Groin Pain in Athletes
Inguinal-related groin pain is common in male athletes participating in sports with explosive change of directions and kicking. The epidemiology, terminology, and definitions for use in clinical practice are discussed in this chapter. The diagnosis can be
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Aali J. Sheen and Adam Weir
21.1 Introduction 21.1.1 Epidemiology Groin pain is common in athletes who participate in sports with rapid changes of direction, rapid acceleration or deceleration and kicking. Groin pain is a common sporting injury. A recent systematic review on soccer showed that it accounts for between 4 and 19 % of all injuries in males with an injury rate of 0.2–2.1 injuries per 1000 h [1]. In other elite sports it has been found to be a common problem in ice hockey and in football codes especially in positions that involve more kicking [2]. Males have around twice as many groin injuries as females [1, 2].
21.2 H ow Is Groin Pain in Athletes Defined? 21.2.1 Background Historically there was no agreement on the terminology or definitions used when describing the causes of groin pain in athletes. Multiple terms or differing definitions of similar terms added complexity to this confusing field, with 33 terms used in 72 studies, in a recent review on the treatment of groin
A.J. Sheen, M.D., F.R.C.S. (Gen Surg.) (*) Department of General Surgery, Central Manchester University Hospital NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK Department of Healthcare Sciences, Manchester Metropolitan University, Oxford Road, Manchester M13 9WL, UK e-mail: [email protected] A. Weir, M.B.B.S., Ph.D. Aspetar Orthopaedic and Sports Medicine Hospital, P.O. Box 29222, Doha, Qatar e-mail: [email protected]
pain in athletes [3]. A Delphi questionnaire survey among 23 experts on the treatment of groin pain in athletes presented two cases and asked the experts to describe the terms they would use to give the diagnosis. Among the 23 experts 18 terms were used to describe the diagnosis for the first case, and 22 for the second highlighting the disparity [4]. To help to address this confusion two consensus meetings have been held recently:
21.2.2 British Hernia Society: Manchester In 2012, the society convened a special session at the annual academic meeting at which both national and international experts from a multidisciplinary field were invited to speak about groin pain in the inguinal region in athletes. Predetermined questions were asked to all the experts to which they replied, reaching a consensus on the etiology, surgical treatment as well as other possible treatment modalities employed for this condition. Inguinal disruption was chosen as a term, with a description of the clinical findings outlined as well as radiology findings and a treatment algorithm [5]. The statement was the first of its kind as no consensus had yet been established to help define and manage what was initially perceived as a “physiological” entity rather that an actual “pathology,” with the realization that to date no real science or data was used to determine the best mode of treatment for “the sportsman’s groin.”
21.2.3 Doha Agreement Meeting on Terminology and Definitions in Groin Pain in Athletes In 2014, 24 international experts representing general surgery, orthopedic surgery, sports medicine, sports phy
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