GROIN INJURIES

2) Rectus abdominis - as above 3) Transversus abdominis - these mus- cles wrap around the abdomen, attaching indirectly to the thoracolumbar fascia, creating an anatomical ‘girdle’ for sup- port. Their main function is to stabilise the trunk 4) Internal obliques - also responsible for trunk flexion

The inguinal canal is an anatomical land- mark often associated with abdominal dis- ruption injuries and knowledge of its anatomy in relation to the abdominal musculature is important in understand- ing this relationship.

Figure 1: Anatomy of the pelvis

In diagonal opposition to the abdominals are the gluteal muscles which extend (gluteus maximus) or abduct/medially rotate (medius and minimus) the lower limb and stabilise the pelvis. In relation to hip extension and pelvic stability the gluteii work closely with the hamstrings, which also have an effect in stabilising the pelvis. In opposition and directly related to the hip/groin region are the iliopsoas and quadriceps muscle groups. The iliopsoas muscle group is the only muscle that has an origin superior to the pelvis. In diagonal opposition to the iliopsoas/quadriceps groups are the lower

Abdominals Lower Back

Inominate bone

Iliopsoas {

Adductor muscles

Psoas minor Psoas major Iliacus

Lumbosacral junction

Sacroiliac joint

Sacrum

Symphysis pubis

Rectus femoris

Inguinal ligament

Iliopsoas Quadriceps

Gluteals Hamstrings

Figure 2: The multi-directional effect of strength and flexibility enforced by the major muscle groups on the pelvic ring (indicated by the

)

Muscle strains - acute injury The most common cause of groin pain is a strain of the adductor longus, rectus abdominus, iliopsoas or rectus femoris muscles.

Clinical symptoms: Acute injuries are associated with all the typical signs of inflammation (pain, swelling, heat, red- ness) whereas chronic injuries present with a more nagging ache produced by the presence of scar tissue. These can be graded according to table 1.

General management: In acute injuries the PRICE (protection of the injury, rest, ice, compression, elevation) formula, electrotherapy and use of NSAIDs will settle many of the inflammatory signs and symptoms. Following on from these acute steps, the rehabilitation pro- gramme must cover the following stages to ensure a full recovery is possible.

28 SportEX

Range of Movement (active and passive)

Proprioception Muscle strength

(isolated and sequential) Function

The more chronic problems may require corticosteroid injection or more rarely soft- tissue release by an orthopaedic surgeon.

Severity Pain/

Strain Sprain

Spasm +

++ Rupture +++ (initially) Table 1: Signs and symptoms of the varying degrees of soft tissue injury Swelling

Calcification and scar tissue can readily develop in the musculotendinous and teno-periosteal junctions of such injuries and give chronic long term symptoms if the injury is not dealt with thoroughly in the early stage.

General rehabilitation: Rehabilitation

should only take place once the acute symptoms have subsided. Soft tissue injuries undergo three stages of recovery after injury and careful consideration of

Colour/

Slight, if any None Moderate

Severe Loss of Loss of bruising ROM Slight Severe

Function Slight

Possible Moderate Moderate Extensive

Severe