Hip & Groin Pain In The Sporting Population

Hockey

Hip & Groin Pain is an extremely common presentation amongst the sporting population. It is especially prevalent in sports that require quick accelerations/decelerations and sudden direction changes (soccer, football, hockey). It’s often a more complex presentation, with the involvement of multiple tissues possible. As a result, an accurate diagnosis is essential to determine both the factors contributing to injury, and to guide your treatment.

Possible Tissues Involved

Many tissues can be involved in presentations of hip and/or groin pain. Including, but not limited to the following:

  • Hip Joint: Joint capsule; Ligament; Labrum; Bone
  • Muscle / Tendon: Adductors; Gluteals; Quads; Hip Flexors; Abdominals
  • Pubic Symphysis
  • Pubic Bones
  • Sacroiliac Joint
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Contributing Factors

A tissue (such as any of those listed above) will become symptomatic when it is loaded adversely (beyond what it is able to tolerate). Determining which tissues are involved in hip and groin pain can help determine the factors contributing to injury and therefore guide injury management and prevention.

Factors contributing to Hip & Groin pain may include:

Intrinsic Factors:

  • Bony Morphology: CAM and Pincer lesions
  • Congenitally shallow acetabulum (socket)/ hip dysplasia
  • Femoral/acetabular anteversion or retroversion
  • Ligament and joint capsule laxity
  • Pelvic stability
  • Foot Posture

 

Extrinsic Factors:

  • Reduce core control and lumbopelvic stability
  • Weakness in stabilising muscles of the hip
  • Poor motor patterning
  • Running/jumping biomechanics
  • High impact and high volume loads
  • Lifestyle and work demands eg. prolonged sitting

What can we do to Diagnose, Fix and Prevent Hip & Groin Pain?

  • Diagnosis: It is important to accurately identify tissues involved and associated contributing factors to ensure appropriate management and prevention of future injury.
  • Motor patterning & control: Improving motor patterning and patterns of muscle activation is essential. Ensuring that the muscles that stabilise our hip joint and pelvis are working well will reduce adverse load through likely symptomatic tissues.
  • Strengthening: Global strength is important. Sport and activity requires complex movement patterns to be performed well and efficiently.
  • Soft Tissue Technique / Dry Needling: Often overworked or overactive tissues need to be released.
  • Load Management: Load may been to be altered to minimise stress on affected tissues and the effects or repetitive microtrauma. This may be related to sports and exercise, or more passive activities such as sitting.
  • Rest: Rest may be advised to give affected tissues a chance to rest and recover.
  • Cortisone Injections / NSAIDS: Can be beneficial in improving pain and inflammation but are not a fix. They create a window of opportunity to address contributing factors whilst pain has eased. Relying on a cortisone injection alone will likely result in recurrence of your symptoms down the track.
  • Surgery: Arthroscopic surgery for various hip and groin pain presentations has had limited success to date. Evidence of poor quality has demonstrated short term improvements in many cases, however is unable to rule out the effect of placebo (which has been proven to be highly prevalent in many knee arthroscopies). Studies have also found significant strength and functional deficits in patients for 12-24 months post hip arthroscopy (on both surgical and non surgical sides). This suggests that surgery alone will not address the contributing factors and underlying cause your condition.  As a result, best practice for hip and groin pain should include a period of conservative management, with those who continue to have pain utilising this period as pre-habilitation.

Summary…

If you are suffering from Hip or Groin Pain or would like some more information we encourage you to contact us on (03) 5229 3911 or info@theinjuryclinic.com.au

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