Sports Hernia – Groin Pain

Athletic Pubalgia, sports related hernia, athletic groin pain.  All describing anterior pain, localized in the groin, anterior hip area.  The U.K. has done a lot of research and the BJSM has published great work looking at how to define “Sports Hernia”, how to consider diagnosis and how to manage it appropriately.

In essence, chronic groin pain, adductor related may be consistent with athletic groin pain.  Rehabilitation of the core musculature and adductor group is critical in the improvement of pain and function.  See this great graphic from BJSM.

Per Holmich’s protocol as described in Lancet 1999 started the gold standard in groin related rehab. More recently, the Copenhagen Adductor Exercise was introduced.  Here’s an editorial in BJSM. https://bjsm.bmj.com/content/early/2021/02/23/bjsports-2020-103564.  this also takes you to a video.

http://www.youtube.com/watch?v=L6qfTLKhjnk

Here is a great video series to describe the exercises in the Lancet on Per Holmich’s protocol.

Yes, it’s from 1999, but it is a terrific study with long-term outcomes, done with a RCT format.  This video series also has a web based app too!

http://h.theapp.mobi/adductorprotocol

Since then Per Holmich has published much to get a handle on the diagnosis and management.  Couple of key articles in the BJSM just published in 2016.

Bottom line, give good exercises guided by a physical therapist a try.  Surgery is always an option but consider exercise therapy using the Copenhagen and Holmich exercises.

REFERENCES

1. Holmich et al. Effectiveness of active physical training as treatment for long standing adductor-related groin pain in athletes: RCT. Lancet 1999.  http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)03340-6/abstract
2. Ishøi L, Thorborg K. Copenhagen adduction exercise can increase eccentric strength and mitigate the risk of groin problems: but how much is enough! British Journal of Sports Medicine Published Online First: 24 February 2021. doi: 10.1136/bjsports-2020-103564. 
3. Falvey et al. Athletic Groin Pain.  BJSM 2015.  http://bjsm.bmj.com/content/early/2015/11/30/bjsports-2015-094912.full
4. Darren de SA, Holmich P , Phillips M et al. Athletic Groin Pain. A SR of Surgical diagnoses investigations and treatments. BJSM 2015 http://bjsm.bmj.com/content/early/2016/05/06/bjsports-2015-095137.abstract
5. King E, Ward J, Small L, et al. Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes. Br J Sports Med 2015;49:1447-1451.  http://bjsm.bmj.com/content/49/22/1447.full?sid=9b6afde9-1f8f-4f9a-a6b4-02e7677c4e57