Groin pain in athletes is a common problem that can result in significant amounts of missed playing time. Many of the problems are related to the musculoskeletal system.
1. Serious and potentially life threatening medical cases of pelvis and groinpain: Stress fractures of the bones of the pelvis occur, particularly after a sudden increase in the intensity of training. Most of these stress fractures will heal with rest, but femoral neck stress fractures can potentially lead to more serious problems, and require closer evaluation and sometimes surgical treatment. Avulsion fractures of the apophyses occur through the relatively weaker growth plate in adolescents. Most of these will heal with a graduated physical therapy program and do not need surgery. Osteitis pubis is characterised by sclerosis and bony changes about the pubic symphysis. This is a self-limiting disease that can take several months to resolve. Corticosteroid injection can sometimes hasten the rehabilitation process.
2. Sports hernias can cause prolonged groinpain, and provide a difficult diagnostic dilemma. In athletes with prolonged groinpain, with increased pain during valsalva manoeuvres and tenderness along the posterior inguinal wall and external canal, an insidious sports hernia should be considered. In cases of true sports hernia, treatment is by surgical reinforcement of the inguinal wall.
3. Nerve compression can occur to the nerves supplying the groin. In cases that do not respond to desensitisation measures, neurolysis can relieve the pain.
4. Adductor strains are common problems in kicking sports such as soccer. The majority of these are incomplete muscle tendon tears that occur just adjacent to, the musculotendinous junction.
5. Pain due to lower lumbosacral nerve root involvement can also present with groin pain that is difficult to treat. (Gozon B, Chu J, Schwartz I: Lumbosacral radiculopathic pain presenting as groin and scrotal pain: Pain management with twitch-obtaining intramuscular stimulation. A case report and review of literature. Electromyogr Clin Neurophysiol 41:315-318, 2001).
Most cases of groin pain will respond to a graduated stretching and strengthening program, but these can sometimes take a long time to completely heal. Patience is the key to obtain complete healing, because a return to sports too early can lead to chronicpain, which becomes increasingly difficult to treat.
Management of groin injuries can be challenging, and diagnosis can be difficult because of the degree of overlap of symptoms between the different problems. By careful history and clinical examination, with judicious use of special tests and good team work, a correct diagnosis can be obtained. (Lynch, S A. Renstrom, P A: Groin injuries in sport: treatment strategies. Sports Medicine. 28(2):137-44, 1999 Aug).