Common running injuries - groin pain

Common running injuries - groin pain

Groin pain can be caused by damage to tissues in the groin area. This is called a sports hernia or 'inguinal disruption'.

Groin pain can be caused by soft tissue disruption (damage e.g. by tearing) that affects an area of the groin near the genitalia, known to physicians as the 'inguinal region'. This tissue disruption is commonly called a sports hernia (though it is not a true hernia) and the medical term for it is an 'inguinal disruption'.

Symptoms

  • Pain in the lower abdomen often radiating into the inner and upper thigh.
  • Perineal pain (i.e. pain in the area between genitalia and anus) and in men, testicular pain can be experienced.
  • Pain varies from being diffuse (i.e. spread across an area) to being severe and sharp.
  • Pain is usually initiated by running, accelerating, changing direction and kicking.
  • Pain is also caused by coughing, sneezing or abdominal exercises which increase pressure in the abdomen.
  • Pain is felt after exercise and particularly when getting out of bed the morning after exercise.
Causes
  • Weakness of the abdominal and pelvic musculature.
  • Stiffness of the hip joints and lower back.
  • Poor flexibility of the hip musculature.
  • Stressful running mechanics.
  • Stressful 'normal' working practices involving heavy or difficult lifting could also contribute.
Note that as well as being caused by a sports hernia, this type of pain could also be caused by:
  • pain originating from an injury in the lower back, one of the joints in the abdomen (sacro-iliac joint) or hip joints
  • inflammation and/or irregularity of the joint (called the pubic symphysis joint) at the front of the pelvis where the two halves of it come together. This condition is called 'osteitis pubis'
  • excessive mobility of the pelvic joints leading to inflammation and pain, called pelvic instability
  • strain or tear of the abdominal (stomach) or adductor (inner thigh) muscles
  • stress fracture of part of the pubic bone called the pubic rami
  • nerve pain from inflamed or entrapped nerves in the area.
Self Help
  • Rest for 2-3 days as soon as you feel symptoms.
  • Ice the area of pain for 15-30 minutes every 2 hours or as often as practical, protecting the skin with oil or a damp cloth.
  • Ask your doctor about the use of oral anti-inflammatories to see if they reduce the symptoms.
  • Gently stretch the lower abdominals, hip flexors, gluteals, quadriceps, hamstrings and adductor muscles.
  • Avoid cambers, slippery surfaces and sudden speed or directional changes when running.
Treatment

This condition needs a diagnosis via a combination of clinical tests often backed up by further investigations to count out other possible causes of pain in this area.

Mild forms of sports hernia sometimes respond to treatment including:
  • manual therapy to increase joint mobility
  • releasing techniques for tight muscles and fascia (the tissue that joins muscles and bone)
  • rehabilitation and re-education to restore balance and strength to the pelvic musculature
  • work to allow the nerves to move more freely (neural mobilizing techniques)
  • graduated return to training and racing.
More severe forms require surgical repair by a sports, orthopaedic or general surgeon. The same therapy and rehabilitation principles and techniques will need to be followed after surgery.

Average recovery times
  • Mild - with appropriate rest, therapy and rehabilitation, ranging from 2-10 weeks.
  • Severe - 10-16 weeks following surgery.
Unfortunately it is not unusual for some symptoms to persist at a lesser level even after surgery.

Prevention
  • Avoid training errors, such as running on uneven surfaces, in inappropriate footwear.
  • Have a biomechanical assessment.
  • Warm up and stretch appropriately with particular attention the lower abdominal and hip musculature.
  • Have an evaluation of muscle balance/imbalance and follow the exercise prescription.
  • Make use of regular self and professional massage.
  • Avoid 'unusual activities' involving fast directional changes and increased intra-abdominal pressures, i.e. occasionally playing football or squash when you are not used to the stresses of these activities.

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