Groin strains and other injuries are very commonly observed in sports, and have been reported to cause up to 16% of injuries in sports like soccer. For those that work with athletes and who have seen these injuries, you know that groin strains can be tricky and often times become a recurrent problem. Thus, it is important to identify risk factors associated with groin injuries to assist in identifying those at risk for injury as well as serving as a potential criteria to return to play.
A recent study from the American Journal of Sports Medicine followed 508 soccer players over the course of one season in an attempt to identify potential factors correlating to groin injury. The authors examined several functional tests (such as jumpy tests and a 40-m sprint) a several clinical examinations including strength, flexibility, and palpation of the hips and lower extremity muscles.
10% of players followed sustained a groin strain. The authors demonstrated that the two most significant risk factors were:
History of previous groin injury – those with a history of previous groin injuries were twice as likely to sustain another groin injury
Weak adductor muscle – those with weak adductor muscle groups show a 4x greater chance of sustaining a groin injury.
Several studies in the past have shown similar results in regard to previous injuries and this is one of the main things I preach when developing and implementing injury prevention programs:
The #1 risk factor for muscle strain injuries is a previous muscle strain injury
Therefore, attempting to prevent injuries is key. The second component of this study is a good step in that direction. Adductor weakness had a very large contribution to groin injuries. I think we could also extrapolate this information to other muscle groups as well, such as the quad or hamstring. The way I think of it is that a healthy athlete with muscle weakness or imbalance is still going to perform at 100% intensity. But if a specific muscle group was at, perhaps 80% strength, something has to give and a strain occurs.
This information really underscores three take home messages for me:
Past injuries are going to lead to future injuries, often times there was a reason this person was injured the first time, right?
We need to do our best to identify those at risk for injuries to prevent this future cycle of injury and reinjury – this includes screening for muscle weakness and imbalances
We need to make sure that the athlete returns to activities when they have restored this weakness or imbalance. I bet one of the reasons that these injuries continue to reoccur is because we far too often rely on pain as our criteria to return to play. Just because the athlete is asymptomatic does not mean they are ready to compete.
What have you found to be helpful in reducing these reinjuries? What do you do to screen for lower extremity imbalances? Have you found them to be effective in preventing injuries?