Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis

Abstract

BackgroundHip and groin injuries are common in many sports. Understanding the factors differentiating athletes with hip/groin pain from those without these injuries could facilitate management and prevention.ObjectiveConduct a systematic review and meta-analysis of the literature on factors differentiating athletes with and without hip/groin pain.MethodsThe review was registered as PROSPERO CRD42014007416 and a comprehensive, systematic search was conducted in June 2014. Inclusion criteria were: cross-sectional, cohort or case–control study designs of n>10 that examined outcome measures differentiating athletes with and without hip/groin pain. Two authors independently screened search results, assessed study quality, and performed data extraction. Methodological heterogeneity was determined and data pooled for meta-analysis when appropriate. A best evidence synthesis was performed on the remaining outcome measures.ResultsOf 2251 titles identified, 17 articles were included of which 10 were high quality. Sixty two different outcome measures were examined, 8 underwent meta-analysis. Pooled data showed strong evidence that athletes with hip/groin pain demonstrated: pain and lower strength on the adductor squeeze test, reduced range of motion in hip internal rotation and bent knee fall out; however, hip external rotation range was equivalent to controls. Strong evidence was found that lower patient-reported outcome (PRO) scores, altered trunk muscle function, and moderate evidence of bone oedema and secondary cleft sign were associated with hip/groin pain.ConclusionsPROs, pain and reduced strength on the adductor squeeze test, reduced range of motion in internal rotation and bent knee fall out are the outcome measures that best differentiate athletes with hip/groin pain from those without this pain.

A Combined Treatment Approach Emphasizing Impairment-Based Manual Therapy and Exercise for Hip-Related Compensatory Injury in Elite Athletes: A Case Series

“…4,5,18,23,24 Key clinical findings in this case series were consistent with risk factors for athletic hip, groin and low back pain previously identified in the literature. 1,6 Initial treatment focused on pain reduction while promoting exercise that addressed identified functional impairments and risk factors, and is consistent with conservative management of similarly described cases. 4,5,48,49 While morphological presentation may the stress on irritated structures.…”

“…8 (Table 2) Ongoing assessment of the aforementioned impairments was conducted daily with note of the identification of, or changes in any comparable signs. 6,47 MT techniques included, but were not limited to soft tissue was to promote pain-free motor recruitment of the lumbopelvic musculature and appropriate motor control of the trunk and lower extremity. Of note, isometric exercise was integrated, specifically to the adductor musculature, in part due to its potential pain-modulating effects.…”

“…1,2,3,4 In athletes with groin and low back pain, accurate diagnosis and appropriate treatment can be challenging due to complex anatomy and similar clinical patient complaints,. 5,6,7 Musculoskeletal differential diagnosis within the lumbopelvic hip complex includes discernment regarding pathologies that may be intra-articular (i.e. acetabular labral tears, cartilaginous damage) or extra-articular (muscular in nature) to the hip.…”

“…13,18,29,30 In addition to limited hip ROM, other risk factors include impaired regional strength and motor control. Inadequate strength profiles of the hip musculature have been identified in those who have sustained groin and lower extremity injury, 31,32,33,34 while individuals with groin pain and LBP have been found to demonstrate motor control deficits of the lumbopelvic region and lower quarter. 14,23,24,35 Those with FAI have been reported to demonstrate altered lower body kinetics and force attenuation, potentially resulting in excessive impulse to the joint.…”

Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management

“…93 Continuing to train and play with groin pain can result in movement compensation strategies, resulting in decreased function and performance. 24,27,41,56,57,93 Therefore, in addition to the use of pain-provocation tests, 69,92 joint ROM, muscle strength, function, and performance must be systematically assessed (FIGURE 4) 69 and the appropriate patientreported outcome measures must be completed (FIGURE 5).…”