Adductor and Upright Abdominal Tendinopathy
Insertional tendinopathy of the adductors and the rectus abdominis is common in male athletes, especially in soccer players. Dysfunction of the adductor muscles represents the most common single cause of groin pain in athletes. If preventive measures and
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Gian Luigi Canata and Valentina Casale
14.1 Introduction Insertional tendinopathy of the adductors and the rectus abdominis is common in male athletes, especially in soccer players [1]. Dysfunction of the adductor muscles represents the most common single cause of groin pain in athletes [2]. Insertional tendinopathies are one of the several causes of chronic groin pain. This condition varies among different sport activities, but it especially develops in the presence of repeated kicking and rapid changes of direction [3]. The exact incidence of this type of tendinopathies remains unknown because of the several different pathologies that might cause groin pain, even if some authors agree with a 2.5–3% incidence of rectus-adductor tendinopathy [4]. More than 70% of patients are males [5]. The wide variety of possible injuries in several anatomical structures and the high prevalence of “abnormal findings” in asymptomatic athletes contribute to the complexity of the “groin pain” issue in athletes [6]. The etiopathogenesis of insertional tendinopathies is multifactorial. It is usually related to repeated microtraumas and functional overuse, especially when physical activity requires sudden
G.L. Canata, M.D. (*) • V. Casale, M.D. Centre of Sports Traumatology, Koelliker Hospital, Turin, Italy e-mail: [email protected]
changes of direction, repeated acceleration and deceleration, and torsion and traction of abdominal and adductor muscles [1]. The most frequently involved sports are soccer, hockey, rugby, football, long-distance running, and basketball indeed [5]. A further predisposing factor is the lack of balance between a hypertonic adductor muscle and a hypotonic large flat muscular sheet of the abdomen, sometimes in addition to a hypertonic femoral quadriceps muscle [7]. The abdominal and paravertebral muscles act together to stabilize the pubic symphysis, especially during static or dynamic single-leg stance. The adductor muscles act as antagonists on the pubic symphysis, through an opposite traction on it [8]. The femoral triangle is located in the upper inner thigh and includes the femoral nerve, the femoral vessels, the sartorius, the iliopsoas, the pectineus, and the adductor longus muscles [9]. The adductor muscles are the adductor longus, the pectineus, and the gracilis in the superficial layer; the adductor brevis in the intermediate layer; and the adductor magnus in the deep layer. Two further examples of adductor muscles are the obturator externus and the quadratus femoris, though they are part of the gluteal region. The adductor longus is thought to be the most frequently injured adductor muscle: its origin and insertion do not guarantee mechanical advantages, making it more susceptible to traumatic lesions [10].
© Springer International Publishing AG 2017 R. Zini et al. (eds.), Groin Pain Syndrome, DOI 10.1007/978-3-319-41624-3_14
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This type of insertional tendinopathy involves both the adductor muscles (gracilis, pectineus, adductor longus, and adductor magnus) (Fig. 14.1) and the re
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