info@hugokine.com
+32 4 73 95 42 83
3 Phases for Effective Athletic Groin Pain Rehabilitation: A Guide to Recovery
Welcome to the blog of Hugo Bogaerts, sports physiotherapist and Orthopedic Manual Therapist in Brussels Centre 1000 and Chaumont-Gistoux 1325, Belgium. In this article, we’ll explore anterior cruciate ligament (ACL) rehabilitation based on the latest scientific recommendations. Whether you’re looking for information after the recent onset of groin pain, or considering a return to sport, this guide will answer your questions.
The groin and hip region is often referred to as the Bermuda Triangle of sports medicine, due to its anatomical complexity and the challenges it presents in terms of pain diagnosis and treatment. Athletic Groin Pain is a recurring problem in the world of sports, mainly affecting athletes involved in sports requiring explosive movements, changes of direction and kicking, such as soccer, field hockey and many others.
What is adductor pubalgia?
In 2023, our understanding of Athletic Groin Pain has evolved considerably thanks to the contributions of numerous experts and the publication of several books and consensuses. In 2020, the Aspetar sports clinic in Qatar brought together over 300 international experts to publish two books, one of which included a chapter dedicated to Athletic Groin Pain. In 2022, HandSpring Publishing also published a major book on hip and knee disorders, highlighting the importance of physiotherapy in the treatment of Athletic Groin Pain.
Classifications of Athletic Groin Pain have evolved thanks to international consensuses such as the Doha Agreement, the Groin Pain Syndrome Italian Consensus Conference and the Vienna Statement. However, there is still some ambiguity in terminology and classifications, as evidenced by a recent Delphi study showing that their use by physical therapy experts for athletic pubalgia varies considerably.
Sports physiotherapy
What are the different categories of athletic groin pain?
When it comes to the clinical entities of Athletic Groin Pain, there are several categories, including pain related to the adductors, ilio-psoas, pubic joint and other causes. Each of these categories has distinct clinical features and specific injury mechanisms. For example, adductor muscle injuries are common in soccer and field hockey players, while ilio-psoas-related Athletic Groin Pain is more common in long-distance runners.
In terms of risk factors, several elements have been identified, including adductor muscle strength deficits, high level of play, male gender, participation in specific sports such as soccer and ice hockey, and total hip range of motion. However, there is still debate about some of these factors, and research continues to explore the causal links between them and Athletic Groin Pain. One of the aims of physiotherapy for Athletic Groin Pain will be to identify and treat these modifiable risk factors.
Athletic Groin Pain : what to do and who to consult?
In most cases, the treatment of sports pubalgia (i.e. Athletic Groin Pain) is the responsibility of the sports physiotherapist. It is a three-phase process requiring a comprehensive approach, including therapeutic patient education and regular psycho-social follow-up. The main aim of this approach is to improve understanding of the pathology and pain, guide the progression of physical activity and prevent the risk of recurrence. Let’s take a closer look at these three phases of physiotherapy treatment for Athletic Groin Pain.
Phase 1: Antalgia and Optimal Loading
Manual therapy: This phase begins with targeted manual therapy. It aims to treat overactive structures and those subject to overuse. Manual therapy techniques include trigger point release, Van den Akker technique, contract-release stretching, mobilization with movement (MWM) techniques and pelvic, lumbar, sacroiliac and hip mobilizations.
Transfer activity: To relieve pain while maintaining some form of physical activity, exercises such as cycling and aquajogging are recommended. These activities are gentle on groin muscles while allowing some mobilization.
Therapeutic exercises: Therapeutic exercises play an essential role in phase 1. They focus on improving the contractile properties of the muscles concerned. Isometric exercises and incomplete active amplitudes are commonly used to restore muscle strength. Per Hölmich’s protocol, with adaptations where necessary, can be implemented.
Criteria for moving on to the next phase of physiotherapy treatment for Athletic Groin Pain include favorable patient feedback, a clinically significant reduction in pain assessed on the visual analog scale (VAS), particularly during daily activities such as walking and climbing stairs, and a significant reduction in the HAGOS score.
Phase 2: Resumption of controlled physical activity
Therapeutic exercises: Phase 2 consists of resuming controlled physical activity. Exercises are aimed at strengthening the hip muscles, including adduction, abduction, flexion and extension, as well as recruiting core muscles, including abdominal and extensor muscles. Stability, proprioception and balance are also at the heart of this phase, with poly-joint exercises and the gradual introduction of external loads, such as machines, free weights and elastic bands.
Running: For running athletes, a progressive recovery program is designed. It involves a gradual increase in elevation gain, speed and time spent running.
Manual therapy: Manual therapy can be continued in this phase if necessary, with techniques similar to those used in phase 1.
Criteria for moving on to phase 3 of physiotherapy treatment for Athletic Groin Pain include favorable patient feedback, a significant reduction in VAS (up to 1/10 maximum for moderate efforts) and a significant reduction in HAGOS score.
Phase 3: Intensification and sport-specific exercises
Therapeutic exercises: Phase 3 marks the intensification of training with the introduction of external loads and increased mechanical stress. Exercises include supramaximal eccentric contractions and are designed to prepare the athlete for a full return to sporting activity.
Running: Running activities become more demanding with the addition of elevation changes, speed, straight and curved sprints, slalom exercises and other discipline-specific movements.
Sport-specific movements: Sport-specific exercises are introduced, including planned and unplanned changes of direction, jumps, kicks, stop-and-go movements, etc…
Return to sports training: In this phase, the athlete is allowed to resume sports training, possibly with certain restrictions depending on progress and ability. This final phase of physiotherapy treatment for Athletic Groin Pain, also known as reathletization, is aimed at restoring performance.
Physiotherapy is of great help in the treatment of Athletic Groin Pain. By following the best international recommendations, you maximize your chances of a complete recovery and a safe return to your favorite activities. Don’t hesitate to consult your physiotherapist for a personalized approach tailored to your situation.
Continue your journey to recovery with confidence with Hugo Bogaerts, your sports physiotherapy expert with BFSP recognition at GOLD STATUS.
References :