Groin pain syndrome: an association of different pathologies and a case presentation

Effects of consecutive days of matchplay on maximal hip abductor and adductor strength in female field hockey players

Background

The purpose of this study was to examine the effects of two competitive field hockey matches, played on consecutive days, on maximal isometric hip adductor and abductor strength, wellness and fatigue.

Methods

Fourteen professional female field hockey players (age: 20.4 ± 5.4 years; body mass: 60.7 ± 7.2 kg; height: 167.0 ± 1.0 cm) volunteered to participate in this investigation. Maximal isometric hip adductor and abductor strength were obtained before (pre-match 1) and after the first match (post-match 1), after the second match (post-match 2), and 48 h after the second match. Locomotion patterns during the matches were obtained with portable Global Positioning System (GPS) and perceived exertion (RPE) was assessed after each match. In addition, Wellness Questionnaire (5-WQ) and the Total Quality Recovery Scale (TQR) were employed before the matches and 48 h after the second match.

Results

For the non-dominant limb, the maximal isometric hip adductor and abductor strength were lower after post-match 2 when compared to pre-match 1 (p = 0.011). Hip abductor strength in the non-dominant limb remained reduced 48 h after post-match 2 (p < 0.001). There were no differences in the total distance covered when comparing match 1 and match 2. Players reported more acute fatigue (5-WQ, p = 0.009) and increased muscle soreness on pre-match 2 compared to pre-match 1 (p = 0.015), while fatigue returned to pre-competition levels 48 h after post-match 2 (p = 0.027). No changes were observed in the TQR.

Conclusion

The assessment of maximal adductor and abductor strength before and after competitive matches, in addition to evaluating self-perceived fatigue by a wellness questionnaire can help to identify field hockey players with excessive fatigue responses during tournaments with a congested match program.

The Case of Insertional Adductor Tendinopathy of an International-Level 3,000-m Steeplechase Runner

Background: Groin pain is a frequent condition among athletes. One of the causes of groin pain is tendinopathy, a frequently diagnosed medical condition, which can also occur in the adductor muscles. Despite the high prevalence of this medical condition among athletes, it is infrequent to observe tendinopathic groin pain in steeplechase runners. The aim of this case study is to describe the case of an international-level 3,000-m steeplechase runner with groin pain, who was subsequently diagnosed with adductor insertional tendinopathy.

Case Presentation: We present the case of an Italian 3,000-m steeplechase and long distance runner, Ala Zoghlami (180 cm, 57 kg), with groin pain, diagnosed as insertional adductor tendinopathy. The runner, after manifesting the painful symptomatology, underwent medical screening (ultrasound and MRI). The radiological investigations highlighted adductor tendinopathy. After refraining from training, the runner underwent medical and physical therapy which, in the first phase, did not improve the painful symptomatology. Further evaluation, after 6 months from the initial training cessation, highlighted a case of malocclusion. Such was treated from a dentistry perspective with the creation of a personalized dental bite.

Results: A multidisciplinary approach which included medical and physical therapy, osteopathy, and dentistry, in adjunct with refraining from training, was able to reduce the symptomatology and allowed a correct return to run (after 9 months from the first painful manifestation) of the steeplechase runner. To date, Ala Zoghlami has fully recovered and was able to win the 3,000-m steeplechase race during the 2021 national Italian competition.

Management of osteitis pubis in athletes: rehabilitation and return to training - a review of the most recent literature

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.

Local high-frequency vibration therapy following eccentric exercises reduces muscle soreness perception and posture alterations in elite athletes

PURPOSE

Exercise-induced muscle damage produces painful sensations (delayed onset of muscle soreness, DOMS). DOMS causes compensatory postural adaptations, which in turn affect athletes' walking and running gait biomechanics. It is still debated whether the postural changes are due to impaired proprioception or pain perception. To disambiguate between these two contrasting hypotheses, we designed a study that tested post-exercise postural adjustments in two groups of athletes: a group who was administered a vibration therapy (VT), to attenuate pain perception, and a control group.

METHODS

Thirty professional futsal players were tested on five different occasions: baseline, eccentric exercises (EE) session day, 24, 48 and 72 h after EE. Vibration therapy (120 Hz) was applied on legs muscles for 15 min in the experimental group, while no vibration was applied in the control group. The measurements included: isokinetic evaluation, stabilometric test, perceived soreness evaluation and serum levels of creatine kinase, and lactate dehydrogenase.

RESULTS

48 h after EE, the control group showed changes in biomechanical parameters (antero-rotations of pelvis, p < 0.05). A substantial alteration in the hip kinematics was found, associated to a reduced contractile force (p < 0.01) and soreness perception. On the contrary, the VT group did not show any change in posture and pain perception. High-intensity VT decreases EE effects on muscle strength and DOMS.

CONCLUSIONS

DOMS significantly changes athletes' posture; but postural changes disappear following a VT therapy that decreases pain perception. It is concluded that soreness perception is the main cause of postural changes and that its effects can be counteracted using VT therapy.

Groin Pain Syndrome Italian Consensus Conference on terminology, clinical evaluation and imaging assessment in groin pain in athlete

The nomenclature and the lack of consensus of clinical evaluation and imaging assessment in groin pain generate significant confusion in this field. The Groin Pain Syndrome Italian Consensus Conference has been organised in order to prepare a consensus document regarding taxonomy, clinical evaluation and imaging assessment for groin pain. A 1-day Consensus Conference was organised on 5 February 2016, in Milan (Italy). 41 Italian experts with different backgrounds participated in the discussion. A consensus document previously drafted was discussed, eventually modified, and finally approved by all members of the Consensus Conference. Unanimous consensus was reached concerning: (1) taxonomy (2) clinical evaluation and (3) imaging assessment. The synthesis of these 3 points is included in this paper. The Groin Pain Syndrome Italian Consensus Conference reached a consensus on three main points concerning the groin pain syndrome assessment, in an attempt to clarify this challenging medical problem.