Course

Groin Injuries

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12 Lessons

Groin injuries are among the three most common and time-consuming injuries in football, accounting for 8-18% of all injuries and with an incidence of 0.4-1.3 injuries per 1,000 hours of football play. 1 A study looking exclusively at acute groin injuries in Swedish soccer found an incidence of 0.8 injuries per 1,000 hours of play, and a Danish study found that 39% of diagnosed groin injuries during one season were acute injuries. 2,3

Groin injuries have historically been challenging to diagnose and treat. A wide range of diagnoses have been described, with an equally long list of different treatment options. In an effort to help clarify the diagnostic terminology used to describe groin injuries in football players, the World Conference on Groin Pain in Athletes was held in 2014.

In the vast majority of cases, groin injuries are managed non-surgically with a period of coordinated rehabilitation. In some situations, surgical management can be useful, however.

Presented by

Per Hölmich

Learning outcomes

By the end of this topic you should:

  • understand the different entities of groin pain;
  • be able to distinguish between the various entities based on history-taking and clinical examination;
  • be able to order and interpret the various diagnostic tests used to diagnose groin pain;
  • be able to initiate a rehabilitation programme to treat football players with groin pain.

Tasks

  • Read the relevant section in the FIFA Medical Manual and other required reading.
  • Review the required and suggested reading.
  • Complete the course quiz.

Required Reading

Brukner and Khan’s
Clinical Sports Medicine – 4th edition
Chapter 29, pages 545-578

Required Reading

Consensus statement
Doha agreement meeting on terminology and definitions in groin pain in athletes

Adam Weir, Peter Brukner, Eamonn Delahunt et al.

Br J Sports Med 2015;49:768-774

References

  1. Werner J., Hagglund M., Walden M., Ekstrand J. UEFA injury study: A prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med. 2009;43(13):1036-1040.
  2. Ekstrand J., Hilding J. The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports. 1999;9(2):98-103.
  3. Hölmich P., Thorborg K., Dehlendorff C., Krogsgaard K., Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med. 2014;48(16):1245-1250.
  4. Hölmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: A prospective study of 207 patients. Br J Sports Med. 2007;41(4):247-52; discussion 252.
  5. Weir A., Brukner P., Delahunt E., et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768-774.
  6. Hölmich P., Hölmich L.R., Bjerg A.M. Clinical examination of athletes with groin pain: An intraobserver and interobserver reliability study. Br J Sports Med. 2004;38(4):446-451.
  7. Harris N.H., Murray R.O. Lesions of the symphysis in athletes. Br Med J. 1974;4(5938):211-214.
  8. Branci S., Thorborg K., Bech B.H., Boesen M., Nielsen M.B., Hölmich P. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med. 2015;49(10):681-691.
  9. Thorborg K., Rathleff M.S., Petersen P., Branci S., Hölmich P. Prevalence and severity of hip and groin pain in sub-elite male football: A cross-sectional cohort study of 695 players. Scand J Med Sci Sports. 2015.
  10. Hölmich P., Larsen K., Krogsgaard K., Gluud C. Exercise program for prevention of groin pain in football players: A cluster-randomized trial. Scand J Med Sci Sports. 2010;20(6):814-821.
  11. Rio E., Kidgell D., Purdam C., et al. Isometric exercise induces analgesia and reduces inhibition in patellar tendinopathy. Br J Sports Med. 2015;49(19):1277-1283.
  12. Serner A., van Eijck C.H., Beumer B.R., Hölmich P., Weir A., de Vos R.J. Study quality on groin injury management remains low: A systematic review on treatment of groin pain in athletes. Br J Sports Med. 2015;49(12):813-2014-094256. Epub 2015 Jan 29.
  13. Esteve E., Rathleff M.S., Bagur-Calafat C., Urrutia G., Thorborg K. Prevention of groin injuries in sports: A systematic review with meta-analysis of randomised controlled trials. Br J Sports Med. 2015;49(12):785-791.
  14. Engebretsen A.H., Myklebust G., Holme I., Engebretsen L., Bahr R. Prevention of injuries among male soccer players: A prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med. 2008;36(6):1052-1060.
  15. van Beijsterveldt A.M., van de Port I.G., Krist M.R., et al. Effectiveness of an injury prevention programme for adult male amateur soccer players: A cluster-randomised controlled trial. Br J Sports Med. 2012;46(16):1114-1118.
  16. Steffen K., Myklebust G., Olsen O.E., Holme I., Bahr R. Preventing injuries in female youth football – a cluster-randomized controlled trial. Scand J Med Sci Sports. 2008;18(5):605-614.