Inguinal-related groin pain
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1 Inguinal-related groin pain Adam Aspetar Sports Groin Pain
2 Talk structure Case Terminology Definition Pathology? Imaging Treatment Rehab protocol
3 History 31 yr male professional soccer R Normally trains on a daily basis Gradual onset L sided groin pain 6 wks Pain: inguinal region Worse on sprinting and changing directions Previous injury: 5 years ago partial medial meniscectomy, good recovery. Previous hamstrings strain 3 years ago with good recovery.
4 Examination Hip: normal Palpation: Pain on palpation of the left external inguinal ring, conjoined tendon and inguinal ligament. There is no palpable inguinal hernia Resistance testing: Abdominal sit up in 45 hip flexion pain in left inguinal region, good strength. Oblique sit ups 45 hip flexion pain in left inguinal region, good strength
5 Discuss with your neighbour
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8 Doha Agreement Meeting: November 2014
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13 Clinical examination based classification system - Groin pain in athletes 1. Defined clinical entities Adductor, iliopsoas, inguinal, pubic-related groin pain 2. Hip-related groin pain 3. Other causes
14 Free Online
15 Inguinal-related groin pain Pain in the inguinal canal region Tenderness: inguinal canal No palpable inguinal hernia More likely if Pain: Valsalva/cough/sneeze Pain: resisted abdominals
16 Terms not to be used: Gilmore s groin Groin disruption Hockey-goalie syndrome /Hockey groin Sports groin, sportsman s groin Sports hernia, sportsman s hernia Adductor/iliopsoas tendinitis/tendinopathy Osteitis pubis Athletic groin pain, athletic pubalgia
17 Considerations Multiple possible (probable!) Aspetar: 62% Adductor 40% Inguinal 44% MULTIPLE Underlying pathology????
18 Inguinal-related groin pain Preferred term Clinical diagnosis
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20 groi n M Hagglund
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22 Dzung Vu (2012)
23 Gilmore / Meyers
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25 Lloyd
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27 Muschaweck / Campanelli
28 Ziprin
29 Vuckovic Collagen deficiency? Wagh PV, Read RC. Collagen deficiency in rectus sheath of patients with inguinal herniation. Proc Soc Exp Biol Med. 1971;137: Wagh PV, Read RC. Defective collagen synthesis in inguinal herniation. American Journal of Surgery. 1972;124: Rosch R, Junge K, Lynen R, Mertens PR, Klinge U and Schumpelick V. Hernia- A Collagen Disease? European Surgery, ISSN , 01/2003, Volume 35, Issue 1, pp
30 groi n M Hagglund
31 Imaging? Identify unknown pathology? Rule out other pathology
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33 An x-ray to rule out? Changes of symphysis 76-85% in controls Harris/Murray 1974, Besjakov 2003 CAM 60% (FAIS talk)
34 Or an MRI?
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37 Or USS
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39 Not a diagnosis of exclusion You always see other shit!
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41 72 papers Quality score (0-27) Levels of evidence
42 Coleman effect
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44 37 Low quality studies (8 / 27!) All surgical Only 32% report on complications Success %
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46 RCT 60 athletes with inguinal related groin pain 30 TEP 30 physio +/- pubic bone +/-adductor If started with adductor = include MRI = oedema = include
47 Treatment TEP bilateral Rehab Total rest NSAIDS Steroid Injection Exercise program minimum 8 weeks 3 times per week 90 minutes
48 Results Full return to sports 1 month TEP 67% / Cons 20% 3 month TEP 90% / Cons 27% 1 year TEP 97% / Cons 50%
49 Review conclusion Moderate evidence TEP > conservative treatment for long-standing inguinal-related groin pain
50 So surgery for all? Chronicity Severity Level sports Risk aversion Whats already been done Timing season.on and on
51
52 ARTICLE ACCEPTED FOR PUBLICATION OPER TECH SPORTS MED
53 BASIC EXERCISES FUNCTIONAL EX WARM UP WALKING HIP CIRCLES LEG SWINGS STAT BIKE 1 NORMAL GAIT PAIN < 3/10
54 BASIC EXERCISES FUNCTIONAL EX SIT UPS STAT BIKE LEG ELASTIC JOGGING ABD/ADD MACHINE 2 LADDERS NORMAL SIT UP (NO PAIN) + JOG 10 MINS
55 BASIC EXERCISES FUNCTIONAL EX SIT UPS + INTERVAL LEG ELASTIC ZIG-ZAGS COPENHAGEN ADDUCTION ACCEL / DECEL 3 10 LEG LOWERS 10 COPENHAGEN ADD + ABDO/ADD PAIN FREE + MAX SPRINT +COD
56 MAINTENANCE FUNCTIONAL EX LEG LOWERS SPORTS SPECIFIC COPENHAGEN ADDUCTION SIDE PLANK 4 PAIN FREE AND CONFIDENT TO RETURN TO GRADED TRAINING
57 TAKE HOME Inguinal-related groin pain Use this term Clinical diagnosis We don t know the pathology Moderate evidence for surgery (TEP) Suggestion for rehab Progressive Strength and functional
58 @adamweirsports
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