Hip/thigh/groin Flashcards
3 common types of groin pain in sports
- gilmores groin
- hockeys groin
- adductor-related pain
3 anatomical landmarks for groin triangle
- ASIS
- pubic tubercle
- midpoint between ASIS and top of patella
medial side of groin triangle- structures involved in pain
lots of adductor muscles
AL/AB/AM
Gracilis
Lateral side of groin triangle- structures involved in pain
femoro-acetabular joint
TFL muscles
ITB
What is the pubic clock and how can it be good to narrow down pain differentials?
Overload pain- seen in area of pubic tubercle
1= rectus abs
3 = pubic symphysis
6= adductor longus
9=inguinal ligament
11 = superficial inguinal ring
Palpate over the clock to pinpoint pain
Steps to hip/groin diagnosis
- Define + align- find anatomical point
- Listen + localise- exam, relate to triangle, Hx
- Palpate and recreate- check each structure, provocation test
- Investigate- eg MRI
Sports that have high risk of groin pain
- football
- rugby
- australian football
- hockey
- cricket
- swimmers
High impact and sudden dynamic changes in loading, twisting/pivoting movements, kicking
Why is the groin/hip so complex and liable to injury?
- load is transferred from trunk to two legs
- This leads to complex loading through pelvis/groin region
- v liable to instability if lack of functional training for changing load
What factors increase risk of hip/groin pain?
- Age
- Lack of adequate training (pre-season)
- Other injuries
- Lack of proper conditioning- functional, multiplanar
Anatomical factors that increase risk of hip/groin injury
- multiple muscle attachments
- Potentially natural deficits in the abdominal wall
Biomechanical factors that increase risk of hip/groin injury
- spine –> pelvis –> hip + symphysis (mobility/stability needed)
- central –> lateral loading distribution
- Muscle imbalances be present
Superficial side of groin triangle- structures present that can cause pain
- Pubic symphysis
- Abdominals
- Hernia
How did the Doha agreement categorise groin pathologies?
- adductor related
- iliopsoas related
- inguinal related
- pubic related
then hip related seperately
Hip related pain - what movements do we test?
- Passive ROM
- FADIR (flexion, adduction, Internal rotation)
- FABER (flexion, abduction, external rotation)
Pathologies not to miss which cause hip/groin pain
- Neural (ilioinguinal nerve, genitofemoral nerve)
- True hernia (cough sign)
- Pelvis injury (acute, morning pain/stifness, warmth/fullness/swelling)
- Testicular pain
What Sx/signs suggest acute groin injury?
- Sharp, obvious
- Big haemorrhage
- Instant loss of balance and performance
First 48h rehab for acute groin injuries
- RICE
- Gentle stretching to P1
- Active pain-free exercises
- Phys mod (TENS, laser)
Tx of acute groin injuries after 48h
Gradually increase:
- stretching
- strengthening: act abd/add, then against resistance.
- functional strengthening + stabilising
- Sport specific skills
Which muscles most important to include in active rehab and prehab?
- adductors
- trunk flexors
- glutes
Patients with groin pain often present with tightness in which muscle? What is the impact of this?
Present with overactive adductor muscles, pull on pubic symphysis, overloading joints
Leads to osteitis pubis
(note, muscle may not be too strong, just dysfunctional)
Why is glute work important in groin pain prehab/rehab?
- Hip joint needs stability - looks to the adductor muscles
- Tight adductor pulls femur into adduction
- Stretches glutes and they don’t work well
2 Common hip pathologies in athletes
- Labral tears
- FAI = femoro-acetabular impingement (morphology not pathology)- cam/pincer
Mx of true hip issues- general
- Develop local stability- esp with fatigue
- Loading management- offload with intense gluteal ex + avoid painful ex
Outcome measures that differentiate athletes with hip/groin pain
- pain and reduced strength on the adductor squeeze test
- reduced ROM in internal rotation
- bent knee fall out
3 Commonest causes of lateral groin pain
1) Impingement/labral pathology of FAJ
2) osteoarthritis of femoacetabular joint
3) ITB friction
impingement/labral pathology- Sx and O/E
- Mechanical- clicking, catching
- Impingement test
osteoarthritis/chondral damage /FAJ damage Sx and O/E
- Hx of traumatic insult/congenital
- older age
- persistent lateral hip pain worse on lying on affected side
- Limited ROM, pain on WB
- Pain on supine-standing transition
