Treatment of longstanding groin pain in athletes: a systematic review

Abstract

The aims of this study were to determine (1) the kinds of treatments applied for longstanding groin pain (LGP) in athletes; (2) the results; and (3) the levels of evidence for the interventions. Digital databases P were searched for articles describing the effects of interventions for LGP in athletes. Treatment of LGP in athletes can consist of conservative measures such as rest or restricted activity, active or passive physical therapy, steroid injections or dextrose prolotherapy. Studies describing surgery generally mention failure of conservative measures, although a description of these conservative measures is mostly lacking. During surgery, a reinforcement of the abdominal wall is applied in most cases, using an open or laparoscopic approach. There is level I evidence that physical therapy aiming at strengthening and coordinating the muscles stabilizing hip and pelvis has superior results compared with passive physical therapy. For patients with a positive herniography and/or positive ilioinguinal or iliohypogastric nerve block tests, there are indications (level II) that surgery results in earlier return to sport compared with exercise therapy. Possibly, laparoscopic intervention might result in an earlier return to sport compared with open approach surgery (level III). For different clinical diagnoses, the same or similar surgical interventions were performed.

ECSS Position Statement 2009: Prevention of acute sports injuries

“…A strain to the groin muscles may be acute but often becomes chronic in nature. Suffering from persistent groin injuries results in extensive rehabilitation and longstanding pain (Jansen, Mens, Backx, Kolfschoten, & Stam, 2008;Macintyre, Johson, & Schroeder, 2006); as an example, 40% of groin injuries in soccer result in more than one week out, and 10% in more than one month out (Maffey & Emery, 2007).…”

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“…Clinical examination identified the dilation of the external inguinal ring, but without a pseudotumoral groin mass. Of a series of 250 athletes who underwent surgery for chronic inguinal pain, only 4% had clear clinical signs of inguinal hernia (Jansen et al, 2008;Campanelli, 2010). Usually, pain had an insidious onset, but it could become bilateral, with some patients also experiencing scrotum pain.…”

“…It was interpreted as athletic pubalgia, pubic osteitis, Gilmore hernia, enthesopathy of Ashby's inguinal ligament, so it was considered to be a pubic inguinal pain syndrome (Campanelli, 2010). This syndrome is often found in ball sports, when shear movements or those involving a sudden change of direction are performed, and may originate in any inguinal structure: muscular, tendinous, bone, fascial, nervous, articular (Jansen et al, 2008;Campanelli, 2010).…”

Changes in Abdominal Muscle Thickness Measured by Ultrasound Are Not Associated With Recovery in Athletes With Longstanding Groin Pain Associated With Resisted Hip Adduction

“…19 These interventions generally result in a positive outcome for a majority of athletes with longstanding groin pain associated with resisted hip adduction. 18 Researchers have recently shown that wearing a pelvic belt can increase hip adduction strength and decrease pain during resisted hip adduction in athletes with longstanding groin pain associated with resisted hip adduction.…”

“…Consequently, treatment is often applied in a nonspecific manner. 19 Longitudinal single-cohort study.…”