This article has been adapted from a handbook, Groin & Hips: the latest international evidence, 2012, written by the author of this article, primarily for premier league football medical personnel, but also for those involved in other elite sports, in response to the controversy and lack of consensus among clinicians working in this area. On reviewing the literature, it became clear that the best answer to these problems is prevention/pre-habilitation. An in-depth knowledge of the basic and functional anatomy of this area is critical and this encompasses the entire kinetic chain above and below the groin. In particular, the adductor muscles are mostly neglected and are invaluable in the prevention strategy. Thus the most pertinent point is that many of the groin/hip pathologies can be averted by thorough and specific pre- habilitation. That is … treat the cause, not the symptom!
There are 82 differential diagnoses relating to the groin + another 41 related to the hip
The literature review that was undertaken for the handbook, Groin & Hips: the latest international evidence (1) was based on 240 studies and confirmed that the groin, an anatomical region where diagnosis and symptoms are often confusing, and may also represent a Bermuda Triangle for clinicians to disappear into in vortices of suppositions and assumptions. The Fédération Internationale de Football Association (FIFA) sports physiotherapist, Dr Mario Bizzini (2) called groin pain “The Bermuda Triangle” of sports medicine, and with good reason. There is little international consensus on diagnosis, pathophysiology, investigation or management. The diagnosis is multifactorial and there are 82 differential diagnoses relating to the groin, plus another 41 related to the hip. It is not simple. Also, in elite sports, it is often very difficult for a doctor to diagnose accurately and thus be able to send the player to the relevant specialist who deals only with his specific area. One of the key points is to understand the entire anatomy and likely generator of pain (3). The importance of the two joints in the pelvis should be emphasised – the hip joint and the pubic symphysis (PS). If one bases one’s diagnosis on this anatomy and, in particular, the functional anatomy, the whole diagnostic reasoning becomes easier.
The author: Helen Millson, physiotherapist
Helen has worked for IRPS Ltd for Elite Sports since 2006. As medical director, her expertise has been taken to all premier league (PL) football clubs to collate and interpret medical information for Insurers. This has included advising lawyers during complicated high financial claims. She organised a bespoke database specifically for PL and therefore has an excellent overview of all injuries/illnesses sustained by PL footballers. She has comprehensive knowledge of PL football medical conditions and has been acclaimed by the industry as a top-class expert. The medical advice to Insurers includes England cricket, international rugby, professional golf, international cyclists, UAE footballers, and other professional sportspeople at the pinnacle of their careers. As sport physiotherapist for Elite National Sport she worked in pre-habilitation, treatment, rehabilitation, and return-to-play criteria. Her professionalism, expert advice and outstanding interpersonal skills have been sought and appreciated by all medical and management teams at elite sports level, with insurers and their medical teams. She has a unique ability to confer and collaborate with other high-level experts in her field. She is the evidence based clinician for the company and the medical legal advisor within and outside the company, Previously Helen gained high acclaim in her field as physiotherapist for national rugby, hockey, cricket and surf lifesaving in South Africa. She also provided physiotherapy cover for two All Africa games, for football (Maccabi Games) and two Commonwealth Games (1992 to 2006).
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