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Afonso J, Claudino JG, Fonseca H, Moreira-Gonçalves D, Ferreira V, Almeida JM, Clemente FM, Ramirez-Campillo R. Stretching for Recovery from Groin Pain or Injury in Athletes: A Critical and Systematic Review. J Funct Morphol Kinesiol 2021; 6:jfmk6030073. [PMID: 34564192 PMCID: PMC8482255 DOI: 10.3390/jfmk6030073] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Revised: 08/24/2021] [Accepted: 08/27/2021] [Indexed: 01/01/2023] Open
Abstract
Stretching is usually used as part of rehabilitation protocols for groin pain or injury, but its specific contribution to and within multimodal recovery protocols is unclear. Our goal was to systematically review the effects of stretching for the recovery from groin pain or injury. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, with eligibility criteria defined according to PICOS: (Participants) athletes with groin pain or injuries; (Interventions) interventions with stretching as the differentiating factor; (Comparators) comparators not applying stretching; (Outcomes) symptom remission or improvement and/or time to return to sport and/or return to play; (Study design) randomized controlled trials. Searches were performed on 26 March 2021, in CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus, and Web of Science, with no limitations regarding language or date, and no filters. Of 117 retrieved results, 65 were duplicates and 49 were excluded at the screening stage. The three articles eligible for full-text analysis failed to comply with one or more inclusion criteria (participants, intervention and/or comparators). We then went beyond the protocol and searched for non-randomized trials and case series, but no intervention was found where stretching was the differentiating factor. We found no trials specifically assessing the effects of stretching on recovery or improvement of groin pain or injury in athletes. Currently, the efficacy of these interventions is unknown, and more research is warranted.
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Affiliation(s)
- José Afonso
- Centre for Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (J.A.); (V.F.); (J.M.A.)
| | - João Gustavo Claudino
- Laboratory of Biomechanics, School of Physical Education and Sport, Universidade de São Paulo, São Paulo 05403-010, Brazil;
- Research and Development Department, LOAD CONTROL, Contagem 32280-440, Brazil
| | - Hélder Fonseca
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (H.F.); (D.M.-G.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-091 Porto, Portugal
| | - Daniel Moreira-Gonçalves
- Research Centre in Physical Activity, Health and Leisure, Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (H.F.); (D.M.-G.)
- Laboratory for Integrative and Translational Research in Population Health (ITR), 4050-091 Porto, Portugal
| | - Victor Ferreira
- Centre for Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (J.A.); (V.F.); (J.M.A.)
| | - José Marques Almeida
- Centre for Research, Education, Innovation, and Intervention in Sport (CIFI2D), Faculty of Sport of the University of Porto (FADEUP), 4200-450 Porto, Portugal; (J.A.); (V.F.); (J.M.A.)
| | - Filipe Manuel Clemente
- Escola Superior Desporto e Lazer, Instituto Politécnico de Viana do Castelo, Rua Escola Industrial e Comercial de Nun’Álvares, 4900-347 Viana do Castelo, Portugal
- Instituto de Telecomunicações, Delegação da Covilhã, 1049-001 Lisboa, Portugal
- Correspondence:
| | - Rodrigo Ramirez-Campillo
- Department of Physical Activity Sciences, Universidad de Los Lagos, Santiago 8320000, Chile;
- Centro de Investigación en Fisiología del Ejercicio, Facultad de Ciencias, Universidad Mayor, Santiago 7500000, Chile
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Gore S, Franklyn-Miller A, Richter C, King E, Falvey E, Moran K. The effects of rehabilitation on the biomechanics of patients with athletic groin pain. J Biomech 2020; 99:109474. [DOI: 10.1016/j.jbiomech.2019.109474] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 08/12/2019] [Accepted: 10/26/2019] [Indexed: 01/29/2023]
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Via AG, Frizziero A, Finotti P, Oliva F, Randelli F, Maffulli N. Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature. Open Access J Sports Med 2019; 10:1-10. [PMID: 30613167 PMCID: PMC6307487 DOI: 10.2147/oajsm.s155077] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Osteitis pubis is a common cause of chronic groin pain, especially in athletes. Although a precise etiology is not defined, it seems to be related to muscular imbalance and pelvic instability. Diagnosis is based on detailed history, clinical evaluation, and imaging, which are crucial for a correct diagnosis and proper management. Many different therapeutic approaches have been proposed for osteitis pubis; conservative treatment represents the first-line approach and provides good results in most patients, especially if based on an individualized multimodal rehabilitative management. Different surgical options have been also described, but they should be reserved to recalcitrant cases. In this review, a critical analysis of the literature about athletic osteitis pubis is performed, especially focusing on its diagnostic and therapeutic management.
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Affiliation(s)
- Alessio Giai Via
- Department of Orthopaedic Surgery and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy
| | - Antonio Frizziero
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Paolo Finotti
- Department of Physical and Rehabilitation Medicine, University of Padova, Padova, Italy
| | - Francesco Oliva
- Department of Orthopaedics and Traumatology, Tor Vergata Hospital, University of Rome "Tor Vergata", Rome, Italy,
| | - Filippo Randelli
- Department of Orthopaedic Surgery and Traumatology, Hip Surgery Center, IRCCS Policlinico San Donato, Milano, Italy
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, School of Medicine and Surgery, University of Salerno, Salerno, Italy.,Centre for Sport and Exercise Medicine, Queen Mary University of London, Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End Hospital, London, England
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Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review. Sports Med 2018; 47:2011-2026. [PMID: 28497284 DOI: 10.1007/s40279-017-0742-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Groin injury is a common musculoskeletal complaint for athletes competing in a variety of sports. The extent to which exercise interventions incorporating external load are an appropriate option for the treatment and prevention of groin injury in athletes is not yet clear. OBJECTIVES The aim of this review was to describe and evaluate exercise therapy interventions and outcomes for the treatment and prevention of groin injury with specific attention to application of external load. DATA SOURCES The databases Medline, PubMed, SPORTDiscus, Web of Science, and Cochrane were searched on 18 April 2016. STUDY ELIGIBILITY CRITERIA This review was registered as PROSPERO CRD42016037752 and a systematic search was conducted with the following inclusion criteria: any study design evaluating exercise interventions for the prevention or treatment of groin pain in athletes. DATA ANALYSIS Two independent authors screened search results, performed data extraction, assessed risk of bias using the modified Downs and Black appraisal tool and determined strength and level of evidence. Reporting standards for exercise interventions were assessed using the Consensus for Exercise Reporting Template (CERT). RESULTS A total of 1320 titles were identified with 14 studies satisfying the inclusion criteria, four (29%) of which demonstrated low risk of bias. Ten (71%) studies utilised external load as a component of the exercise intervention. Reporting standards for exercise intervention scores ranged from 0 to 63%. CONCLUSION There is limited evidence from level 2 and 3 studies indicating exercise therapy may reduce the incidence and hazard risk of sustaining a groin injury in athletes. There is strong evidence from level 4 studies indicating exercise therapy is beneficial as a treatment for groin injury in athletes in terms of symptom remission, return to sport and recurrence outcomes. However, there are limited studies with low risk of bias, and exercise interventions for the treatment of groin injury are poorly described.
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Ramazzina I, Bernazzoli B, Braghieri V, Costantino C. Groin pain in athletes and non-interventional rehabilitative treatment: a systematic review. J Sports Med Phys Fitness 2018; 59:1001-1010. [PMID: 30160087 DOI: 10.23736/s0022-4707.18.08879-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Groin pain is a common complaint both in high-performance and recreational athletes. Diagnosis is based on the patient's history and physical examination. Imaging assessments are often considered to exclude other pathologies. To date there is no strong evidence to support conservative or surgical treatment options. The purpose of this study is to shed light on the more effective non-interventional rehabilitative treatments for the management of groin pain in athletes and, if possible, provide guidelines useful for clinical practice. EVIDENCE ACQUISITION The following electronic databases were searched: PubMed, Physiotherapy Evidence Database (PEDro), Scopus, Web of Science, Google and Google Scholar. Databases were investigated from January 1997 until March 2017. EVIDENCE SYNTHESIS The results reported in the randomized clinical trial studies highlight that active treatment is better than passive treatment to improve clinical signs of groin pain. Comparing the active strategy with multi-modal treatment the latter allows a faster return to sport activity. Although the evidence remains poor, all the included literature highlights that an integrated strategy which combines active and passive treatment, the assessment of perceived pain, a return to running program and specific-sport exercises is an effective strategy for management of groin pain in athletes. CONCLUSIONS Although we shed some light on common key aspects able to improve the typical signs of groin pain, on the basis of available data we were unable to provide practice guidelines. Further studies are necessary to set the best treatment algorithm for the management of groin pain in athletes.
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Affiliation(s)
- Ileana Ramazzina
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Benedetta Bernazzoli
- Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Cosimo Costantino
- Department of Medicine and Surgery, University of Parma, Parma, Italy - .,Graduate School of Physical Medicine and Rehabilitation, Department of Medicine and Surgery, University of Parma, Parma, Italy
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Nonoperative Management, Rehabilitation, and Functional and Clinical Progression of Osteitis Pubis/Pubic Bone Stress in Professional Soccer Players: A Case Series. J Orthop Sports Phys Ther 2017; 47:683-690. [PMID: 28774219 DOI: 10.2519/jospt.2017.7314] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Case series. Background Pubic bone stress (PBS) is a common acute or chronic response of the pelvis in sports where sprinting, kicking, twisting, and cutting are the dominant movements. There are few nonoperative rehabilitation strategies for the condition reported in the literature, and the outcome of conservative treatment has not been documented. Case Description Five professional and academy soccer players complaining of pubic symphysis pain, confirmed as PBS on magnetic resonance imaging and objective assessment, were treated with a nonoperative rehabilitation program that featured functional and clinical objective markers as progression criteria. Interventions in the acute phase included pharmacological and physical therapeutic modalities to reduce pain initially. Rehabilitation management focused on improving range of motion at the hips and thorax, adductor strengthening, trunk and lumbopelvic stability, gym-based strength training, and field-based rehabilitation and conditioning. Clinical follow-up was performed at least 8 months following return to play. Outcomes All players demonstrated reduced or resolved pain, increased adductor squeeze strength, and return to pain-free training and match play. Return-to-training time averaged 40.6 days (range, 30-60 days) and return to play averaged 49.4 days (range, 38-72 days) within the 5 players. At final follow-up (mean, 29.6 months; range, 16-33 months), there had been no recurrences. Discussion This report of 5 cases suggests that a nonoperative protocol, using clinical and functional progression criteria, may be successful in rehabilitating athletes with PBS for return to sport within 11 weeks. Level of Evidence Therapy, level 4. J Orthop Sports Phys Ther 2017;47(9):683-690. Epub 3 Aug 2017. doi:10.2519/jospt.2017.7314.
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Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study. Knee Surg Sports Traumatol Arthrosc 2017; 25:1958-1966. [PMID: 28093636 DOI: 10.1007/s00167-017-4423-z] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Accepted: 01/03/2017] [Indexed: 01/16/2023]
Abstract
PURPOSE The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football. METHODS In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image. RESULTS Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy. CONCLUSION Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy. LEVEL OF EVIDENCE I.
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Abstract
Context: Groin pain is a common entity in athletes involved in sports that require acute cutting, pivoting, or kicking such as soccer and ice hockey. Athletic pubalgia is increasingly recognized as a common cause of chronic groin and adductor pain in athletes. It is considered an overuse injury predisposing to disruption of the rectus tendon insertion to the pubis and weakness of the posterior inguinal wall without a clinically detectable hernia. These patients often require surgical therapy after failure of nonoperative measures. A variety of surgical options have been used, and most patients improve and return to high-level competition. Evidence Acquisition: PubMed databases were searched to identify relevant scientific and review articles from January 1920 to January 2015 using the search terms groin pain, sports hernia, athletic pubalgia, adductor strain, osteitis pubis, stress fractures, femoroacetabular impingement, and labral tears. Study Design: Clinical review. Level of Evidence: Level 4. Results and Conclusion: Athletic pubalgia is an overuse injury involving a weakness in the rectus abdominis insertion or posterior inguinal wall of the lower abdomen caused by acute or repetitive injury of the structure. A variety of surgical options have been reported with successful outcomes, with high rates of return to the sport in the majority of cases.
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Affiliation(s)
- Osama Elattar
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Ho-Rim Choi
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
| | - Vickie D Dills
- Director of Clinical Services, Physical Therapy Innovations, Auburn, Massachusetts
| | - Brian Busconi
- Orthopaedic Sports Medicine, University of Massachusetts, Worcester, Massachusetts
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Angoules AG. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach. World J Orthop 2015; 6:672-679. [PMID: 26495244 PMCID: PMC4610909 DOI: 10.5312/wjo.v6.i9.672] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Revised: 07/13/2015] [Accepted: 08/07/2015] [Indexed: 02/06/2023] Open
Abstract
Osteitis pubis (OP) is a debilitating overuse syndrome characterizing by pelvic pain and local tenderness over the pubic symphysis commonly encountered in athletes often involved in kicking, twisting and cutting activities in sports such as soccer and rugby and to a lesser degree distance running. It is a common source of groin pain in elite athletes attributable to pubis sympysis instability as the result of microtrauma caused by repetitive muscle strains on pubic bones. Diagnosis is based mainly on detailed sports history and a meticulous clinical examination, although occasionally is difficult to distinguish this nosological entity from other pathologies affecting the involved area which may occur concomitantly in the same patient. Radiologic examinations such as plain radiographs, magnetic resonance imaging and 3 phase bone isotope scanning may be helpful to differentiate from other clinical entities with similar clinical presentation. Most cases respond well to conservative treatment which includes several physical modalities and especially a progressive rehabilitation programmed individualized to each one of patients diagnosed with OP. Local injection therapies have been also been proposed as a non-operative therapeutic option for the efficient management of these patients. In refractory cases, surgical therapeutic strategies are warranted. These include several open or minimally invasive surgical interventions such as arthroscopic or open symphysis curettage, wedge or total resection of pubic sympysis, polypropylene mesh placement and pubic fusion. In this review a critical analysis of OP in elite athletes is performed with special focus on current concepts of diagnosis and management of this source of athletic groin pain.
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McAleer SS, Gille J, Bark S, Riepenhof H. Management of chronic recurrent osteitis pubis/pubic bone stress in a Premier League footballer: Evaluating the evidence base and application of a nine-point management strategy. Phys Ther Sport 2015; 16:285-99. [PMID: 26150099 DOI: 10.1016/j.ptsp.2015.04.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 03/26/2015] [Accepted: 04/23/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND/AIM The aim of this paper was to use a clinical example to describe a treatment strategy for the management of recurrent chronic groin pain and evaluate the evidence of the interventions. METHODS A professional footballer presented with chronic recurrent OP/PBS. The injury was managed successfully with a nine-point programme - 1. Acute pharmacological management. 2. Tone reduction of over-active structures. 3. Improved ROM at hips, pelvis and thorax. 4. Adductor strength. 5. Functional movement assessment. 6. Core stability. 7. Lumbo-pelvic control. 8. Gym-based strengthening. 9. Field-based conditioning/rehabilitation. The evidence for these interventions is reviewed. RESULTS The player returned to full training and match play within 41 and 50 days, respectively, and experienced no recurrence of his symptoms in follow up at 13 months. CONCLUSION This case report displays a nine-point conservative management strategy for OP/PBS, with non-time dependent clinical objective markers as the progression criteria in a Premier League football player.
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Affiliation(s)
- Stephen S McAleer
- Department of Sports Medicine and Science, Brighton and Hove Albion Football Club, Brighton, UK; British Athletics, University of Bath Sports Training Village, Bath, BA2 7AY, UK.
| | - Justus Gille
- Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Stefan Bark
- Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
| | - Helge Riepenhof
- Department of Sports Medicine and Science, Brighton and Hove Albion Football Club, Brighton, UK; Sektion Unfallchirurgie, University Hospital Schleswig-Holstein, Campus Lübeck, Germany
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