Physiotherapy in Groin Pain

A lot of athletes complain about pain in the groin or Pubalgia, also commonly termed as Sports hernia. Elite sportsmen like Odell Beckham, Lucas Digne, Kareem Hunt, Delon Wright, and most recently Indian bowler Bhuvaneshwar Kumar suffer from groin pain. This can lead to a setback in sporting career and a fall in performance.

It is a common complaint among male sportsmen who are involved in sports which requires the athlete to perform repetitive kicking, twisting at high energy like soccer, hockey, long distance running, American football, cricket etc. The underlying cause of pain is multifactorial. The female athletes are less prone to this condition due to difference in anatomy, thus changing the biomechanics. The groin is a complex structure anatomically. Some of the causes for groin pain can be:

·         Tendonitis (inflammation of the muscle tendon)

·         Muscle sprain or tear

·         Impingement (pinching of structures)

·         Fracture

·         Inguinal hernia

·         Arthritis of the hip joint

·         Bursitis (inflammation of the fluid filled sac: bursa)

·         Avascular necrosis of the Hip (death of bone tissue due to poor blood supply)

·         Urinary tract infection

·         Nerve impingement (pinching of the nerve)

One of the common cause of groin pain/sports hernia can be an underlying muscular weakness of the lower abdominal muscles and muscles of the inner thigh. A balance between these two muscles is essential for good pelvic and hip control and mobility. Any weakness/tightness in one of the muscles can lead to change in biomechanics which causes abnormal pull on muscles. Inequality in muscle pulls can lead to muscle tears and herniation, in extreme cases.

Common complaints:

PAIN

Where?  - Groin pain which spread to upper end of front aspect of the thigh, lower abdomen, low back, scrotum especially on one side (affected side).

When? – It hurts more after athlete performs activities like kicking, running, twisting, and sit-ups. Pain can also be experienced while coughing or sneezing. Pain reduces with rest. Activities which involve excessive back bending (hyperextension of back) or excessive outward movement at the hip (hyper-abduction at hip) increases the load on the structures causing pain.

Type of pain? – Sudden deep seated severe pain episodes. 

TENDERNESS - Person experiences pain on touch and pressure around the front of the hip, thigh and lower abdominal area.

SWELLING – Swelling can be present in the groin, upper thigh area when compared to other side.

SKIN CHANGES – bluish, blackish, reddish discoloration can also be present in the groin or upper thigh.

Investigation of groin pain by an expert is very important as finding out the underlying cause of pain is critical, as sports hernia is a misleading term which can point towards multiple diagnoses. Ultrasound, MRI, CT scan and special tests performed by medical professionals can help to come on a conclusion. Line of treatment and recovery period varies depending on the structure affected.

Role of physiotherapy in groin pain-

Prevention (PREHAB)

Rehabilitation (REHAB)

EARLY ASSESSMENT- ·         Identifying muscular imbalance in an early stage ·         Posture and sports specific assessments PREVENTIVE EXERCISE PLAN- ·         Posture corrections ·         Strengthening- lower abdominals, hip, core and pelvic floor muscles ·         Stretching- adductors, back fascia, hip capsule ·         Core stability and engagement during sport specific activities ·         Sports related biomechanical corrections ·         Proper warm-up and cool-down regime

ACUTE PHASE MANAGEMENT- ·         Rest and protection ·         Pain relief with cryotherapy, manual therapy and electrotherapy modalities like- ultrasound, IFT, etc. ·         Taping for recovery and optimal loading MANAGEMENT FOR RETURN TO ACTIVITIES- ·         Improving hip and pelvic mobility ·         Stretching and strengthening programs ·         Motor control training for back, pelvis and hips ·         Incorporation in sports specific activities ·         Return to sports/ play protocol

In extreme cases, surgery may be indicated to repair the muscle tear and hernia. Thus early assessment can detect muscular imbalances and reduce the chances of groin pain. If an athlete is already suffering with groin pain, finding out the underlying reason on time can help to reduce complications, impairments and off field time.

REHAB STATION is a sport and musculoskeletal centric physiotherapy lab, situated in the heart of Pune city. We are a team of physiotherapists who have expertise in the field manual therapy, exercise therapy and advanced electrotherapy. The lab has high end electrotherapy modalities which can help in the early phase of pain relief, thus hasten the recovery process. Early intervention and correction of posture, muscular imbalance and biomechanics can reduce the risk of complications like hernia.

At REHAB STATION, we screen the athlete thoroughly and design individualised exercise programs. We have machines like HUBER ®360 and Wireless professional which can used to make customised training programs more robust and sports specific.

We believe that "Prevention is better than cure” and thus we aim to spread awareness regarding Preventive Rehabilitation. A tailor-made protocol after a detailed athletic assessment can help to reduce the risk of injuries like groin pain.