Edwin Goedhart

Groin complaints in professional footballers

EpidemiologyElite level

– Ekstrand e.a. – UCL Study – 14% hip / groin region

(1.1/1000hr)

Overuse injuries

Adductor longus lesionPainful sensation while shooting, scores but had to be substituted 5 minutes laterReturn to play 7 days

Distribution of muscle injuries during a match

Injurytime

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

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)

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

Risk factors

• Previous injury• Weak adductor

muscles• Age • Limited Abduction

ROM exo/endo• Cutting sports

– Soccer– Football– Icehockey

Physical

More accelerations / decelerations

Higher load musculotendinous system

More pivoting moments

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

Sportsman hernia

• Same risk factors as for adductor related injuries

• Conservative therapy 6 wks.

• Surgery– Laparoscopic repair

faster return than open repair

Bursitis

Avulsionfractures

• 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