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Hip and Core Muscle Injuries in Soccer

October 11, 2018 | Surgery
Benjamin Sherman, DO ; Jorge Chahla, MD, PhD ; William Hutchinson, MD ; Michael Gerhardt, MD
Author and Disclosure Information

Authors’ Disclosure Statement: Dr. Gerhardt reports that he is a consultant for Arthrex, Ferring Pharmaceuticals, Stryker, and Medacta. The other authors report no actual or potential conflict of interest in relation to this article.

Dr. Sherman is a Resident Physician, Riverside University Health System, Moreno Valley, California. Dr. Chahla is a Sports Medicine Fellow, Cedars-Sinai Kerlan-Jobe Institute, Santa Monica, California. Dr. Hutchinson is a Medical Director, Pacific Coast Hernia Center, Santa Monica, California. Dr. Gerhardt is a Sports Medicine Co-Fellowship Director, Cedars-Sinai Kerlan-Jobe Institute; and Team Physician, US Soccer and Major League Soccer, FIFA Medical Center of Excellence, Santa Monica, California.

Address correspondence to: Benjamin Sherman, DO, Riverside University Health System, 26520 Cactus Ave., Moreno Valley, CA 92555 (tel, 951-486-4698; email, Sherms04@gmail.com).

Benjamin Sherman, DO Jorge Chahla, MD, PhD William Hutchinson, MD Michael Gerhardt, MD . Hip and Core Muscle Injuries in Soccer. Am J Orthop.

October 11, 2018

TAKE-HOME POINTS

  • Groin injuries in soccer players can cause significant decreases in athletic performance, result in lost playing time, and may ultimately need surgical intervention.
  • Groin pain can be separated into 3 categories: (1) defined clinical entities for groin pain (adductor-related, iliopsoas-related, inguinal-related [sports hernias/athletic pubalgia], and pubic-related groin pain), (2) hip-related groin pain (hip morphologic abnormalities, labral tears, and chondral injuries), and (3) other causes of groin pain.
  • Acute groin pain in soccer players is most commonly caused by muscle strain involving the adductor longus, the iliopsoas or the rectus femoris.
  • Inguinal-related groin pain is a common cause of chronic groin pain and typically is the most challenging to treat with a complex pathophysiology and a high association with femoroacetabular impingement.
  • Hip-related groin pain (femoroacetabular impingement, labral tears, and chondral injuries) usually respond well to surgical intervention and has high rates of return to sport.

Each year, the global audience for soccer grows. Soccer has long surpassed all other sports as the most popular sport in the world, reaching 3.2 billion viewers during the 2014 World Cup.1 In the latest Fédération Internationale de Football Association (FIFA) Big Count survey, the organization estimated that 265 million people are actively involved in soccer, accounting for approximately 4% of the world’s population.2 Moreover, the number of people playing soccer increased by 9.5% within 6 years after the previous Big Count Survey.2 In the United States, soccer accounts for the fourth most common cause of sports injuries next to basketball, exercise, and football with approximately 228,000 injuries per year.3 The total cost of treatment related to worldwide soccer injuries tops $30 billion.4 The most common body parts injured are the thigh (25%), knee (18%), and hip and/or groin (14%).5

Hip and groin injuries in soccer players can be separated into 3 main categories based on the Doha Agreement:6 (1) defined clinical entities for groin pain, (2) hip-related groin pain, and (3) other causes of groin pain in athletes. Defined clinical entities include adductor-related, iliopsoas-related, inguinal-related (sports hernia/athletic pubalgia), and pubic-related groin pain; while hip-related groin pain includes hip morphologic abnormalities, labral tears, and chondral injuries. Included in other causes of groin pain are injuries not clinically defined. The Doha Agreement has acknowledged that not all causes of groin pain fit into the classification system including injuries of the rectus femoris, but they will be included under defined clinical entities for groin pain in this review. While they are not a cause of groin pain, proximal hamstring and gluteal and piriformis injuries are important causes of posterior and lateral hip pain in soccer players and will also be covered in the first section of this review.

DEFINED CLINICAL ENTITIES FOR GROIN PAIN IN SOCCER ATHLETES

ADDUCTOR-RELATED GROIN PAIN

Acute groin pain in soccer players is most commonly caused by muscle strain.7 Of the muscle strains, 66% involve the adductor longus, 25% the iliopsoas, and 23% the rectus femoris.7 The Doha Agreement defines adductor-related groin pain as adductor tenderness and pain on resisted adduction.6 Adductor longus strains in soccer players are typically noncontact injuries (62.5%) and most commonly the result of kicking (40%).7-9 Many athletes will remember a pop at the time of the original injury.9 The combination of history and physical examination is usually sufficient for diagnosis; however, magnetic resonance imaging (MRI) may be helpful in complicated situations with a reported 86% sensitivity and 89% specificity.10 The average playing time lost is 2 weeks.5 Management includes rest, anti-inflammatory medication, physical therapy with core strengthening, and avoidance of aggressive stretching. While partial and distal avulsions can heal with conservative measures, proximal osseous and retracted avulsions of the adductor longus can be treated surgically.11

Continue to: ILIOPSOAS-RELATED GROIN PAIN...

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