Introduction
The Groin Pain Masterclass, taught by Andrea Mosler and Liam West, provides a completeoverview of the assessment and management of Groin injuries. This position statementprovides clinically relevant, actionable information that may be useful to health professionals.
Part 1: Definition of Hip and Groin Pain and Epidemiology
Hip and groin anatomy is complex and there has been plenty of discussion regarding the appropriate terminology used. In 2014 the Doha agreement meeting (Weir et al, 2016) developed a standardised way of defining hip/groin pain. This simplified the communication between practitioners from both a research and clinical point of view.
- The Doha agreement developed a classification system for hip/groin pain. This system divides hip/groin pain into adductor-related, iliopsoas-related, inguinal-related, pubic-related, hip-related groin pain and other causes of groin pain.
- If the patient’s pain is hip-related, clinical suspicion will be raised through either their objective history (worse in certain positions) or clinical examination (impingement type tests).
- For FAI syndrome, as per the Warwick agreement (Griffin et al, 2016), the patient must have symptoms, clinical signs (reduced ROM, positive FADIR) & imaging findings (CAM or Pincer)
Part 2: Groin Pain Diagnosis
Using the Doha agreement terminology is the simplest way of obtaining a diagnosis for a patient’s pain. Clinicians need to obtain specific information and perform a robust objective examination to help develop the management plan. The hip/groin region is a personal area, thus appropriate draping and explanation from the clinician is important to ensure patient comfort.
- The subjective history includes demographics, sport type/level/goal, occupation, previous illness/injury, loading history and relevant family history.
- The objective examination includes palpation, muscle strength/length testing, pain location and orthopaedic tests (FABER and FADIR).
- Conditions not to be missed include apophysitis/avulsion fractures, stress fractures (RED-S) and tumour.
- MRI findings in asymptomatic individuals are very common, so it’s important to use the images alongside the patient’s symptoms to best guide the management plan.
Masterclass Preview
Enjoy this 7mins of clinical gold from Andrea as she shares with us the best way to get start with rehab for those presenting with acute onset groin pain.
Part 3: Syndesmosis Injury
During the examination of the hip/groin it is important to find the main impairments to further guidethe management plan. The main impairments assessed are ROM, strength, functional testing andother body areas.
- For strength testing, assess the adductors, abductors, 45-degree squeeze test, internal/externalrotation, hip flexion, abdominal endurance (plank and side plank) and/or calf endurance.
- For the functional tests, assess single leg squat, star excursion, hop tests and change of directiondrills.
- Use neurodynamic tests to assess possible nerve involvement including the femoral nerve andobturator nerve.
- During the examination of the hip/groin it is important to find the main impairments to further guidethe management plan. The main impairments assessed are ROM, strength, functional testing andother body areas.
Part 4: Rehabilitation and Return to Sport
Management should strive to have the athlete at the centre of care. The framework of rehabilitation is built on education, strategies for reducing pain, restoring impairments and a progressive overload program with a gradual return to sport-specific tasks.
- There is good evidence for the use of compression shorts, manual therapy, dry needling and taping techniques for adductor-related groin pain management.
- In the early stage of rehab, it is good to teach the athlete pelvic positional awareness concurrently with isometric contractions to modulate pain levels.
- Mid-late stage rehab includes adding in different planes of movement to keep the athlete engaged in their rehab.
