Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes

King, Enda; Small, Leigh; Falvey, Éanna; Franklyn-Miller, Andrew

doi:10.1136/bjsports-2014-093715

Cited by 42 publications

(38 citation statements)

References 81 publications

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“…When reinjury occurs, or if adductor and abdominal injury coexist, a longer absence from sport can be expected 84–86. RTS times after surgery for long-standing groin pain are similar to RTS times after non-surgical procedures,87 but for full adductor ruptures a faster RTS is seen with a non-surgical approach compared with surgery 88…”

Section: Section 3: What Evidence Do We Have To Inform the Clinician'mentioning

confidence: 95%

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

et al. 2016

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Deciding when to return to sport after injury is complex and multifactorial-an exercise in risk management. Return to sport decisions are made every day by clinicians, athletes and coaches, ideally in a collaborative way. The purpose of this consensus statement was to present and synthesise current evidence to make recommendations for return to sport decision-making, clinical practice and future research directions related to returning athletes to sport. A half day meeting was held in Bern, Switzerland, after the First World Congress in Sports Physical Therapy. 17 expert clinicians participated. 4 main sections were initially agreed upon, then participants elected to join 1 of the 4 groups-each group focused on 1 section of the consensus statement. Participants in each group discussed and summarised the key issues for their section before the 17-member group met again for discussion to reach consensus on the content of the 4 sections. Return to sport is not a decision taken in isolation at the end of the recovery and rehabilitation process. Instead, return to sport should be viewed as a continuum, paralleled with recovery and rehabilitation. Biopsychosocial models may help the clinician make sense of individual factors that may influence the athlete's return to sport, and the Strategic Assessment of Risk and Risk Tolerance framework may help decision-makers synthesise information to make an optimal return to sport decision. Research evidence to support return to sport decisions in clinical practice is scarce. Future research should focus on a standardised approach to defining, measuring and reporting return to sport outcomes, and identifying valuable prognostic factors for returning to sport

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Section: Section 3: What Evidence Do We Have To Inform the Clinician'mentioning

confidence: 95%

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

et al. 2016

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“…Athletic groin pain is a chronic musculoskeletal condition that is common among athletes participating in field sports. 13 Faster return to play rates have been observed in those undertaking rehabilitation compared to surgery 14 indicating a role for rehabilitation. A broad range of physical performance characteristics, the target of rehabilitation interventions, have been associated with athletic groin pain including strength, 1 reactive strength 15 and change of direction biomechanics.…”

Section: Objectivesmentioning

confidence: 99%

Rehabilitation interventions need more than methodological standardisation: an individualised approach

Welch

Richter

Moran

et al. 2020

BMJ Open Sport Exerc Med

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Objectives: The main aim in the current study was to use a single-subject analysis to profile the physical performance characteristics of individuals within an injured group and a between-group approach to profile the group as a whole. These profiles were then used to inform single-subject and between-group rehabilitation interventions. Methods: Fifty-three (28 with athletic groin pain and 25 non-injured) Gaelic football players (24.8 years±7.1 years; 179 cm±5.5 cm; 79.7 kg±9.2 kg) underwent 3D biomechanical analysis, which was used to measure a series of physical performance characteristics. The non-injured group was used to create a ‘performance database’ to compare the injured individuals, and a between-group analysis was also conducted. The scores from each analysis were used to inform the targets of interventions. Results: The analysis highlighted the variety of profiles that existed across the tested individuals and that these profiles differed from that of the between-group analysis. By analysing individuals in a single-subject approach, detail can be seen that is lost with between-group analysis.

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“…No clear differences in outcomes on return to play (RTP) times or rates, between surgical intervention and rehabilitation, were found in a recent systematic review. 7 The success of exercise-based rehabilitation for AGP has been documented. 8 9 Programmes targeting lumbopelvic control and muscle strength, focusing on adductor strengthening, have been compared with manual therapy 10 and with rest and active recovery 11 with good outcomes at long-term follow-up.…”

Section: Introductionmentioning

confidence: 99%

Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients

et al. 2018

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BackgroundClinical assessments and rehabilitation in athletic groin pain (AGP) have focused on specific anatomical structures and uniplanar impairments rather than whole body movement.ObjectiveTo examine the effectiveness of rehabilitation that targeted intersegmental control in patients with AGP and to investigate post rehabilitation changes in cutting biomechanics.MethodsTwo hundred and five patients with AGP were rehabilitated focusing on clinical assessment of intersegmental control, linear running and change of direction mechanics in this prospective case series. Hip and Groin Outcome Score (HAGOS) was the primary outcome measure. Secondary measures included pain-free return to play rates and times, pain provocation on squeeze tests and three-dimensional (3D) biomechanical analysis during a 110° cutting manoeuvre.ResultsFollowing rehabilitation, patients demonstrated clinically relevant improvements in HAGOS scores (effect size (ES): 0.6–1.7). 73% of patients returned to play pain-free at a mean of 9.9 weeks (±3.5). Squeeze test values also improved (ES: 0.49–0.68). Repeat 3D analysis of the cutting movement demonstrated reductions in ipsilateral trunk side flexion (ES: 0.79) and increased pelvic rotation in the direction of travel (ES: 0.76). Changes to variables associated with improved cutting performance: greater centre of mass translation in the direction of travel relative to centre of pressure (ES: 0.4), reduced knee flexion angle (ES: 0.3) and increased ankle plantar flexor moment (ES: 0.48) were also noted.ConclusionsRehabilitation focused on intersegmental control was associated with improved HAGOS scores, high rates of pain-free return to sporting participation and biomechanical changes associated with improved cutting performance across a range of anatomical diagnoses seen in AGP.

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Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes

Abstract: The review suggested better outcomes with rehabilitation for pubic-related groin pain with no difference between the adductor and abdominal groups. The review highlighted the poor quality and risk of bias in the literature making accurate comparison difficult.

Cited by 42 publications

References 81 publications

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern

Rehabilitation interventions need more than methodological standardisation: an individualised approach

Clinical and biomechanical outcomes of rehabilitation targeting intersegmental control in athletic groin pain: prospective cohort of 205 patients

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