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Groin pain is the third most common cause of missed games in the AFL injury data survey over the last 10 years.
AFL injury lists in the late 90’s and early 2000’s often had up to 10 players with OP (Osteitis Pubis) listed as their diagnosis. Management of OP resulted in some players resting 6-12 weeks and resolving their problems with exercises whilst others returned with ongoing pain and failed to recover their previous levels of kicking penetration, agility and speed. Local level footballers often continue playing through their groin pain with recurrent flare ups diagnosed as adductor/hip flexor strains and their gradual loss of speed and agility accepted as a sign of their aging body.
Current AFL injury lists have virtually no player listed as OP and far more listed simply as hip. So what is the actual diagnosis at an elite level and what is being done to allow these players return to play?
Many players are now being diagnosed with FAI (Femoro-Acetabular Impingement) where there is extra bone on the neck of the femur (thigh bone) close to the actual hip joint called a CAM lesion. When players sprint and then bend to pick up the football or change direction and rotate their hip joint at high velocity this extra bone can impinge onto softer parts of the actual hip joint and create internal hip joint damage.
Cartilage damage can be related to a Labral tear, the articular cartilage which covers the bone or actually at the junction between these two cartilage areas. Other damage can happen to an important internal ligament called Ligamentum Teres.
This ligament can be compressed and irritated or stretched and torn depending on the position a player is in at the time of injury. When these internal hip structures become damaged and painful, certain muscles around the hip joint increase their activity and become over worked whilst others become inhibited and reduce their control of the hip joint. If players continue to train and play then this imbalance can cause pelvic overload symptoms with sore groin muscles and true pelvic pain related to OP. Developments in Hip Arthroscopy surgery over the last 5-8 years have provided a major step forward in managing many footballers with FAI and hip joint damage. Surgery is done using small keyhole incisions and the CAM lesion is removed along with repairs to the internal cartilage and ligament damage in the actual hip joint.
Early and accurate diagnosis is essential to provide the best management of where groin pain is coming from and what can be done to settle it down, stop it from recurring and limit the likelihood of progressing on to OP. Clinical tests that Physiotherapists and Sports Doctors complete are very good predictors of the pathology but may require X-Ray and at times MRI to assist with diagnosis and therefore best management. Physiotherapy intervention utilising massage and dry needling to settle over active muscles and exercises to increase activity in under active muscles is very effective if the internal hip damage is not significant. Some injuries do need arthroscopic surgery of the hip to actually deal with the damage in the hip joint which is often where the pain is truly coming from.