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Edwin Goedhart
Groin complaints in professional footballers
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EpidemiologyElite level
– Ekstrand e.a. – UCL Study – 14% hip / groin region
(1.1/1000hr)
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Overuse injuries
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Adductor longus lesionPainful sensation while shooting, scores but had to be substituted 5 minutes laterReturn to play 7 days
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Distribution of muscle injuries during a match
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Injurytime
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Sub-elite level
– ♂ >♀
– Hölmich 0.4/1000hrs– Mainly adductor and psoas-related– Abdominal related, inguinal
related and hip related– 60% overuse– 68% dominant leg– Combination abdominal and
adductor: longstanding
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Anatomy• Robertson (2009)• Proximal attachment Adductor
longus >60% muscular (Tuite, Straus)
• Conjoint tendon (lower fibres Transversus abdominus and Internal oblique) (Hollinshead, Sandring)– 3%– 8% TA direct pubic attachment– 89% attached into rectus sheath
• Adductor longus and Rectus abdominis in continuity via capsular tissues pubic symphysis (Schilder, Robinson)
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Osteitis pubis Pubic bone stress injury
• Robinson 2014
• Prospective MRI
• BoneMarrowEdema, cleft, parasymphyseal capsule/tendon oedema in asymptomatic players
• The presence of abnormal imaging features did not predict future symptoms
• Paajanen 2010• 40 athletes, 20 controles• 48% athletes grade 1
BME• 20% athletes grade 2
BME• 50% controles grade 1
BME
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Risk factors
• Previous injury• Weak adductor
muscles• Age • Limited Abduction
ROM exo/endo• Cutting sports
– Soccer– Football– Icehockey
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Physical
More accelerations / decelerations
Higher load musculotendinous system
More pivoting moments
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Prevention / intervention• Exercise: Multi-intervention
approach– Hübscher 2013
• Eccentric strengthening hip adductor training– Jensen, 2012
• Adductor tenotomy– Robertson 2010– 68% + result (amateur level) severe
cases
• Compression shorts– Chaudhari, 2014
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Sportsman hernia
• Same risk factors as for adductor related injuries
• Conservative therapy 6 wks.
• Surgery– Laparoscopic repair
faster return than open repair
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Bursitis
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Avulsionfractures
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• Groin injuries incidence 0.4 – 1.1 /1000 hr.• mainly adductor related, tendency for fast recovery, (8%>1
month), Adductor and abdominal : longstanding
• There is a drirect anatomical relationship between abdominals, pubic bone and adductors
• Weak adductors and previuos injury are proven riskfactors, Multi exercise intervention appraoch reduces the injury risk
• The value of MRI in the diagnosis of longstanding groinpain is questionable.
• Laporoscopic repair of a sportsman’s hernia ensures a faster recovery than open procedure
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