Injuries of the obturator muscles in professional soccer players

An Unlikely Cause of Groin Pain: Obturator Externus Tear in a Professional Soccer Player

Groin pain is a common and complex problem in athletes, especially soccer players, associated with a wide variety of possible injuries in numerous anatomical structures. One of the causes of groin pain is damage to the deep muscles of the hip region, with isolated traumatic injury of the obturator externus muscle rarely described and probably underdiagnosed. This report describes a clinical case of a soccer player who presented with acute hip pain and buttock pain resulting from a rapid change of position in load, associated with pain with active hip external rotation and passive internal rotation. MRI demonstrated the presence of subaponeurotic/myo-aponeurotic obturator externus muscle tear. A conservative treatment was decided, targeting pain reduction and progressing range of motion gain and muscle strengthening of the stabilizing muscles of the pelvis and hip, and subsequently, it led to re-athletisation, with soccer-specific exercises. Return to play was 23 days after injury. This case shows that a high level of suspicion is necessary for the correct diagnosis; treatment is generally conservative and the isolated rupture of the external obturator can be considered relatively benign. However, it has the potential to be associated with a long period of absence from training and games.

Isolated Adductor Magnus Injuries in Athletes: A Case Series

Background

Little is known about injuries to the adductor magnus (AM) muscle and how to manage them.

Purpose

To describe the injury mechanisms of the AM and its histoarchitecture, clinical characteristics, and imaging features in elite athletes.

Study Design

Case series; Level of evidence, 4.

Methods

A total of 11 competitive athletes with an AM injury were included in the study. Each case was clinically assessed, and the diagnosis and classification were made by magnetic resonance imaging (MRI) according to the British Athletics Muscle Injury Classification (BAMIC) and mechanism, location, grade, and reinjury (MLG-R) classification. A 1-year follow-up was performed, and return-to-play (RTP) time was recorded.

Results

Different mechanisms of injury were found; most of the athletes (10/11) had flexion and internal rotation of the hip with extension or slight flexion of the knee. Symptoms consisted of pain in the posteromedial (7/11) or medial (4/11) thigh during adduction and flexion of the knee. Clinically, there was a suspicion of an injury to the AM in only 3 athletes. According to MRI, 5 lesions were located in the ischiocondylar portion (3 in the proximal and 2 in the distal myoconnective junction) and 6 in the pubofemoral portion (4 in the distal and 2 in the proximal myoconnective junction). Most of the ischiocondylar lesions were myotendinous (3/5), and most of the pubofemoral lesions were myofascial (5/6). The BAMIC and MLG-R classification coincided in distinguishing injuries of moderate and mild severity. The management was nonoperative in all cases. The mean RTP time was 14 days (range, 0-35 days) and was longer in the ischiocondylar cases than in the pubofemoral cases (21 vs 8 days, respectively). Only 1 recurrence, at <10 months, was recorded.

Conclusion

Posteromedial thigh pain after an eccentric contraction during forced adduction of the thigh from hip internal rotation should raise a suspicion of AM lesions. The identification of the affected portion was possible on MRI. An injury in the ischiocondylar portion entailed a longer RTP time than an injury in the pubofemoral portion.

Acute Obturator Externus Injury in Professional Soccer Players: A Case Series

When patients present with hip or groin pain, proximal quadriceps or adductor injuries are often initially suspected. In this case report, however, we present three cases of professional soccer players who were found to have obturator externus injury. A 30-year-old player and a 24-year-old player complained of pain in the left side after long distance shooting during an in-season training session and a match, respectively. Another 24-year-old player complained of pain in the right side after long distance passing during a preseason training session. On physical examination, active hip external rotation and passive hip internal rotation and extension elicited pain in all three players. All three players underwent magnetic resonance imaging (MRI) which found obturator externus grade II injuries for two players and grade I injury for one player. Rehabilitation protocols included relative rest, cryotherapy, and electrotherapy over a period of one week. All patients were able to return to play after 10 days. Correct identification of obturator externus injury afforded our players a favorable prognosis and a relatively quick return-to-sport compared with quadricep or adductor injury.

Isolated Obturator Internus Muscle Strain Injury in a Professional Football Player: A Case Report

The present case report concerns an isolated obturator internus muscle strain. The patient, who was a 30-year-old professional, elite-level football player, suffered the injury during the warm-up before a football match. Isolated injuries of the obturator internus are very uncommon and they are extremely rarely reported in the literature. The diagnosis was made clinically, documented by magnetic resonance imaging. The rehabilitation program was conducted conservatively with physical therapy and kinesiotherapy. The patient’s return to full athletic activity took place 2 weeks after the incident.

Physical exercises for preventing injuries among adult male football players: A systematic review

BACKGROUND

Football is the most practised sport in the world and is associated with the risk of injuries in the players. Some studies have been published that identify injury prevention programs, but there is no review of the full body of evidence on injury prevention programs for use by football coaches. The aim of this article was to carry out a systematic review of published studies on injury prevention programs for adult male footballers, identify points of common understanding and establish recommendations that should be considered in the design of injury prevention strategies.

METHODS

PubMed and EMBASE databases were used to identify relevant published articles using the following keywords: "soccer" AND "injury" AND "prevention".

RESULTS

A total of 2512 studies were identified initially, but only 11 studies met the inclusion criteria, and their outcomes are presented. Results revealed that injury prevention programs in football have focused on strength training, proprioceptive training, multicomponent programs (balance, core stability, and functional strength and mobility), and warm-up programs.

CONCLUSION

Based on results from the studies analyzed, football players can lower the incidence of match and training injuries by participating in dynamic warm-up programs that include preventive exercises before games or during training sessions, and by adding strength, balance, and mobility training to the training sessions.

The dominant leg is more likely to get injured in soccer players: systematic review and meta-analysis

In soccer (football), dominant limb kicking produces higher ball velocity and is used with greater frequency than the non-dominant limb. It is unclear whether limb dominance has an effect on injury incidence. The purpose of this systematic review with meta-analysis is to examine the relationship between limb dominance and soccer injuries. Studies were identified from four online databases according to PRISMA guidelines to identify studies of soccer players that reported lower extremity injuries by limb dominance. Relevant studies were assessed for inclusion and retained. Data from retained studies underwent meta-analyses to determine relative risk of dominant versus non-dominant limb injuries using random-effects models. Seventy-four studies were included, with 36 of them eligible for meta-analysis. For prospective lower extremity injury studies, soccer players demonstrated a 1.6 times greater risk of injury to the dominant limb (95% CI [1.3-1.8]). Grouped by injury location, hamstring (RR 1.3 [95% CI 1.1-1.4]) and hip/groin (RR 1.9 [95% CI 1.3-2.7]) injuries were more likely to occur to the dominant limb. Greater risk of injury was present in the dominant limb across playing levels (amateurs RR 2.6 [95% CI 2.1-3.2]; youths RR 1.5 [95% CI 1.26-1.67]; professionals RR 1.3 [95% CI 1.14-1.46]). Both males (RR 1.5 [95% CI 1.33-1.68)] and females (RR 1.5 [95% CI 1.14-1.89]) were more likely to sustain injuries to the dominant limb. Future studies investigating soccer injury should adjust for this confounding factor by using consistent methods for assigning limb dominance and tracking use of the dominant versus non-dominant limb.

Acute Groin Pain Syndrome Due to Internal Obturator Muscle Injury in a Professional Football Player

Traumatic groin pain syndrome is the result of an acute trauma, usually an indirect muscle injury (i.e., an overstretching of the muscle fibers). The most affected muscles in traumatic groin pain syndrome are rectus abdominis, adductors, and iliopsoas. The internal obturator muscle lesion is very rare. The internal obturator muscle externally rotates the thigh and contributes to the stabilization of the hip joint and its indirect injury may cause the onset of traumatic groin pain syndrome. This case report describes a rare indirect injury of internal obturator in a 29-year-old professional male soccer player.

Traumatic Obturator Internus and Quadratus Femoris Injury in a Pediatric Patient: A Case Report

We present the case of a 11-year-old White female patient with a traumatic quadratus femoris and obturator internus tear after a sprint while at school. She felt immediate pain, swelling, and point tenderness in her posterosuperior thigh with a severely antalgic gait. Magnetic resonance imaging demonstrated a quadratus femoris tear, obturator internus tear, and ischial spine avulsion fracture. Although a less common etiology for acute hip pain in the pediatric population, traumatic injury to the short external rotators should not be excluded. The prognosis is favorable with a full return to previous activities expected using an appropriate rehabilitation program.

Obturator internus muscle strain in an adolescent skier

There are many causes of acute hip pain. Obturator internus (OI) muscle strain is a rare cause of the presentation. We report a case of OI muscle strain in a 15-year-old ski racer who presented with new onset acute right hip pain. Magnetic resonance imaging showed enhancement of the obturator internus muscle indicating muscle injury. Patient was treated conservatively with target physical therapy and NSAIDs for pain management. This case illustrates an atypical diagnosis for a common chief complaint.