Athletic Groin Pain

: A diagnosis without injury?

Abstract

Athletic Groin pain is a chronic musculoskeletal condition common in players of multidirectional sports with an incidence between 3 and 23 %. Despite attempts at global consensus, there remains no agreement on the identification of pathological structures injured in patients presenting with pain. The aim of this research was to (i) implement a systematic clinical examination, to identify pain, combined with radiological imaging to determine if the differential diagnosis can be narrowed and (ii) analyse movement during change of direction, to determine if certain biomechanical features which associate with pubic confluence overload could be identified to inform a different approach to rehabilitation to enhance outcomes. Following original anatomical dissection, we devised a system of examination to clarify potential diagnosis. Then in a prospective cohort clinical study, we sought to enhance the clinical examination by combining this with radiological data, patient reported outcomes and a pain-provoking task. These steps did not enhance the diagnosis and led us to undertake a systematic review and meta-analysis of the outcomes of rehabilitation and surgical interventions in AGP. We found little evidence for an actual pathology and as such began to investigate causes of mechanical overload. The use of three-dimensional motion capture allowed us to analyse a pain provoking manoeuvre (change of direction) in terms of joint coordination and loads. In athletes with AGP, we identified three distinct distributions of joint work and kinematic techniques. When these data were used to guide rehabilitation intervention, patients evidenced enhanced outcomes including faster return to play and a greater success rate at return to play than generally reported in the literature. Further work is required to evidence the best use of biomechanical data on an individual basis to inform and develop rehabilitation based on feature selection for this group to expedite return to play.

Date of Award	19 Apr 2023
Original language	English
Awarding Institution	University of Roehampton
Supervisor	Siobhan Strike (Director of Studies) & Andrew Greene (Co-Supervisor)