inguinal-related pain:
Inguinal-related hip pain is a common yet often misunderstood condition that affects individuals across various activity levels. It is characterised by discomfort or pain in the inguinal region (groin area), which can be associated with musculoskeletal, neurological, or even visceral causes. This type of hip pain is often seen in athletes, particularly those engaged in sports involving sudden changes in direction, kicking, or repetitive hip flexion movements.
Anatomy:
The inguinal region consists of multiple anatomical structures, including muscles, tendons, ligaments, and nerves. Key components include:
- Inguinal ligament: Runs from the anterior superior iliac spine (ASIS) to the pubic tubercle.
- Iliopsoas muscle: A major hip flexor that plays a significant role in movement and stability.
- Adductors: Particularly the adductor longus, which is frequently involved in groin injuries.
- Nerves: The ilioinguinal and genitofemoral nerves can contribute to referred pain in the region.
- Pubic symphysis and surrounding structures: These contribute to pelvic stability and can be affected in cases of inguinal-related hip pain.
Physiology and Function:
The primary role of the inguinal region is to facilitate hip and pelvic movements necessary for activities such as walking, running, and kicking. The muscles and connective tissues in this area help maintain core stability, facilitate dynamic movements, and absorb forces during weight-bearing activities. Any dysfunction in this region can lead to compensatory mechanisms, increasing strain on surrounding structures.
Mechanism of Injury:
Inguinal-related hip pain is often caused by:
- Overuse injuries due to repetitive strain on the hip flexors and adductors.
- Acute trauma from sudden changes in direction, forceful kicks, or direct impact.
- Muscle imbalances where weak or tight hip stabilizers contribute to poor biomechanics.
- Hip joint pathology including femoroacetabular impingement (FAI) or labral tears, which may lead to secondary inguinal pain.
- Nerve entrapment particularly involving the ilioinguinal or obturator nerve, leading to neural irritation and referred pain.
Risk Factors:
Several factors predispose individuals to inguinal-related hip pain, including:Strengthening the quadriceps and glutes to support knee mechanics:
- High-impact sports participation (e.g., football, hockey, rugby, martial arts).
- Inadequate warm-up or conditioning before intense physical activity.
- Poor biomechanics or muscle imbalances affecting hip and pelvic stability.
- History of previous groin injuries, making recurrence more likely.
- Hip joint abnormalities, such as FAI or dysplasia.
- Postural issues leading to excessive strain on the inguinal region.
Signs and Symptoms:
Common clinical presentations of inguinal-related hip pain include:
- Gradual onset of pain in the groin area, exacerbated by activity.
- Pain during resisted hip flexion or adduction.
- Tenderness along the inguinal ligament or pubic region.
- Referred pain into the lower abdomen or inner thigh.
- Weakness or discomfort with explosive movement, such as sprinting or cutting maneuvers.
- Pain with prolonged sitting, standing, or changes in hip positioning.
Physiotherapy Management:
A comprehensive physiotherapy approach is essential for effective management. Key strategies include:
- Pain Management
- Relative rest and activity modification.
- Use of ice or heat therapy based on patient tolerance.
- Soft tissue techniques such as massage and myofascial release.
- Manual Therapy
- Joint mobilization techniques to address hip and pelvic restrictions.
- Nerve gliding exercises if neural involvement is suspected.
- Exercise Rehabilitation
- Strengthening exercises targeting the core, hip flexors, adductors, and gluteal muscles.
- Mobility work to improve range of motion and prevent compensatory patterns.
- Progressive loading to restore strength and endurance safely.
- Biomechanical Correction
- Addressing muscle imbalances and movement inefficiencies.
- Functional retraining to enhance sports performance and reduce reinjury risk.
- Return-to-Sport Protocol
- Gradual reintroduction to sport-specific activities.
Monitoring for pain recurrence and adjusting rehabilitation accordingly.
By implementing a structured physiotherapy approach, patients with inguinal-related hip pain can achieve optimal recovery, restore function, and reduce the likelihood of future injuries. If symptoms persist despite conservative management, referral for further medical evaluation, including imaging or specialist consultation, may be warranted.
References:
- Weir, A., Brukner, P., Delahunt, E., et al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes.British Journal of Sports Medicine, 49(12), 768–774.
- Thorborg, K., Rathleff, M. S., Petersen, P., et al. (2018). Prevalence and severity of groin problems in sub-elite and elite football players: A cross-sectional cohort study. Scandinavian Journal of Medicine & Science in Sports, 28(2), 658–666.
- Reiman, M. P., Goode, A. P., Cook, C. E., et al. (2015). Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: A systematic review with meta-analysis. British Journal of Sports Medicine, 49(12), 811–822.
- Crossley, K. M., Mansournia, M. A., van Dijk, C. N., et al. (2020). The role of physiotherapy in the management of hip-related pain: A systematic review and meta-analysis of clinical trials.British Journal of Sports Medicine, 54(23), 1382–1394. doi:10.1136/bjsports-2019-101456
- Griffin, D. R., Dickenson, E. J., O’Donnell, J., et al. (2018). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): An international consensus statement. British Journal of Sports Medicine, 50(19), 1169–1176.
