Resolving Groin Injuries
Groin injuries are a common athletic injury in both contact and non-contact sports. Injuries to the groin can occur from direct trauma in sports such ice hockey, basketball, football, rugby, and in non-contact sports such as gymnastics. These injuries should be taken seriously because, once an athlete injures their groin, they are twice as likely as other players to incur the same injury again.
Anatomically your groin is the area where your upper thigh meets your pelvis (lower abdomen), essentially the crease or fold between these two areas. However, Groin injuries involve a much larger area than just this. A groin injury can encompass an area that extends from your lower abdomen, to your pelvis, to your hip and inner thigh, and right down to your knee.
Differential Diagnosis of Groin Injuries
Fortunately most groin injuries are musculoskeletal injuries (mechanical problems) that will respond well to manual therapy and exercise. However, it is still important to evaluate other causes of groin pain (pathological causes) rather than assuming the problem is just a simple muscle strain. Some of the other problems that must be considered are:
A hernia is a condition that must be ruled out whenever a groin injury presents itself. Minor hernias do respond to rest, ice, and range of motion exercises. More severe hernias require surgery (mesh reinforcement).
The hip contains approximately eighteen superficial and deep bursae. Bursae are small pouches with slippery surfaces that reduce friction between two moving surfaces (increase gliding). The bursae are usually located in areas where muscles and tendons glide over bones. When the bursa becomes inflamed it loses the ability to decrease the friction between the moving surfaces. As inflammation increases, instead of providing ease of movement, they become a source of friction and pain. Chronic bursitis can be due to an underlying inflammatory condition.
Fractures (Frank or Stress fractures)
If the initial groin injury has been caused by trauma (in a contact sport) then possible fractures must be considered. The two most common sites for stress fractures are in the upper leg (femoral neck) and in the pelvis (pubic rami). A simple X-ray is often all that is needed.
An avulsion often refers to a bone injury where the tendon (which attaches muscle to bone) is torn away from its insertion point. Some of the possible sites of avulsions in a groin injury are:
ASIS (anterior superior iliac spine) – The site of the sartorius muscle attachment.
AIIS (anterior inferior iliac spine) – This is the site where the middle quadriceps (rectus femoris) attaches.
Ischial tuberosity – This is the site of attachment for your hamstrings.
This condition is also known as gracilis syndrome. It is a repetitive stress injury that affects the pubic symphysis. This is an injury that can occur in runners, or sports that involve jumping or kicking. Osteitis Pubis can be increased after childbirth due to ligamentous laxity.
Diagnosing a Musculoskeletal Groin Injury – The Hip Joint
When discussing a groin injury, the hip is a logical place to start. Your hip joint is the largest weight bearing joint in your body. It is designed to absorb shock, generate force, while maintaining an impressive range of motion when functioning correctly. Unfortunately this has also made the hip joint very susceptible to injury due to the amount of repetitive motion and force this joint is subject to.
Treating Groin Injuries
The 72-hour phase after an injury is characterized by swelling and pain. During this phase, use ice to reduce inflammation (ice massage), and if required, take an over-the-counter anti-inflammatory medication. Avoid using these medications after the first 72 hours since they can have a negative effect on tissue regeneration. Even during this initial stage, it is important to get some motion into the affected area to speed the healing process.
During this stage, I recommend that you get as much rest as possible. I also recommend you use a compression strap which will help to prevent further injury. Elevating the injured leg while doing the ice massage every 2 to 3 hours is also essential (ice only 7 to 9 minutes each time).
Manual therapy should be implemented as soon as possible. The longer that the injured person waits for therapy to begin, the longer the resolution time may be. The period of time that you will be unable to perform your usual activities will depend on the cause of injury and the degree of injury.
The first thing practitioners must do in treating a groin injury is perform a biomechanical analysis. In this process they evaluate the patients gait for alteration in movement patterns. Then the practitioner will need to examine these areas (hands-on palpation) to confirm that there is a restriction present. The practitioner will feel an alteration in normal tissue consistency, it will feel ropy, rigid, and there will be a lack of tissue glide between adjacent structures. Once the area needing treatment has been identified, manual therapy can begin. There are several forms of therapy that can achieve good results in addressing myofascial adhesions; they include: Motion Specific Releaes,Active Release, Graston Technique, Massage Therapy, and Fascial Manipulation.
The success rate in resolving a groin injury is very high in the hands of an experienced soft tissue practitioner. As the practitioner work through the soft tissue restrictions they will be looking for changes in tissue consistency, movement and function. Some of these changes are often noted even during the first treatment.