The Grumbling Groin
September 03, 2018 at 3:10 PM
If you’ve ever presented to your physio with groin pain you may have noticed - just for a split second - the look of dread in their eyes… Rest assured that this is not because we are worried about touching your groin, but because by the time you come to see us for the pain, it is often because the ‘groin strain’ that you put off or ignored previously has returned, or you’ve had a mild grumble for a long time until it’s finally forced you to stop and see someone. As most physios know, this type of groin pain is unlikely to be resolved by a bit of massage and a few stretches, but will more likely take weeks of specific rehab which can be met by a bit of grumbling - from you, not your groin. The good news is once you’re on board, we can get great results with the rehab, helping to relieve the current pain and prevent further pain and injury.
So what causes longstanding or recurrent groin pain?
One of the most common diagnoses is Osteitis Pubis. Osteitis Pubis describes an overuse injury caused by repetitive trauma or overload to the pubic symphysis – the joint at the front of the pelvis. This is actually quite a vague description of what is often the end result of a number of different pathologies. As you can see in the picture there are numerous structures that attach into and around the groin area. The adductor muscles, hip flexor muscles (iliopsoas) and even the abdominals all attach and pull in different directions around the pubic bone at the front of the pelvis.
Any of these muscles can be the original cause of groin pain, either from an acute injury that hasn’t been properly rehabilitated or from overuse, usually in sports that involve kicking, fast running and quick changes of direction such as soccer and basketball, although I have recently found even yoga can sometimes be too much for an unstable pelvis. Continuing to do these activities once there is some pain can lead to an imbalance in the structures mentioned above that pull on the pubic bone, causing stress. Other factors that can contribute to stress on the pubic bone include low back dysfunction and poor core stability which puts an asymmetrical force on the pelvis. The symptoms are pain on one or both sides of the groin or the front of the hips and tenderness over the pubic bone.
So what can we do as a physio?
It all sounds a bit complicated, with eventually many structures becoming involved, and if I’m honest the rehab can be a bit slow and frustrating but the issue certainly can be resolved and is well worth the hard work to finally get on top of a longstanding issue. The goal of treatment is to take the stress off the pubic bone; this means resting from the aggravating sport or activity is really important. Pain-free rehabilitation can commence straight away and will include strengthening of the affected structures (such as the adductor muscles), as well as a core stability programme to improve control around the pelvis and ensure the load is distributed evenly. In my experience, I have found Clinical Pilates is a great way to incorporate all aspects of this rehab.
Having to tell a basketballer to stay off the court or a yogi to stop stretching is definitely the worst part of my job but in the case of the grumbling groin, the sooner you stop and embrace the Pilates studio, the sooner you will be back out there doing what you love!
Michelle has completed specialised training in the area of Women’s Health physiotherapy including the treatment of incontinence and pelvic floor dysfunction. She is passionate about empowering women to take control and keep fit and healthy throughout pregnancy and beyond and finds this area extremely rewarding.