Diagnostics and treatment of adductor-related groin pain in athletes - new insights

Abstract

The work contained within this thesis presents new insights into the diagnostics and treatment of long-standing adductor-related groin pain (LSARGP) in athletes. In the Netherlands a novel treatment programme using heat, manual therapy according to Van den Akker, stretching and a return to running programme has been used for many years by a number of sports medicine practitioners. This treatment had never been subjected to research to assess the effects. In chapter 1 an introduction to the work in this thesis is given. Chapters 2 till 4 are related to diagnsotics of athletes with LSARGP. In chapter 2 it is shown that the resting thickness of the tranversus abdominus muscle was significantly less in those with LSARGP when compared to athletes without groin pain. Due to the nature of the study it is not possible to say whether this reduction is a cause of the groin pain or the result of the long-standing complaints. In chapter 3 athletes with LSARGP underwent a physical examination of the hip and groin and had x-rays performed. Eight known radiological signs said to be present in femero-acetabluar impinegement (FAI) were examined for. This study showed that radiological signs of FAI are extremely common in athletes who present with LSARGP. Chapter 4 presents the results of a study examining the reliability of a number of common clinical tests thought to assess core stabilityand showed that the six commonly recommended tests, assessed in this study cannot be reliably assessed even by experienced clinicians. In chapter 5 the results of a retrospective case study on the effect of the new multi-modal treatment (MMT) programme for LSARGP are presented. After the treatment 50% reported being able to return to sports at pre injury level and 40% at a lower level. Eighty four percent gave a good or excellent subjective patient satisfaction. Chapter 6 presents the results of a case series evaluating the short and mid-term results of an active physical therapy training programme for LSARGP. This is the first study to report recurrence rates and mid-term follow-up. The short-term results were good but 29% experience a recurrence. In chapter 7 the results of a randomised controlled clinical trial comparing the effects of the MMT programme and exercise therapy (ET) are presented. The MMT group returned to sports significantly quicker, in 12.8 weeks, than those in the ET group (17.3 weeks). An objective outcome score showed no difference between the two treatment groups in numbers able to return to sport. Chapter 8 presents the results of mid-term follow-up of the RCT presented in chapter 7. The average follow-up was 29 months after completion of the treatment. 30% of the athletes who had recovered at short-term follow-up had had a recurrence. There were no significant differences between the groups. In chapter 9 a discussion of the studies presented in chapters 2-8 is given and recommendations for clinical practice are made.