Getting on top of groin injuries

By Jonny Kelly

HAVE you experienced a groin injury playing sport? If so, you will know how frustrating these injuries can be.

Groin injuries are the second most common injuries sustained in Gaelic football (14.9%) and hurling (12.6%). Gaelic sport involves running, twisting, turning and kicking. This places stress and strain on the structures of the pelvis and groin.

In this article, we will explain the six most common causes of groin pain, the steps needed to make a recovery and how long it will take to get back on the pitch.

What could be causing my groin pain?

1. Adductor muscles

These muscles attach high up in the inner thigh. They produce a lot of force when sprinting and kicking. There are two types of tendon conditions that cause groin pain:

Tendon strain or tear – the player often reports a sudden onset of pain during running or kicking a ball.

Tendinopathy – gradually over time, the tendon thickens and eventually causes pain. This occurs over weeks or months due to the stress and strain placed on the pelvis and tendon. Players often complain of a dull ache during warm-up exercises and the day following activity.

2. Hip joint

The hip joint lies deep in the groin area and can be a source of groin pain:

Cartilage (labrum) – this thick ring of cartilage inside the hip joint can get damaged or degenerate over time.

Femoroacetabular impingement (FAI) – the hip is a ball and socket joint. Over a long period of time, the ball and/or socket part can grow in size, causing less flexibility within the joint.

Ligamentum teres – this strong ligament connects the ball of the hip to the socket. It can tear and result in groin pain, locking and popping during hip movements. The running and turning, landing and twisting actions of sport predisposes players to these conditions.

3. Hip flexors

The hip flexors muscles cross over the front of the groin. They drive the leg forward with force when running or kicking. Players often report a sudden onset of pain during these activities. Sometimes a popping sensation is felt at the time of injury.

4. Lower back

The lumbar spine can cause sciatica. Most commonly, pain, pins and needles or numbness refer down the leg and into the foot.

However, it can refer pain directly into the groin area. Players may feel lower back stiffness or pain, with their groin symptoms.

5. Gilmore’s groin or sportsman’s hernia

Often referred to as ‘hernia’, this condition does not result in a true hernia where there is a lump or bump present in the groin. It occurs when there is a tear in the connective tissue that attaches the abdominal muscles to the lower pelvis.

Players report a dull ache that gets worse over time, eventually resulting in having to stop sporting activity.

Pain when coughing or sneezing, or doing sit-ups is also a sign of this injury. Unfortunately, surgery is required to enable a player to fully train and play.

6. Osteitis pubis

The pelvis is made up of two large bones. The area where they meet in the middle at the front is known as the pubic joint.

When the stress and strain of sport gets too much for this joint, the joint changes shape, and swelling and pain occurs.

The recovery for this condition takes months. It can be very frustrating for players as they will have good days and bad days during their recovery.

People who struggle with rehabilitation exercises will require a cortisone injection to allow them to progress through their recovery programme. Rarely, surgery is required if a player is unable to return to sport.

Other less common causes of groin pain to be aware of:

Stress fracture of the pelvis or hip joint.

Perthes’ disease – seen in children. It occurs when there is not enough supply of blood to the ball part of the hip joint. This results in degeneration of the bone and can be a source of groin pain.

Slipped upper femoral epiphysis (SUFE) – another childhood condition. The upper thigh bone (femur) has a growth plate which is where the bones grow longer. The growth plate can ‘slip’ and children complain of hip, groin or knee pain, and find it difficult to walk.

Testicular, prostate, gynaecological or urinary tract conditions – these conditions usually have symptoms at rest, regardless of activity. If you suspect any of these conditions or have lost weight for an unknown reason, you should consult with your General Practitioner

Steps you need to make to overcome groin pain:

1. Get a diagnosis!

As you have read, there are a few conditions that can cause groin pain. To get the right treatment, you must find out the true cause. Otherwise it will lead to weeks and months of frustration.

A Sports Physiotherapist will be able to assess and find out what is wrong. Sometimes a scan is required to further investigate players’ symptoms.

2. Find out what is tight or weak

The pelvis and groin have several muscles and tendons crossing it, all pulling in different directions. It is important to identify what muscles are tight or weak, and work on correcting this. This is also important in preventing these conditions from happening in first place.

How long will it take to get back on the pitch?

The million dollar question that all players and coaches ask. The simple answer is, it depends on what is causing the pain.

A mild adductor strain would take twp-four weeks to recover. Osteitis pubis takes months of rehabilitation to overcome. Conditions such as a sportsman’s hernia require surgery.

Are you frustrated with injury? Jonny Kelly is a chartered Sports Physiotherapist and owns Physio Performance in Belfast. He has helped get world-class athletes back on the pitch and performing at their best. Contact us for a complimentary Get Back On The Pitch Quick consultation at www.physioperformance.co.uk.