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Groin Pain: More than just a strain?

Groin pain is a common presentation in sports. Our previous blog highlights the role of the hip in this presentation and should always be considered a possible contributing factor. Groin pain is often multi-factorial and has the tendency to become chronic if not assessed or managed appropriately. The new edition of the Clinical Sports Medicine textbook provides a detailed overview of the anatomy, pathophysiology, imaging and possible management strategies for groin pain presentations.

It is no secret that a thorough clinical assessment will aid the clinician in assessing whether further investigations are warranted and aide in the development of rehabilitation goals. The new edition of the textbook outlines a clinical examination including the numerous special tests which are needed for differential diagnoses.  The adductor squeeze test may prove to be particularly useful and is discussed in detail.

The groin chapter is co-authored by orthopaedic surgeon and lead researcher in the field of long standing groin pain in athletes, Per Holmich, and Australian sports physician Chris Bradshaw. In 2007, Per Holmich introduced the concept of three clinical entities for diagnosis of groin pain in his paper titled: Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach. The 2012 edition of Clinical Sports Medicine now incorporates four clinical entities. These include; adductor, iliopsoas, abdominal wall and pubic bone stress related. All four clinical entities are presented and possible management options are discussed. The chapter also provides an example of how multiple clinical entities may develop over time and addresses critical elements of rehabilitation such as the role of core stability training and conditioning of the gluteal muscles.

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