As pre-season training gets underway for winter sports codes we generally see an increase in the number of patients with groin pain presenting to our clinic. Discussing groin pain as a whole is a very large topic, so for the purposes of this blog I will discuss non-traumatic groin pain and in particular the most common factors that can lead to injury.
Non-traumatic groin injuries are typically complex and require a thorough assessment to determine the factors that have led to the injury and a comprehensive exercise rehabilitation program to recondition the athlete to be ready to return to their sport.
WHAT IS IT?
Groin pain is an umbrella term for pain felt in the groin area. It is not diagnostic and does not indicate a specific pathology or tissue(s) affected. Groin pain can be sub-grouped into 6 different areas:
· Adductor related
· Hip flexor (iliopsoas) related
· Abdominal (inguinal) related
· Pubic related
· Hip joint related
· Other (neural, referred pain, fractures, abdominal/gynaecological conditions etc)
It is common more than one of these sub-groups to be affected and insufficiencies in one area can lead to an overload in another.
WHY DOES IT OCCUR?
Three common reasons for the development of groin pain in sporting people include training errors, poor mechanics and age.
· Training errors causing injury usually refers to “too much too fast” and is usually seen with athletes rapidly increasing their training amounts without adequate recovery between sessions causing a progressive overload of structures in the groin area. Groin pain will commonly present as preseason training reaches 3-4 weeks in and more commonly as running demands transition into higher amounts of sprinting and agility.
· Poor mechanics refers to muscle imbalances, poor movement control and patterns, poor posture, inadequate strength, lack of flexibility and sub-optimal technique for sport specific skill. This is where a good sports physiotherapist will be able to conduct a comprehensive assessment to determine which of these factors are contributing to your groin pain.
· Younger athletes are more susceptible to developing groin pain as their skeletal system is less mature to withstand the stress that training can put on the body compared to older athletes (25+ years).
The pain will generally settle with a combination of rest and anti-inflammatory medication. During this rest period it is important to address the factors that have led to developing groin pain (poor mechanics) to avoid reaggravating the injury when you return to running. It is very important to have a graduated return to running plan in place to allow for optimal recovery between sessions and avoiding too much load too soon.
The old adage “prevention is the best cure” is applicable for groin pain and there is plenty that can be done to prevent it. If you have had groin pain in the past, having a preseason screen with your physiotherapist is beneficial to assess if any predisposing factors are present. A comprehensive strength and conditioning program to address any factors as well as condition your body to tolerate the training loads can help prevent groin injuries. Also making sure to optimise your recovery between sessions – for helpful tips read our blogs on recovery – will help prevent the development of groin pain.