also represent a Bermuda Triangle for clinicians to disappear into in vortices of suppositions and assumptions.

The Fédération Internationale de Football Association (FIFA) sports physiotherapist, Dr Mario Bizzini called groin pain “The Bermuda Triangle” of sports medicine, and with good reason. There is little international consensus on diagnosis, pathophysiology, investigation or management. The diagnosis is multifactorial and there are 82 differential diagnoses relating to the groin, plus another 41 related to the hip. It is not simple.

Also, in elite sports, it is often very difficult for a doctor to diagnose accurately and thus be able to send the player to the relevant specialist who deals only with his specific area. One of the key points is to understand the entire anatomy and likely generator of pain. The importance of the two joints in the pelvis should be emphasised – the hip joint and the pubic symphysis (PS).

If one bases one’s diagnosis on this anatomy and, in particular, the functional anatomy, the whole diagnostic reasoning becomes easier.”

Source: Millson, H. (2013) Groin and Hip Quandries: The ‘Bermuda Triangle’ of Sport Medicine. SportEx.


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