Rehabilitation from Hip and Groin Surgery



Assessment of groin pain in the young adult population is complex and requires a systematic and integrated approach to create a marriage between the history, the investigations used and the physical examination. Through this process it is possible to ascertain the relationships between the primary and secondary conditions or clinical entities, and accurately identify the source of pain verses the source of dysfunction.


Soccer Player Groin Pain Inguinal Canal Inguinal Ligament Chronic Groin Pain 
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  1. 1.
    Renstrom P, Petersen L. In: Renstrom P, editor. Sports injuries: their prevention and treatment. London: Martin Dunitz; 2002.Google Scholar
  2. 2.
    Puig P, Trouve P, Savalli L. Pubalgia: from diagnosis to return to the sports field. Ann Readapt Med Phys. 2004;47(6):356–64.PubMedCrossRefGoogle Scholar
  3. 3.
    Cowan SM, Schache AG, Brukner P, Bennell KL, Hodges PW, Coburn P, et al. Delayed onset of transversus abdominus in long-standing groin pain. Am Coll Sports Med. 2004;36:2040–5.Google Scholar
  4. 4.
    Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med. 2008;42:551–4.CrossRefGoogle Scholar
  5. 5.
    Holmich P, Holmich LR, Berg AM. Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med. 2004;38:446–51.PubMedCrossRefGoogle Scholar
  6. 6.
    Holmich P. Long-standing groin pain in sportspeople falls into three primary patterns, a “clinical entity” approach: a prospective study of 206 patients. Br J Sports Med. 2007;41:247–52.PubMedCrossRefGoogle Scholar
  7. 7.
    Malycha P, Lovell G. Inguinal surgery in athletes with chronic groin pain: the sportsman’s hernia. Aust N Z J Surg. 1992;62:123–5.PubMedCrossRefGoogle Scholar
  8. 8.
    Falvey E, Franklyn-Miller A, McCrory P. A 3G approach to a 3-dimensional problem. Br J Sports Med. 2009;43:145.PubMedCrossRefGoogle Scholar
  9. 9.
    Mitchell EC. The area of pain of patients undergoing Hip arthroscopic surgery. J Am Coll Sports Med. 2006;38(5 S11):627.Google Scholar
  10. 10.
    Orchard J, Best TM, Verrall GM. Return to play following muscle strains. Clin J Sports Med. 2005;15(6):436–41.CrossRefGoogle Scholar
  11. 11.
    Lloyd-Smith R, Clement DB, McKenzie DC, Taunton JE. A survey of overuse and traumatic hip adn pelvic injuries in athletes. Phys Sports Med. 1985;13(10):131–7, 141.Google Scholar
  12. 12.
    Verrall GM, Slavotinek JP, Barnes PG, Fon GT. Description of pain provocation tests used for the diagnosis of sports-related chronic groin pain: relationship of tests to defined clinical (pain and tenderness) and MRI (pubic bone marrow oedema) criteria. Scand J Med Sci Sports. 2005;15:36–42.PubMedCrossRefGoogle Scholar
  13. 13.
    Verrall G, Hamilton I, Slavotinek J, Oakeshott J, Spriggins A. Hip joint range of motion reduction in sports-related chronic groin injury diagnosed as pubic bone stress injury. J Sci Med Sport. 2005;8(1):77–84.PubMedCrossRefGoogle Scholar
  14. 14.
    Ekstrand J, Gillquist J, Liljedahl S-O. Prevention of soccer injuries supervision by doctor and physiotherapist. Am J Sports Med. 1983;11(3):116–20.PubMedCrossRefGoogle Scholar
  15. 15.
    O’Connor DM. Groin injuries in professional rugby league players: a prospective study. J Sports Sci. 2004;22:629–36.PubMedCrossRefGoogle Scholar
  16. 16.
    Molsa J, Airaksinen O, Nasman O, Torstila I. Ice hockey injuries in Finland. A prospective epidemiologic study. Am J Sports Med. 1997;25(4):495–9.PubMedCrossRefGoogle Scholar
  17. 17.
    Torry ML. Neuromuscular hip biomechanics and pathology in the athlete. Clin Sports Med. 2006;25:179–97.PubMedCrossRefGoogle Scholar
  18. 18.
    Schilders E, Bismil Q, Robinson P, O’connor PJ, Gibbon WW, Talbot CJ. Adductor-related groin pain in competitive athletes. Role of adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg. 2007;89:2173–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Lovell G, Galloway H, Hopkins W, Harvery A. Osteitis pubis and assessment of bone marrow edema at the pubic symphysis with MRI in an elite junior male soccer squad. Clin J Sports Med. 2006;16(2):117–22.CrossRefGoogle Scholar
  20. 20.
    Orchard JW, Read JW, Neophyton J, Garlick D. Groin pain associated with ultrasound findings of inguinal canal posterior wall deficiency in Australian Rules footballers. Br J Sports Med. 1998;32:134–9.PubMedCrossRefGoogle Scholar
  21. 21.
    Orchard J, Wood T, Seward H, Broad A. Comparison of injuries in elite senior and junior Australian football. J Sci Med Sport. 1998;1(2):82–8.CrossRefGoogle Scholar
  22. 22.
    Tyler TF, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effectiveness of a Preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002;30:680–3.PubMedGoogle Scholar
  23. 23.
    Mens J, Inklaar H, Koes BW, Stam HJ. A new view on adduction-related groin pain. Clin J Sports Med. 2006;16(1):15–9.CrossRefGoogle Scholar
  24. 24.
    Verrall GM, Slavotinek JP, Fon GT, Barnes PG. Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury. Am J Sports Med. 2007;35:467–74.PubMedCrossRefGoogle Scholar
  25. 25.
    Fricker P. Osteitis pubis – infection, inflammation or injury. Sports Med. 1991;12(4):266–79.PubMedCrossRefGoogle Scholar
  26. 26.
    Verrall GM, Henry L, Fazzalari NL, Slavotinek JP, Oakeshott RD. Bone biopsy of the parasymphyseal pubic bone region in athletes with chronic groin injury demonstrates new woven bone formation consistent with a diagnosis of pubic bone stress injury. Am J Sports Med. 2008;36(12):2425–31.PubMedCrossRefGoogle Scholar
  27. 27.
    Bialosky J, Bishop M, Price D, Robinson M, George S. The mechanisms of manual therapy in the treatment of musculoskeletal pain: a comprehensive model. Man Ther. 2009;14:531–8.PubMedCrossRefGoogle Scholar
  28. 28.
    Holmich P, Uhrskou P, Ulnits L, Kanstrup I-L, Nielsen MB, Bjerg AM, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. The Lancet. 1999;353(9151):439–43.CrossRefGoogle Scholar
  29. 29.
    Thorborg K, Serner A, Petersen J, Madsen TM, Magnusson P, Holmich P. Hip adduction adn abduction strength profile in elite soccer players – implications for clinical evaluation of hip adductor muscle recovery after injury. Am J Sports Med. 2010;20(10):1–6.Google Scholar
  30. 30.
    Wollin MGL. Osteitis pubis in four young football players: a case series demonstrating successful rehabilitation. Phys Ther Sport. 2006;7:153–60.CrossRefGoogle Scholar
  31. 31.
    Klein-Nulend J, Bacabac RG, Mullender MG. Mechanobiology of bone tissue. Pathol Biol. 2005;53(10):576–80.PubMedCrossRefGoogle Scholar
  32. 32.
    Rubin J, Rubin C, Jacobs C. Molecular pathways mediating mechanical signaling in bone. Gene. 2006;367:1–16.PubMedCrossRefGoogle Scholar
  33. 33.
    Fritton S, McLeaod K, Rubin C. Quantifying the strain history of bone: spatial uniformity and self-similarity of low-magnitude strains. J Biomech. 2000;33:317–25.PubMedCrossRefGoogle Scholar
  34. 34.
    Bacabac RG, Smit TH, Mullender MG, Dijcks SJ, Van Loon JJ, Klein-Nulend J. Nitric oxide reproduction by bone cells is fluid shear stress rate dependent. Biochem Biophys Res Commun. 2004;315:823–9.PubMedCrossRefGoogle Scholar
  35. 35.
    Burr D, Milgrom C, Fyhrie D, Forwood M, Nyska M, Finestone A, et al. In vivo measurement of human tibial strains during vigorous activity. Bone. 1996;18(5):405–10.PubMedCrossRefGoogle Scholar
  36. 36.
    Judex S, Zhong N, Squire M, Ye K, Donahue L-R, Hardjiargyrou M, et al. Mechanical modulation of molecular signals which regulate anabolic and catabolic activity in bone tissue. J Cell Biochem. 2005;94:982–94.PubMedCrossRefGoogle Scholar
  37. 37.
    Smedberg S, Broome A, Gullmo A, Roos H. Herniorrhaphy in athletes with groin pain. Am J Surg. 1985;149(3):378–82.PubMedCrossRefGoogle Scholar
  38. 38.
    Ekberg O, Persson N, Abrahamsson P-A, Westlin N, Lilija B. Longstanding groin pain in athletes a multidisciplinary approach. Sports Med. 1988;6(1):56–61.PubMedCrossRefGoogle Scholar
  39. 39.
    Lovell G. The diagnosis of chronic groin pain in athletes: a review of 189 cases. Aust J Sci Med Sport. 1995;27(3):76–9.PubMedGoogle Scholar
  40. 40.
    Orchard J, Read JW, Verrall GM, Slavotinek JP. Pathophysiology of chronic groin pain in the athlete. Int Sports Med J FIMS. 2000;1(1):1–16.Google Scholar
  41. 41.
    Brown RA, Mascia A, Kinnear DG, Lacroix V, Feldman L, Mulder DS. An 18-year review of sports groin injuries in the elite hockey player: clinical presentation, new diagnostic imaging, treatment, and results. Clin J Sports Med. 2008;18(3):221–6.CrossRefGoogle Scholar
  42. 42.
    Schleip R, Klinger W, Lehmann-Horn F. Fascia is able to contract in a smooth muscle-like manner and thereby influence musculoskeletal mechanics. In: 5th world congress of biomechanics. Munich: Medimond; 2006. p. 51–4.Google Scholar
  43. 43.
    Gilmore J. Groin pain in the soccer athlete fact, fiction and treatment. Clin Sports Med. 1998;17(4):787–93.PubMedCrossRefGoogle Scholar
  44. 44.
    Akita K, Niga S, Yamato Y, Muneta T, Sato T. Anatomic basic of chronic groin pain with special reference to sports hernia. Surg Radiol Anat. 1999;21:1–5.PubMedCrossRefGoogle Scholar
  45. 45.
    Gunn CC. The Gunn approach to the treatment of chronic pain – intramuscular stimulation for myofascial pain of radiculopathic origin. Singapore: Churchill Livingstone; 1997.Google Scholar
  46. 46.
    Lloyd DM, Sutton CD, Altafa A, Fareed K, Bloxham L, Spencer L, et al. Laparoscopic inguinal ligament tenotomy and mesh reinforcement of the anterior abdominal wall – a new approach for the management of chronic groin pain. Surg Laparosc Endosc Percutan Tech. 2008;18(4):363–8.PubMedCrossRefGoogle Scholar
  47. 47.
    Hackney RG. The sports hernia: a cause of chronic groin pain. Br J Sports Med. 1993;27(1):58–62.PubMedCrossRefGoogle Scholar
  48. 48.
    Simonet W, Saylor III H, Sim L. Abdominal wall muscle tears in hockey players. Int J Sports Med. 1995;16:126–8.PubMedCrossRefGoogle Scholar
  49. 49.
    Polglase A, Frydman G, Farmer K. Inguinal surgery for debilitating chronic groin pain in athletes. Med J Aust. 1991;155(10):674–7.PubMedGoogle Scholar
  50. 50.
    Karlin LI. Injuries to the hip and pelvis in the skeletally immature athlete. In: Nicholas JA, Hershman EB, editors. The lower extremity and spine in sports medicine. St. Louis: C V Mosby; 1986. p. 1292–332.Google Scholar
  51. 51.
    Irshad K, Feldman LS, Lavoie C, Lacroix VJ, Mulder DS, Brown RA. Operative management of “hockey groin syndrome”: 12 years of experience in National Hockey League players. Surgery. 2001;130(4):759–66.PubMedCrossRefGoogle Scholar
  52. 52.
    Thumbe V, Evans DS. To repair or not to repair incidental defects found on laparoscopic repair of groin hernia. Surg Endosc. 2001;15:47–9.PubMedCrossRefGoogle Scholar
  53. 53.
    Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. Am J Roentgen. 2008;191:962–72.CrossRefGoogle Scholar
  54. 54.
    Muschaweck E, Berger L. Minimal repair technique of sportsmen’s groin: an innovative open-suture repair to treat chronic inguinal pain. Hernia. 2010;14(1):27–33.PubMedCrossRefGoogle Scholar
  55. 55.
    Wang JH. Mechanobiology of tendon. J Biomech. 2006;29:1563–82.CrossRefGoogle Scholar
  56. 56.
    Khan KM, Scott A. Mechanotherapy: how physical therapists prescription of exercise promotes tissue repair. Br J Sports Med. 2009;43:247–52.PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.The Centre for Health and Human Performance (CHHP)LondonUK

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