SOFT-TISSUE DIFFERENTIAL DIAGNOSIS

PELVIC, ABDOMINAL & GROIN INJURIES

FACTS

● The most common cause of groin pain in soccer players is musculo- tendinous strain of the adductor group ● Statistical prevalence of groin injuries in soccer varies between 5- 28% of the total number of injuries ● In the 95/96 season, the equiva- lent of more than four Premier League teams were sidelined with abdominal wall injuries (over 45 peo- ple) ● A total of 22 muscles attach them- selves to each inominate bone and apply different directional and shear- ing forces to the pelvic ring during activity, more than any bony struc- ture in the human body ● The male groin is particularly sus- ceptible to injury because of the embryonic descent of the testes

By David Fevre, MCSP, MSc

The terms ‘groin injury’ and ‘sports- man’s hernia’ are often used to describe a multitude of pelvic and groin injuries and cover a wide variety of injury sce- narios for both player and coaching staff, particularly in soccer or rugby.

In the world of professional sport the pressure to win is so intense that often abdominal wall surgery may be necessary immediately after diagnosis. In the undi- agnosed or amateur player, rest, rehabili- tation and a period of frustration may be the only immediate option. Full function- al recovery is possible within 4-6 weeks with the appropriate surgery and rehabili- tation programme.

The aim of the following series of articles is to assist in the diagnosis, rehabilitation and prevention of acute and chronic pelvic and groin injury, with a practical

emphasis on functional rehabilitation in the injured soccer player.

Anatomy The ‘groin’ is best described as the portion of the anterior abdominal wall below the level of the anterior superior iliac spines, extending as far as the upper one third of the femur. The pelvic ring consists of the sacrum and the two inominate bones with three joint sites at the symphysis pubis and the two sacroiliac joints. The lumbar spine extends postero-superiorly from the lumbosacral junction and inferiorly and bilaterally run the lower limbs from the hip joint. The abdomen and groin are sub- jected to varying angles and degrees of pull from the surrounding muscles.

The abdominal wall consists of four layers of muscle tissue: 1) External obliques - extend from the lower ribs to the pelvis and are primarily responsible for trunk flexion and rotation

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