Hip and Groin Pain: Physiotherapy and Rehabilitation Issues

Abstract

Groin and hip injuries are common in sport. The diagnosis, treatment and rehabilitation of these injuries has long been identified as a complex and challenging area for all clinicians involved in the management of such injuries. While our knowledge increases steadily the challenge still remains for appropriate and successful treatment strategies. Rehabilitation has been identified as an important factor in the management of hip and groin pain. Rehabilitation can occur prior to and after surgery or can be a stand alone treatment for long standing or acute pain. Due to the number and complexity of injuries in the hip and groin area, the physiotherapist must have a strong anatomic and biomechanical knowledge base in order to identify possible aggravating structures or movement abnormalities during the assessment process. Often there is not one single cause for the symptoms but multiple causes. If rehabilitation is appropriate the physiotherapist must put in place a progressively graded rehabilitation programme appropriate to a given sport. There are still gaps in the literature on the provision of the specifics of successful rehabilitation. Therefore the physiotherapist must use sound principles of healing, exercise physiology, manual therapy and rehabilitation, in addition to knowledge of specific stresses and strains that the pelvic area is exposed to within a given sport, in order to provide a successful outcome for the athlete.

Risk factors for groin/hip injuries in field-based sports: a systematic review

“…These biomechanical requirements, in addition to the axial and rotational loads of 12 times player's body weight experienced during competition,6 could explain the high incidence of groin/hip injuries in this population. Groin/hip injuries have been studied across the sporting population and encompass: skeletal (pubic bone stress fracture, femoral fractures, avulsion injuries and bony bruising), articular (labral tears, osteitis-pubis and femoral-acetabular impingement), soft tissue (muscular strains/tendinopathies, bursitis, inguinal/sports hernia) and others (hip haematoma, neural, referred pain and tumors) 2 5 7. The complexity of the diagnosis in groin/hip injuries creates a difficult rehabilitation prospect.…”

Which is the most useful patient-reported outcome in femoroacetabular impingement? Test–retest reliability of six questionnaires

“…Hip and groin pains in adults have been traditionally attributed to osteoarthritis (OA)1 2; however, femoroacetabular impingement (FAI) is increasingly recognised as a major cause of hip and groin pain in young active adults 3 4. FAI is characterised by impingement between the proximal end of the femur and the acetabular rim,5 caused by either an abnormally shaped femoral head (known as cam impingement) and/or an abnormally shaped or oriented acetabulum (known as pincer impingement) 6.…”

MRI of the Hip: Important Injuries of the Adult Athlete

“…Depending on the study and sport, the hip accounts for 3-18 % of all sports-related injuries [3][4][5][6][7]. Pain and dysfunction from athletic hip injuries cause significant morbidity, including the greatest time lost from sports compared to other lower extremity injuries [8] and progressive degeneration leading to early osteoarthritis or even hip arthroplasty.…”