Hip and Groin Pain in the Professional Athlete

Optimizing Conservative Management of Groin Pain in Athletes: Insights from a Narrative Review

Background: Groin pain is a complex and multifactorial condition commonly observed in athletes, often impairing performance and quality of life. While conservative treatments are the first-line approach, the variability in intervention protocols and inconsistent evidence necessitate a comprehensive synthesis of current knowledge. Methods: This narrative review analyzed the available literature on conservative management of groin pain in athletes. A systematic search was conducted across the MEDLINE, Cochrane CENTRAL, Scopus, PEDro, and Web of Science databases. Studies focusing on pain reduction, functional recovery, return-to-sport outcomes, and prevention strategies were included. Findings were synthesized to evaluate the efficacy of conservative interventions and identify gaps in the evidence. Results: Conservative treatments, particularly active rehabilitation and multimodal therapy, demonstrated significant efficacy in reducing pain (50-80%) and improving function, as measured by tools such as the HAGOS score. Return-to-sport rates ranged from 70% to 90%, depending on intervention type and adherence. Screening tools, including the adductor squeeze test, were effective in predicting and preventing groin injuries. However, variability in methodologies, small sample sizes, and a lack of long-term follow-up limited the generalizability of the findings. Conclusions: Conservative management remains a cornerstone for treating groin pain in athletes, offering effective outcomes for pain reduction, functional recovery, and injury prevention. However, standardized protocols and high-quality research are needed to enhance clinical guidance and optimize patient outcomes.

Comparison of Modular Control during Side Cutting before and after Fatigue

The purpose of this study was to clarify the coordination between the trunk and lower limb muscles during sidestep and to compare this coordination before and after fatigue intervention. The intervention was lateral jump until exhaustion. Nonnegative matrix factorization (NMF) was used to extract muscle synergies from electromyography. Subsequently, to compare the muscle synergies, a scalar product that evaluates the coincidence of synergies was calculated. Three muscle synergies were extracted before and after the intervention from the NMF analysis. In accordance with the evaluation of the scalar product, these synergies were the same before and after the intervention. One of these synergies that engaged the internal oblique/transversus abdominis, rectus femoris, and adductor muscle was activated from before landing to midstance during sidestep motion; therefore, this synergy is thought to suppress excessive hip abduction. However, the activation timing of this synergy was delayed after the intervention (P = 0.028, effect size: 0.54, Wilcoxon test). This delay is considered to decrease hip stability. Thus, this change may induce a reduction in hip control function.

The prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement

OBJECTIVE

To determine the prevalence of athletic pubalgia imaging findings on MRI in patients with femoroacetabular impingement and assess for correlative risk factors.

MATERIALS AND METHODS

A retrospective search identified 156 hips with femoroacetabular impingement and a control group of 113 without femoroacetabular impingement that had an MRI performed between January 1, 2015, and January 1, 2018. Two fellowship-trained musculoskeletal radiologists reviewed studies for the presence of acute osteitis pubis, chronic osteitis pubis, adductor tendinosis, and tendon tear; rectus abdominis tendinosis and tendon tear; and aponeurotic plate tear. Findings were correlated with various clinical and imaging risk factors. Univariate and multivariate statistical analyses were performed.

RESULTS

Imaging findings of adductor tendinosis (p = 0.02) and chronic osteitis pubis (p = 0.01) were more prevalent in FAI patients than controls. Univariate analyses in FAI patients showed that an alpha angle ≥ 60° had a higher prevalence of aponeurotic plate tears (p = 0.02) and adductor tendinosis (p = 0.049). Multivariate analyses showed that an alpha angle ≥ 60° had a higher prevalence of chronic osteitis pubis (OR = 2.27, p = 0.031), sports participation had a higher prevalence of adductor tendon tears (OR = 4.69, p = 0.013) and chronic osteitis pubis (OR = 2.61, p = 0.0058), and males had a higher prevalence of acute osteitis pubis (OR = 5.17, p = 0.032).

CONCLUSION

Sports participation, alpha angle ≥ 60°, and male sex predict a higher prevalence of athletic pubalgia imaging findings in patients with femoroacetabular impingement.

Hip and Groin Injuries in Professional Basketball Players: Impact on Playing Career and Quality of Life After Retirement

BACKGROUND

Professional basketball players are at increased risk of hip and groin pain. Epidemiologic data exist on the prevalence of hip and groin issues among players in the National Basketball Association (NBA), but little is known about how these injuries affect athletes after retirement.

HYPOTHESIS

A high proportion of retired NBA athletes would have hip and/or groin pain.

STUDY DESIGN

Cross-sectional survey.

LEVEL OF EVIDENCE

Level 4.

METHODS

A survey was developed through an interdisciplinary focus group. The survey was developed to capture data regarding demographics, collegiate and professional athletic injuries, and current quality of life and musculoskeletal health. The questionnaire was electronically distributed to all members of the National Basketball Players Association using SurveyMonkey (N = 900).

RESULTS

A total of 108 (12%) retired NBA players completed the survey. More than one-third (36.3%) of athletes report currently experiencing hip and/or groin pain, and 17.6% had received injections for hip or groin conditions since retiring from the NBA. Since retiring, 14.7% of respondents had undergone total hip arthroplasty. The median Tegner activity level scale was 3 out of 10. Nearly one-third (32.4%) of athletes report moderate to severe problems with mobility, and close to half (48%) had moderate to extreme pain/discomfort.

CONCLUSION

Hip and groin injuries are common among NBA athletes, affecting players throughout their careers and into retirement. A subset of athletes may exist in whom intra-articular hip pathology is not appropriately identified and treated while playing in the NBA.

CLINICAL RELEVANCE

Retired NBA athletes are at high risk of hip and groin pain after retirement and are more likely to require total hip arthroplasty compared with the general population.

Groin pain in athletes and non-interventional rehabilitative treatment: a systematic review

INTRODUCTION

Groin pain is a common complaint both in high-performance and recreational athletes. Diagnosis is based on the patient's history and physical examination. Imaging assessments are often considered to exclude other pathologies. To date there is no strong evidence to support conservative or surgical treatment options. The purpose of this study is to shed light on the more effective non-interventional rehabilitative treatments for the management of groin pain in athletes and, if possible, provide guidelines useful for clinical practice.

EVIDENCE ACQUISITION

The following electronic databases were searched: PubMed, Physiotherapy Evidence Database (PEDro), Scopus, Web of Science, Google and Google Scholar. Databases were investigated from January 1997 until March 2017.

EVIDENCE SYNTHESIS

The results reported in the randomized clinical trial studies highlight that active treatment is better than passive treatment to improve clinical signs of groin pain. Comparing the active strategy with multi-modal treatment the latter allows a faster return to sport activity. Although the evidence remains poor, all the included literature highlights that an integrated strategy which combines active and passive treatment, the assessment of perceived pain, a return to running program and specific-sport exercises is an effective strategy for management of groin pain in athletes.

CONCLUSIONS

Although we shed some light on common key aspects able to improve the typical signs of groin pain, on the basis of available data we were unable to provide practice guidelines. Further studies are necessary to set the best treatment algorithm for the management of groin pain in athletes.

Ultrasound Diagnostic and Therapeutic Injections of the Hip and Groin

Hip and groin pain often presents a diagnostic and therapeutic challenge. The differential diagnosis is extensive, comprising intra-articular and extra-articular pathology and referred pain from lumbar spine, knee and elsewhere in the pelvis. Various ultrasound-guided techniques have been described in the hip and groin region for diagnostic and therapeutic purposes. Ultrasound has many advantages over other imaging modalities, including portability, lack of ionising radiation and real-time visualisation of soft tissues and neurovascular structures. Many studies have demonstrated the safety, accuracy and efficacy of ultrasound-guided techniques, although there is lack of standardisation regarding the injectates used and long-term benefit remains uncertain.

Groin pain in athletes: a novel diagnostic approach

Groin pain in a performing athlete can be very challenging to diagnose and treat. The differential diagnosis includes intra-articular causes, extra-articular causes and non-musculoskeletal causes. A detailed clinical and radiological assessment of groin pain in this group is critical and can identify the underlying pathology. Diagnostic hip block is a valuable tool to differentiate intra-articular causes from extra-articular causes. Hip arthroscopy can help in identifying some of the elusive intra-articular conditions, which were once undiagnosed and therefore, left untreated, resulting in premature ending of competitive careers. This article attempts to explore current thinking on evaluation of groin pain, particularly in young individuals, and to establish a simple protocol for a clinical and diagnostic approach to this difficult problem.

Isokinetic imbalance of hip muscles in soccer players with osteitis pubis

In this study, we compared the isokinetic torques of hip flexors/extensors and abductors/adductors in soccer players suffering from osteitis pubis (OP), with normal soccer players. Twenty soccer male athletes with OP and 20 normal soccer athletes were included in this study. Peak torque/body weight (PT/BW) was recorded from hip flexor/extensor and abductor/adductor muscles during isokinetic concentric contraction modes at angular velocity of 2.1 rad · s(-1), for both groups. The results showed a significant difference between the normal and OP groups for hip flexors (P < 0.05). The normal group had significant, lower PT/BW value than the OP group for their hip flexors (P < 0.05). The hip flexor/extensor PT ratio of OP affected and non-affected limbs was significantly different from that of normal dominant and non-dominant limbs. There were no significant differences between the normal and OP groups for hip extensor, adductor and abductor muscles (P > 0.05). Regarding the hip adductor/abductor PT ratio, there was no significant difference between the normal and OP groups of athletes (P > 0.05). The OP group displayed increase in hip flexor strength that disturbed the hip flexor/extensor torque ratio of OP. Therefore, increasing the hip extensor strength should be part of rehabilitation programmes of patients with OP.