Clinical Vignette of a Runner’s Frustrating Groin Pain

Abstract

HISTORY AND PHYSICAL EXAMINATIONA 45-yr-old healthy male runner presented with predominantly right lower abdominal, pelvic, and worsening groin pain that started 1 yr ago after completing a 22-mile run. His symptoms developed 3 wks after this last run. He was increasing his weekly mileage with a running coach to train for a full marathon. He did not have similar previous symptoms. He did not change his running style, shoe wear, or running surface. His pain was constant, sharp, throbbing, graded 5/10, and nonradiating. Pain worsened with prolonged running, quick transitions, coughing, and sneezing. For 6 mos, he stopped running and competing at races but gradually returned to running inconsistently for 10-15 mile/wk. He consulted an orthopedic sports surgeon who prescribed ibuprofen for 2 wks and physical therapy twice weekly for 3 mos, focusing on lumbopelvic stability, core strengthening, balance, and kinetic chain deficiencies, while cross training independently with biking. When he tried short intermittent runs after completing therapy, his pain worsened at the 5-mile mark. This strategy failed to provide significant pain relief or functional improvement. He did not try osteopathic/chiropractic manipulations, acupuncture, or electromechanical modalities. Given the persistent symptoms, he consulted a sports physiatrist. On examination, his vitals were stable, and he was well appearing. He had a nonantalgic gait with nontender lumbar paraspinal muscles, lower abdomen, pubic symphysis, hip flexors, and greater trochanters, but tenderness over right hip adductor origin. He had painless full range of motion at the lumbar spine/hips, except his right hip internal rotation was 15 versus 20 degrees on the left. His lower motor strength was 5/5 bilaterally, except right hip abductor was 4/5 and left side was 4+/5. Trendelenburg sign was seen with single-leg stance bilaterally. Resisted side-lying right hip adduction reproduced his symptoms mildly. Lower