Do you suffer with Groin Pain?
Groin pain can be referred from a number of anatomical regions. This includes adductor, iliopsoas, inguinal, pubic and hip related groin pain (Delahunt et al. 2015).
Adductor-related groin pain (ARGP) has the highest incidence reporting rate in field sports. Over seven consecutive soccer seasons an incidence rate of 64% of ARGP has been reported (Werner et al. 2009). This study reported 628 hip and groin injuries, 399 were ARGP (Werner et al. 2009). In sub-elite soccer players, ARGP was the most frequently occurring, 30 were recorded out of 58 groin injuries (Holmich et al. 2014). In senior male Gaelic football the incidence of groin injuries (9.4%) was the fourth highest injury following, thigh (33.3%), knee (11.3%), and ankle (10%) (Murphy et al. 2012). For chronic groin pain in Gaelic footballers an incidence rate of 24% has been reported (Glasgow et al. 2011). ARGP also causes moderate (8-28 days) to severe injury (> 28 days) time loss from participation in soccer (Holmich et al. 2014). This highlights that ARGP is a longstanding injury. Inappropriate rehabilitation protocols may increase this time lost to play due to inappropriate categorization of groin pain. Therefore it is important to consult with a Chartered Physiotherapist for the assessment and treatment of groin pain.
Orchard (2015) reported that hip adductor injury rates are high in sports that involve kicking and multidirectional movements. These functional movement traits are commonly associated with Gaelic football. Non-modifiable risk factors of hip adductor injury in field sports include previous injury, older age, playing at a higher level and dominant kicking leg (Ryan et al. 2014). In soccer, players previously injured were seven times more likely to sustain a new hip adductor injury (Arnason et al. 2004). Hip adductor weakness is a high risk factor therefore the initial adductor injury may be associated with a reduction in hip adductor strength (Whittaker et al. 2015). Hip adductor weakness is also evident in soccer players with ARGP (Thorborg et al. 2014). Hip adductor strength is a modifiable risk factor that players can increase with specific exercises (Ishoi et al. 2015).
A study has found that implementation of an 8 week progressive eccentric hip adductor exercise largely increased eccentric strength (Ishoi et al. 2015). The Copenhagen hip adduction exercise (Figure 1.1) increased adductor strength by 35.7% (Ishoi et al. 2015). This eccentric hip adductor exercise may have the same effect as the Nordic exercise utilised for prevention and treatment of hamstring injuries. Teams that implement the Nordic exercise have shown to reduce hamstring injury occurrence up to 51% (Al Attar et al. 2016). However in professional soccer low compliance of the Nordic exercise is reported (Bahr et al. 2015). This is replicated by the 4% annual increase of hamstring injuries recorded between 2001 to 2013 in professional soccer (Ekstrand et al. 2016).
Figure 1.1 Copenhagen Groin strength exercise
Damien Mc Mahon, MISCP.
Al Attar, W. S., Soomro, N., Sinclair, P. J., Pappas, E. and Sanders, R. H. (2016) ‘Effect of Injury Prevention Programs that Include the Nordic Hamstring Exercise on Hamstring Injury Rates in Soccer Players: A Systematic Review and Meta-Analysis’, Sports Med, 2016/10/19.
Arnason, A., Sigurdsson, S. B., Gudmundsson, A., Holme, I., Engebretsen, L. and Bahr, R. (2004) ‘Risk factors for injuries in football’, Am J Sports Med, 32(1 Suppl), 5s-16s.
Bahr, R., Thorborg, K. and Ekstrand, J. (2015) ‘Evidence-based hamstring injury prevention is not adopted by the majority of Champions League or Norwegian Premier League football teams: the Nordic Hamstring survey’, Br J Sports Med, 49(22), 1466-71.
Delahunt, E., Thorborg, K., Khan, K. M., Robinson, P., Holmich, P. and Weir, A. (2015) ‘Minimum reporting standards for clinical research on groin pain in athletes’, Br J Sports Med, 49(12), 775-81.
Ekstrand, J., Walden, M. and Hagglund, M. (2016) ‘Hamstring injuries have increased by 4% annually in men’s professional football, since 2001: a 13-year longitudinal analysis of the UEFA Elite Club injury study’, Br J Sports Med, 50(12), 731-7.
Glasgow, P., Webb, M., McNicholl, C. (2011) ‘Report of Gaelic Groin Think Tank’. Sports Institute Northern Ireland in Association with Ulster Council GAA.
Holmich, P., Thorborg, K., Dehlendorff, C., Krogsgaard, K. and Gluud, C. (2014) ‘Incidence and clinical presentation of groin injuries in sub-elite male soccer’, Br J Sports Med, 48(16), 1245-50.
Ishoi, L., Sorensen, C. N., Kaae, N. M., Jorgensen, L. B., Holmich, P. and Serner, A. (2015) ‘Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial’, Scand J Med Sci Sports, 2015/11/22.
Murphy, J. C., O’Malley, E., Gissane, C. and Blake, C. (2012) ‘Incidence of injury in Gaelic football: a 4-year prospective study’, Am J Sports Med, 40(9), 2113-20.
Orchard, J. W. (2015) ‘Men at higher risk of groin injuries in elite team sports: a systematic review’, Br J Sports Med, 49(12), 798-802.
Ryan, J., DeBurca, N., Mc Creesh, K. (2014) ‘Risk factors for groin/hip injuries in field based sports: a systematic review’, Br J Sports Med, 48, 1089-1096
Thorborg, K., Branci, S., Nielsen, M. P., Tang, L., Nielsen, M. B. and Holmich, P. (2014) ‘Eccentric and Isometric Hip Adduction Strength in Male Soccer Players With and Without Adductor-Related Groin Pain: An Assessor-Blinded Comparison’, Orthop J Sports Med, 2(2), 2325967114521778.
Werner, J., Hagglund, M., Walden, M. and Ekstrand, J. (2009) ‘UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons’, Br J Sports Med, 43(13), 1036-40.