In hip and groin problems, which constitute 5-8% of all sports injuries, since the most common complaint among athletes is groin pain, such injuries are discussed under the heading of groin pain. Although it is frequently encountered, it is one of the least understood topics of sports medicine. Pain can arise from many joints, muscle groups, and nerve structures. The difficulty in diagnosis arises not from the structures themselves, but from the close relationship between the structures. Considering the biomechanics around the hip and groin, dysfunction of one anatomical structure may lead to dysfunction of another structure. As a result, the physician's finding the main dysfunction after a careful history and systemic examination and offering the athlete a realistic and targeted rehabilitation program will increase success.
Injuries to the adductors, osteitis pubis and athlete's hernia are the most common problems. Other important reasons; hip joint problems, hip circumference problems, nerve damage, waist problems, urogenital problems and intra-abdominal problems.
- Groin Pain Related to Adductors (Adductor Strain)
It is one of the most common groin problems (62%). It is more common in football, hurdle racing, karate and ice hockey athletes. Those in the tendinous region are injuries that heal slowly. Muscle-tendon junction injuries are the most common adductor injuries. Another injury may occur in the muscle area.
Lower extremity biomechanical disorders play an important role among the causes. These are foot and leg deformities, length inequality and muscle imbalance.
The most important finding in diagnosis is pain. It decreases as you warm up and increases towards the end of the activity or when it cools down. Sprinting, changing direction, and hitting the ball are painful. The location of the pain is important. It is often at the adductor longus attachment site. Adduction against resistance and stretching of the muscle are painful.
Ultrasonography is important in diagnosis. The area and degree of injury can be evaluated with MRI.
Treatment: In acute injuries, ice application and painkillers begin. It is then continued with physical therapy to preserve joint range of motion and prevent muscle weakening. controlled Stretching, strengthening and proprioceptive exercises are performed. Return to sports is achieved with ideal strength, flexibility and endurance.
For chronic injuries, strengthening and proprioceptive exercises are performed. Physical therapy combined with active training exercise can give good results. In resistant cases, surgical treatment, often tendon release, is applied.
Return to sports can be made after 70% of muscle strength is gained and full range of motion without pain is achieved. This may take up to 4-8 weeks for acute injuries and 6 months for chronic injuries.
- Osteitis Pubis
Painful pain of the symphysis pubis and surrounding structures. It is an inflammatory and non-infectious disease. Chronicity and joint deterioration are the main features. It is frequently seen in football players, runners (long-distance-disabled)and swimmers.
The causes include micro-traumas caused by the abdominal muscles and adductor muscles, muscle imbalance, tension in the adductor and abdominal muscles, tension in the hips. Internal rotation limitation, instability in the sacroiliac joint or symphysis pubis, excessive lumbar cupping and pelvic anteversion, lower extremity inequality, increased pronation, varus and valgus deformities.
Diagnosis: As a clinical finding. There is pain in the pubic area, inner thigh, radiating to one or both sides. It may spread to the hip or groin area. During physical examination, symphysis tenderness, adductor longus and inferior pubic arm sensitivity, hip rotation limitation, pelvic disharmony, sacroiliac joint sensitivity and mobility limitation can be detected. Pain in the groin or pubic area when jumping on one leg is described as a significant test. Pain may increase with active adduction and sports activity. Pain can be provoked by sitting upright. Direct radiography is normal in the early period. It may not be parallel to the complaints. In the future, there may be enlargement of the symphysis pubis, periarticular sclerosis, irregularity at the joint edge, or a moth-eaten appearance on the pubic arms. MRI shows bone marrow edema.
Treatment: The basis of treatment is rehabilitation. Rest and pain treatment are followed by physical therapy. Hip range of motion exercises, adductor stretching and strengthening exercises are performed. exhaust Pain should be avoided while performing erections. Corticosteroid injection is controversial. Surgical treatment options are drilling, curettage, resection and arthrodesis (freezing the joint). Collaboration between doctor, physiotherapist, athlete and coach is important throughout the treatment. The patient should return to sports after being completely pain-free. The average recovery time is 6–9 months.
- Athlete Hernias
Causes:
Posterior groin - abdominal wall anomalies, posterior groin wall muscle tears due to overuse, muscle imbalance (weak abdominal - strong adductor), muscle shortening may occur.
Diagnosis: A good clinical history should be taken. It starts insidiously and progresses slowly. Pain is the most important finding. It is a widespread and deep groin pain. It can spread to the rectus abdominus, adductors, perineum and groin. Movements that increase intra-abdominal pressure are painful. Ultrasonography may reveal posterior abdominal wall anomaly. Herniography can be performed.
Treatment is usually surgical. It can be done by endoscopic or open method. Repair - mesh application is made. Successful results can be achieved with a rate of 97%. Return to sports may occur in 6-8 weeks.
- Hip Joint Problems
The hip joint is subject to high additional stress and is vulnerable to injury. is a joint. An intra-articular problem should be considered if complaints persist after 4-6 weeks in an athlete who has had a hip injury.
- Capsular Laxity
It is hip instability of unknown cause. There is extension and relaxation in the joint capsule. It can be seen in professional and high-level athletes who do sports such as gymnastics, football, ballet and taekwondo.
The athlete may express complaints such as a feeling of slipping, a feeling of external rotation, insecurity, pain, painful cracking, external rotation gap. X-ray, MR arthrography and fluoroscopic control are helpful in diagnosis. Treatment is usually surgical. The aim is to reduce the capsular volume. Capsular stretching and arthroscopic thermal capsulorrhaphy can be performed. Return to sports is 13-17 weeks.
- Acetabular Labrum Tears
It is the most important hip joint problem that causes groin pain in athletes. Labrum tear in hip pain that does not go away for weeks in athletes It should be considered. Causes of injury include compression, joint looseness, trauma (dislocation, semi-dislocation) and developmental delay. History is very important in diagnosis. The most obvious symptom is deep anterior groin pain. It increases with activity in some positions and disappears with rest. Painful clicking or sticking, temporary locking, limitation of movement, feeling of slipping, decreased performance, and limitation of daily activities may occur. On physical examination, pain in flexion, internal rotation and adduction of the hip is significant. MR, MRI Arthrography is 90% - 95% sensitive. A 98% definitive diagnosis is made with arthroscopy.
In treatment, conservative methods such as pain management, physical therapy, intra-articular injection, bed rest, traction, and non-loading are applied. Arthroscopy is the gold standard as a surgical treatment.
- Femoroacetabular impingement
It is an important cause of groin pain. It is especially seen in young athletes. Abnormal structure of the femoral head and neck and dysplastic acetabulum may be the cause. The patient has groin pain and it increases with sports activity. The pain is sharp and stabbing like a knife. Flexion and internal rotation of the hip are painful. X-ray, MRI, MRI arthrography are helpful in diagnosis.
Treatment is started with conservative methods. Activity modification, activity limitation, control of excessive hip movement, painkillers, physical therapy (passive stretching) are applied. Surgical treatment can be performed open or arthroscopically. Correction of the contours of the femoral head and neck region, and sometimes resection is performed for the anterior edge of the acetabulum.
- Ligamentum Teres Injury
Ballet, judo It can be seen in people who do karate and taekwondo sports. Pain, insecurity, slipping and feeling of turning outward are the main symptoms. Diagnosis can be made with MRI. Diagnosis and treatment are possible with arthroscopy.
Other Hip Joint Problems (Intra-articular); avascular necrosis of the femoral head, synovitis (toxic, inflammatory), transient synovitis, osteochondritis dissecans, osteoarthritis (posttraumatic,inflammatory), arthritis, stress fractures, fractures, traumatic hip dislocation , Perthes-Calve-Legg disease, dysplasia, pigmented villonodular synovitis, slipped capital femoral epiphysis, chondral injuries in the femoral head, capsular tears, capsular stiffness, tumors, infections.
- Hip Circumference Problems (Extra-articular)
Stress Fractures (Pubis Arm), bursitis, snapping hip syndrome, gluetus Medius Syndrome (Sciatic nerve), muscle-tendon injuries, myositis ossificans, avulsion fractures.
<Pudendal neuropathy, genitofemoral neuropathy, obturator neuropathy, lateral femoral cutaneous nerve compression, sciatic neuropathy (Priformis – Hamstring)
- Lumbosacral Problems
Herniated discs, stenosis in the waist, slipped disc, rheumatoid arthritis, ankylosing spondylitis, gout, bone infections.
- Urogenital Problems
Urinary system infections, prostatitis, urethritis, kidney stones, scrotal and testicular problems.
- Intra-abdominal Problems
Aneurysms, appendicitis, diverticulosis, tumors, inflammatory bowel diseases.
Prevention of Groin Injuries
- Covering the lack of strength
- Flexibility
- Muscle balance around the pelvis (adductor, abductor, abdominal)
- Pelvic proprioception
- Detailed examination before participation in sports
- Removal of risk factors
- Physical fitness - Conditioning
- Adequate warm-up - Cooling down
- Progressive training programs
- Correct technique
- Appropriate equipment – orthotic
- Proper nutrition and fluid intake
- Adequate sleep
- Teamwork
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