Osteitis Pubis was a common diagnosis during the early 2000’s within the AFL injury lists and the trend was certainly reflected in local level football.
Groin pain characterised by an insidious onset of vague tightness that progressed to debilitating pain in the upper groin of football players was common in all levels of football. The condition reduced explosive speed, agility and kicking penetration from promising younger players usually between 16-24 years of age. There appeared to be a correlation between the increase of intensity required by the step up to senior football and the less mature body. The diagnosis of “OP” is vaery rare on an injury list from an AFL club in 2013, so where did “OP” go?
Sports Medicine and Physiotherapy intervention continue to learn, research and improve their understanding of the human body and the various injuries we assess and treat. OP treatment was often reactionary when a player finally presented for an assessment of groin pain that they had finally recognised was reducing their effectiveness to play football at their level of competition. Common treatment recommendations were 6-12 weeks rest from running, “core” exercises, massage of the adductor and gluteal muscles, a graded return to straight line running then eventually training and playing. Unfortunately success rates were only about 50:50 in regards to full resolution and no recurrence. Players bounced between practitioners and other disciplines like Chiropractic, Osteopathy, Bowen, Acupuncture and a renowned self trained trigger point therapist in Donald. Unfortunately success rates were similar to mainstream management.
Further investigations of the driving pathology and enhanced diagnosis of the differences between players who didn’t have groin pain and those that developed groin pain has demonstrated some clear objective differences. Players often have poor control of their hip joint with reduced adductor strength, external rotation strength and gluteal strength. They have overactive hip flexors, abdominal power muscles like the “6 pack” and painful, overloaded weak adductors. At times this is a developmental weakness of the younger player now diagnosed as “Pelvic Overload”.
Successful treatment relies upon player’s compliance with a program of muscle release and strengthening throughout the season along with relative rest, not absolute rest from running. Reliable clinical tests rather than player’s reports of amount of pain guide physiotherapists and clients through times when they can progress and play versus times they need to reduce load of running and playing. Waiting for players to report pain often leads to failed rehabilitation similar to previous “OP” management.
An interesting study completed by a prominent Geelong Sports Physician in England in the late 2000’s showed that 50% of clients presenting with groin pain to his clinic had hip joint pathology as their primary cause of their groin pain. This is certainly now reflected in the groin pain clients presenting to Corio Bay Health Group Clinics and also the Geelong Falcons players that I manage in the TAC Cup. Hip joint pathology often relates to a compromised shape of the upper thigh bone very close to the hip joint called a CAM lesion. This thickening of the upper thigh bone impinges on the hip joint creating Femoro-Acetabular Impingement (“FAI”). Reduced control of the hip joint in these younger athletes combined with the speed and agility requirements of football these days can cause serious damage to the softer parts of the hip joint like the labrum, ligamentum teres and the articular cartilage. Management can require arthroscopic surgical treatment similar to what is now well known and somewhat common place at the knee joint. Some players can certainly be managed conservatively with strengthening exercises, controlled training and massage release of appropriate muscles. However this relies upon early diagnosis and not playing through pain, even mild pain, for prolonged periods of time.
So, where did “OP” go? Early diagnosis of conditions that lead on to debilitating “OP” are now diagnosed and treated effectively to significantly reduce the number of players ending up with “OP”.
Justin Edwards is a Senior Physiotherapist at our Geelong and Norlane clinics.