Injuries to the Groin
Injuries to the groin are very frequent in many different sports, typically those where an inward movement of the hip with some force is a common action. This injury is more common in sports such as football (soccer), ice skating and hockey. Up to 5 percent of all musculoskeletal injuries in football may be of the groin area. If children, adolescents or women present with hip and groin related pain then the possibility of a more serious diagnosis rather than a muscle or tendon strain should be considered and checked for accordingly.
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.
Examination of a patient with a groin injury is not simple as the pain area and the report of the pain can be imprecise. Groin pain can be caused by an extensive list of medical and other conditions which doctors need to consider. The most frequent type of acute injury to the groin is the groin strain and there are many muscles which connect the femur to the pelvis, controlling the tendency for the leg to be held in the mid line during activity. Fast changes of direction, running and sprinting, going into the splits and kicking are all potentially aggravating activities. Typical presentation is groin pain with radiation into the inner thigh.
Groin strains typically occur at the junctional area between the tendon and the muscle, with tearing of fibres and bleeding occurring. Healing occurs with fibrous tissue and scar but the area remains at higher risk of re-injury over a long period, repeat injuries being common and older players are more susceptible than younger ones. Larger injuries may even cause avulsion fractures as they pull a small amount of bone off the pelvis, with more severe injuries requiring surgical fixation. Most groin strains recover with conservative treatment and physiotherapists employ rest, ice and exercise therapy.
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 diagnoses of pain in the groin areas include hernias of the abdominal wall which are often not detectable on physical examination, with conservative treatment initially and surgical intervention if it does not settle. Hip fractures are possible in high velocity events although elderly people can fracture with much less force. Attention should be paid to the severity of the pain and any limitation of hip movements, with orthopaedic evaluation. Repetitive sporting stresses can cause stress fractures of the pubic ramus or the femoral neck, with running a primary cause. Other possible causes include the severe and sudden pain of avulsion fractures, avascular necrosis of the femoral head and bursitis.