Evidence-based Sports Medicine

Evidence-based Sports MedicineWe are fortunate that recent improvements in imaging andinformation processing (and communication) have helped to untanglethe knot of musculoskeletal and neurological complaints that affectthe groin in athletes. Much of the literature cited in this chapter reliesupon the association between symptoms and signs and findings indiagnostic imaging, with a diagnosis confirmed by surgery in manycases, or with resolution of the clinical problem after some therapeuticintervention. This is as good as it gets and, although patchy, clinicalresearch is making our understanding of groin pain easier.Groin pain in the athlete refers to the discomfort noted around thearea of the lower abdomen anteriorly, the inguinal regions, the area ofthe adductors and perineum and, by extension, the upper anteriorthigh and hip.This chapter outlines the approach taken by the author to themanagement of groin pain in athletes and considers the patterns ofpain, biomechanical factors, anatomical structures, and diagnostictests (clinical and technical) that are all relevant. The broad scope ofdiagnoses are discussed and management plans outlined. It shouldbe recognised that while there is an emphasis on evidence-basedmanagement, much of our practice is still empirical and it begs all ofus to pursue an understanding of groin pain through thoughtfulscientific endeavour.MethodThis chapter is an expanded and updated version of a reviewpublished in 1997. 1 A literature search using Medline and SPORTDiscusdatabases over the interval 1990–97 (February) had been employedfor this review, and for this chapter a literature search using “NationalSports Information Centre Easy Search” (Australian Sports Commission)specifying the period 1982–2000 (December) was undertaken.Literature in English was specified and combinations of key wordsused for both the initial review and this chapter include groin pain,athletes, osteitis pubis, conjoint tendon, hernia, adductor, stressfracture, footballers, injury, and imaging. The author’s own collectionof papers and personal correspondence has been used. Many of thesehad been collected for another previous publication. 2References have been selected on each paper’s individualcontribution to understanding the nature, pathomechanics, andmanagement of chronic groin pain in athletes. Outcomes ofmanagement protocols were especially considered. Anecdotal reportswere taken into account but preference remained for larger, welldesigned studies.390