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Clinical entities in groin pain

The anatomy of the groin region is complex and encompasses multiple structures. Many of these structures share a close structural and biomechanical relationship. As a result, groin pain is often multi-factorial. An understanding of the anatomy and biomechanics of the groin region will help clinicians to identify possible contributing factors to groin pain and inform assessment and management strategies. Our blogs titled ‘Groin Pain: More than just a strain?* and ‘Hip impingement: the femoral acetabular story* discuss some of the tests used to identify movement impairments and activity limitations associated with hip related and groin pain.

*To view previous blogs simply enter their title into the search box on our website 

The latest British Journal of Sport Medicine podcast interviews Associate Research Professor from the University of Copenhagen and Orthopaedic surgeon Per Holmich. Professor Holmich co-authors Chapter 29 ‘Groin Pain’ in the new edition of the Clinical Sports Medicine Textbook. He has a special interest in overuse injuries, particularly hamstring, hip and groin. In this latest podcast, Professor Holmich highlights the continued difficulty in assessing and diagnosing groin injuries in sports all over the world. To improve assessment and management he purports that a consensus of groin injury terminology and classification needs to be established. He argues that consistent terminology will allow the results of studies to be more easily compared and analysed, leading to the ability to establish strong evidence based recommendations and guidelines for groin-related pain syndromes.

Professor Holmich suggests that all clinicians should become familiar with the underlying literature and what clinical tests they use for assessment purposes. Knowing the psychometric properties of common clinical tests can help define the outcomes of these tests. Rather than relying on a single structural diagnosis, by categorising groin pain into entities using specific clinical tests, clinicians can become more consistent and transparent with their diagnosis and reporting of groin pain.

Currently Professor Holmich suggests there are three important clinical entities in groin pain:

1. Adductor related groin pain

2. Iliopsoas related groin pain

3. Inguinal related groin pain (including sports hernias)

Chapter 29 ‘Groin Pain’ of the new edition of the Clinical Sports Medicine textbook is a valuable resource to help any clinician incorporate the above entities into clinical practice. Of course all clinicians should be aware of the role that the hip joint, lumbar spine, sacroiliac joints and pubic symphysis may play in groin pain presentations.

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