GROIN INJURIES

Presentation: The player often describes a chronic injury which has been niggling for a period of time but has never been severe enough to warrant medical atten- tion. This gradually gets worse until they realise it is affecting their physical per- formance. Pain can often be reproduced on resisted hip flexion with the player lying supine on a plinth with the knee flexed over the edge.

Rehabilitation: The most important fea- ture of rehabilitation is to regain full, pain free mobility with emphasis on hip extension and associated hip rotation. Players whose position requires repeated kicking activities, such as crossing the ball, must be fully rehabilitated before being allowed to return to competition.

iv) Rectus femoris strain History: The player will describe pain over the upper one-third of the rectus femoris. Other signs and symptoms are dependent on the grade of injury. Partial or total rup- ture is not uncommon in this situation.

Cause: This acute injury often occurs dur- ing sprinting or kicking the ball, with the player demonstrating physical symptoms immediately. They are unable to repeat the action without describing a severe sudden pain.

Presentation: As this is a two joint mus- cle, objective examination must include combined movements at both the hip and knee joint. The player will complain of pain on resisted hip flexion and knee extension. These symptoms may also be produced during flexibility tests, particu- larly when the hip is extended and knee flexed, with the player in the prone posi- tion.

Rehabilitation: Acute care is dependant on the clinical signs, symptoms and grade of injury. Full mobility, incorporating hip extension and medial rotation along with knee flexion, is essential in any strain. Functional re-education of acceleration/ deceleration and diagonal kicking of the ball is essential to ensure that concentric, isometric and eccentric control has been fully restored before allowing the player to return to full competition.

2) Abdominal trauma Abdominal trauma in many collision sports, such as soccer, result in 10% of

30 SportEX

the abdominal injuries produced in sports related incidents. Immediate attention should be given to these injuries but par- ticular notice should be given to any play- er who develops pain in the area of the spleen, liver, kidney and pancreas.

Clinical symptoms: The player may go into shock and other clinical symptoms including sweating, thirst, rapid pulse, low blood pressure and haematuria (blood in the urine) may be present. Urgent medical evaluation is critical in these circumstances. Once damage to the major internal organs has been eliminated a more common diagnosis following trauma is a haematoma to various bony sites such as the anterior superior iliac spine and soft tissue structures of the abdomen and groin.

Examination: The abdomen must be pal- pated to assess if there is any area of ten- derness or guarding to manual pressure. If the player demonstrates a positive response then the medical personnel must suspect abdominal bleeding until ruled out after hospital admission. Blood pres- sure and pulse rate must be monitored throughout as signs and symptoms can easily develop with such an injury.

Management: Trauma to the left lower rib cage may cause damage to the spleen and in severe cases may result in rupture. This should be referred directly to hospi- tal for observation, intravenous fluids and pain relief. Surgery will be needed if signs of circulatory collapse are evident.

Pain in the upper right side of the abdomen suggests damage to the liver. The most common injury is capsular haematoma which requires rest, observa- tion and intravenous fluids. The need for surgery is rare.

The presence of blood in the urine and pain over the flank of the abdomen sug- gests a direct blow to the kidney and pres- ence of blood in the urine requires hospi- tal admission for rest and oral fluids. Major damage will require surgery.

Rehabilitation: Soft-tissue trauma

responds well to the use of the various thermal and electrotherapy modalities available to the therapist. The use of non- steroidal anti-inflammatory drugs may also be useful in the acute stage.

Management: Electrotherapy modalities and the use of NSAIDs in the initial stages may be of benefit. Corticosteroid injec- tions have been used and are inserted directly into the symphysis or the inser-

Figure 4: Roughening of the periosteum at the symphysis pubis

A standard blood test may be of use as some researchers have suggested that osteitis pubis is a result of a chronic low-grade infection

Recovery can be slow and protective padding may be beneficial before return- ing to full contact training. 3. Osteitis pubis - degenerative damage History: Osteitis pubis is common in players involved in heavy training and/or playing schedules, particularly if they involve hard surfaces. It usually develops following chronic repetitive movement of the symphysis pubis which produces shearing and tensile forces and subse- quent laxity in the symphysis ligaments.

Presentation: The player tends to com- plain of vague low abdominal pain along the pubic bone or in the pubic symphysis.

Investigations: The diagnosis is con- firmed by ‘stork’ or ‘flamingo’ view radi- ographs (standing on one leg), with a fraying or roughening of the periosteum of the symphysis pubis. Ligamentous instability is present if a step in the joint line exists of three millimetres or more. Computerized tomography (CT) or bone scans might reveal an increase in radionu- clide uptake in the region.

X-rays that demonstrate roughening at the symphysis pubis (Fig.4) may be mis- leading in determining the diagnosis of groin pain. Erosion of the symphysis pubis is an occupational hazard for the profes- sional soccer player and diagnosis should never be made on the x-ray report alone.

TIP