Groin pain

The degree of pain depends on which injury is involved.
Complaints sometimes present nagging, sharp or even burning. We also distinguish between acute
symptoms and symptoms the slowly got worse. Both are possible in the onset of groin pain.
To find out what is causing your groin pain, a physiotherapy examination is performed.
If necessary, consultation with your GP will take place for further investigation.

The vast majority of cases involve a muscle injury. Usually, this also happens during sports. During braking or rapidly changing direction, the forces on the muscles in the groin are too great and can result in a muscle strain or tear. With a muscle tear, the pain is sharp and immediately noticeable. The cause of the symptoms is obvious. The inside of the thigh to the lower abdominal muscles may be sensitive and feel stiff. You may also be able to exert less force (temporarily).

The muscles in the groin are called the adductors and consist of 6 different muscles:

• Adductor longus
• Adductor brevis
• Adductor magnus
• Gracilis
• Pectineus
• Obturatorius externus

The above muscles are responsible for the force in the hip inwards. We therefore call this movement adduction. The adductors are very important during different types of sports such as: football, sprinting, swimming, rugby and hockey.

In a muscle injury, we use different grades(1-3). Namely, it is possible that there is only a mild strain but there may also be a muscle tear or even a complete tear.

• Stage 1: Mild sensitivity, often no limitations in normal walking, climbing stairs or even running.
• Stage 2: Moderate sensitivity, often restrictions in activities such as running and jumping. Possible blue discolouration and/or swelling in the groin region.
• Stage 3: High degree of pain, everyday activities are painful or even impossible to perform. Swelling is present along with stiffness of the muscles in the groin region. Possible blue discolouration.

When there is a serious muscle injury, it is necessary to have it examined by a professional. Signs of a serious muscle injury are:

• Difficulty or inability to walk
• Pain at rest
• Nighttime pain that does not subside when you change positions

In rare situations, surgical intervention is needed where the muscle needs to be fixed. This is almost rare, often it can also recover without surgical intervention but under the guidance of a physiotherapist. Possible causes of a muscle injury in the groin. Groin injuries are usually the result of several factors such as:

• strength of surrounding muscles in the hip and abdominal muscles
• general condition
• injury history

For this reason, it is important to ensure that muscle strength and general fitness are in order for the sport you play. For athletes and especially footballers, it is important to train the abs and adductors to prevent injuries. You often hear (personal) trainers say that performing compound exercises such as a squat and lunge is enough to maintain the strength and load capacity of the adductors. However, research shows that the load on the adductors during these exercises is many times lower than during more isolated exercises for the adductors.

To achieve the best results, a training protocol has been developed that shows very good results with regard to injury prevention in football players. Research shows an increase in muscle strength of 35.7% over an 8-week period. This involves eccentric strength. In addition, it was found that with this exercise protocol, there is also a positive effect on the abductors of the hip. Here, the same 8-week intervention achieves an eccentric strength increase of 20%. The exercises are relatively easy to perform and are easy to incorporate into your current training. It is advised to start with this exercise protocol in preparation for the season. You can then continue performing the exercise throughout the season.

Besides a muscle injury, other conditions can also cause groin pain. We list the most common causes for you below.

The labrum is a cartilage ring at the edge of the socket of the hip joint. It is a very thin ring only a few millimetres thick that, deeper in the joint, passes into the articular cartilage. The function of the labrum is to create an airtight joint Its function is to create an airtight joint in which the joint moves. In addition, the labrum provides stability/strength in the hip. Hip complaints due to labrum injury mainly occur at a relatively young age. Here we are talking about the age when a sport is practised fanatically, often up to 30-35 years old.

Why labrum injury occurs is not always clear. Several problems are known to underlie the development of labrum problems.

There may be a bone defect in the hip. This abnormality can occur in both the head and socket of the hip or in some cases both. In the case of an abnormality in the head, we speak of a CAM deformity; in the case of an abnormality in the socket, we speak of a PINCER deformity. A CAM deformity is a deviation in the curve of the femoral head. This prevents the head from moving smoothly through the hip socket. Compare it to a ball that is not round, it will never be able to roll smoothly in one direction either. With pincer deformity, we see that the hip socket is actually a little deeper than normal. This causes some extra bone to form at the edge of the socket, limiting mobility. In both cases, trapping occurs when a large range of motion is required of the hip. In long-term complaints, damage to the labrum often occurs.

Injury to the labrum can also occur after an accident or during sports. Here we generally see that there is a clear (traumatic) moment of origin of complaints. Sports in which labrum complaints are more common are gymnastics, football, volleyball, martial arts and golf. Presumably, this happens because these are sports in which very much for rotational movements recur in the hip. In addition, the muscles around the hip may not be strong enough to support you in your daily activities. Here, too much is asked of the labrum causing problems.

Hip pain where the labrum is the source of the pain can often be recognised by the following:

• Deep pain at the front of the hip.
• A painful click during hip movements (the sensation of dislocation).
• Pain that increases with long sitting or standing.
• Pain in hip when squatting.
• Reduced strength of muscles around the hip.
• Stiffness in the hip (reduced mobility?).

Labrum injury is not always easy to diagnose. Often, other images are ruled out and an MRI confirms the diagnosis. A tear in the labrum does not repair itself. If necessary, surgery is sometimes performed to repair the cartilage ring. In other cases, the symptoms can be controlled just fine with physiotherapy. Want to know more?

Hernia Inguinalis. 

An inguinal hernia (hernia inguinalis) involves a weakness in the abdominal wall. So it is not as if your groin is actually broken. Because of this weakness in the abdominal wall, there is a possibility that intestines, abdominal fat or peritoneum bulge slightly. This then happens mainly when coughing, sneezing or pressing (increasing abdominal pressure). This creates a bulge in the groin that can be felt but sometimes also easily seen. An inguinal hernia can be recognised by pain in the groin during the above activities or certain movements in combination with the presence of swelling/a lump. Sometimes an inguinal hernia is less easy to recognise. In such cases (when other diagnoses have also been ruled out), an ultrasound of the groin area may have added value. An inguinal hernia can occur in both women and men. However, it is a problem that occurs more often in men.

An inguinal hernia (hernia inguinalis) involves a weakness in the abdominal wall. So it is not as if your groin is actually broken. Because of this weakness in the abdominal wall, there is a possibility that intestines, abdominal fat or peritoneum bulge slightly. This then happens mainly when coughing, sneezing or pressing (increasing abdominal pressure). This creates a bulge in the groin that can be felt but sometimes also easily seen. An inguinal hernia can be recognised by pain in the groin during the above activities or certain movements in combination with the presence of swelling/a lump. Sometimes an inguinal hernia is less easy to recognise. In such cases (when other diagnoses have also been ruled out), an ultrasound of the groin area may have added value. An inguinal hernia can occur in both women and men. However, it is a problem that occurs more often in men.

Possible problems with an inguinal hernia.
An inguinal hernia in itself need not be a problem or an obstacle. If the inguinal hernia is only very small, you may not even notice it is there. Risk factors for developing an inguinal hernia include smoking, obesity and pregnancy. A large inguinal hernia that causes a lot of symptoms is usually repaired surgically. The same applies when women have an inguinal hernia. This is because an inguinal hernia in women generally has a higher risk of complications.

What is osteoarthritis?
In hip osteoarthritis, the cartilage between the head and socket is in a reduced condition. Its quality often decreases as we age. In many cases, this decrease in quality does not cause any problems. You don't always have to notice this. The development of osteoarthritis is largely hereditary. This factor has much more influence than, for example, choice of sport or having a physically demanding job. If you have symptoms, they often manifest themselves in symptoms such as pain and stiffness in the hip. Cracking noises, restriction in movement and instability complaints may also be part of the symptom picture. The pain at hip osteoarthritis can present itself in the groin region, among others.

Gradations within osteoarthritis symptoms.
There are four grades with which to classify hip osteoarthritis;

• Grade 1: The springiness of the cartilage is reduced. There is minimal osteophyte formation (extra bone formation). This degree of osteoarthritis is not yet visible on an X-ray.
• Grade 2: There are irregularities in the cartilage surface. Osteophyte formation can sometimes be observed on X-ray. This degree of osteoarthritis is also not always detectable on a photograph.
• Grade 3: Deeper cracks and grooves are visible in the cartilage. However, the bone surface is not yet exposed in this case. The joint gap may be narrowed; this is visible on an X-ray. Abnormalities can often be seen in the bone edges.
• Grade 4: The cartilage has almost completely disappeared and the joint gap is little to no longer visible.

Notable for osteoarthritis complaints.
What is remarkable is that more osteoarthritis does not equal more symptoms(pain, stiffness, loss of strength). So there are people with a lot of ageing of a joint but relatively few complaints, also the other way around, little visible osteoarthritis but still a lot of disability. In fact, it is not ageing itself that causes complaints. This may have several causes. For instance, we see that in an area where the joint has aged, the nerve sensitivity to pain increases due to a kind of inflammatory process. As a result, normal movements can be experienced as painful without any real immediate danger. With osteoarthritis symptoms, it is important to work with your physiotherapist to identify where your daily limitations lie. This allows you to work together with the physiotherapist to reduce the symptoms and remain as vital and independent as possible in your daily activities. In some cases, it is chosen to replace an arthritic hip. Would you like to know more about this? Read it here

Radiance back

Complaints in the hip do not always have to have an origin in that area. This is because there are different structures in the body with a radiating area. For example, when there are complaints of a nerve from the back, this may manifest itself in another area of the body. When a nerve from the spine causes problems, it sometimes affects the entire course of the nerve in the leg. So you may then experience symptoms in the hip. Possibly, complaints such as osteoarthritis in the back may also cause a different movement pattern in the hip. It is therefore logical that physiotherapists, if they suspect this might be the case, also include the back in their diagnostic process at hip complaints.

Groin pain can also be caused when the attachment of the thigh to the pelvis (front) is overloaded. This often occurs as a result of overuse in sports that involve faster and explosive movement. Complaints often present themselves as follows:

• Pain when lifting the thigh
• Supporting the leg with the hands when moving the upper leg(often getting in and out of the car)
• Radiation to the outside of the hip

We see this as a secondary complaint, so I wonder if we should mention it. There is nothing else we can do about the bursa itself. We can, however, do about the primary source of the complaints. On the outside of the hip is a bursa. Its purpose is to reduce friction between muscles and bone parts in that area. This bursa can become irritated and then cause symptoms.

There are several known causes for the development of a bursitis in the hip;

• Damage to tendons running around the bursa
• Irritation of tendons around the bursa
• Calcification of tendons around the bursa
• Inflammation of the bursa itself
• Overload

A bursitis in the hip can be recognised by pain at the side of the hip. This pain may radiate to the buttock or towards the knee. The pain is felt while walking or lying on the hip. Complaints can also occur when crossing the legs or while climbing stairs. Typically, pain is often present precisely at night too. Bursitis is a persistent complaint that can take weeks to months to recover. It is important (if there is an underlying cause) to address it. Thus, treatment of bursitis never targets the bursa itself. Sometimes an anti-inflammatory injection is administered by a doctor to speed up the recovery process.

Sometimes people retain groin pain as a result of surgery. An example is groin pain after inguinal hernia surgery or caesarean section. Groin pain after surgery occurs approximately in 11% of men after inguinal hernia surgery and in 7% of women after caesarean section. It often involves irritation or damage to one of the three inguinal nerves:

• ilioinguinal nerve
• genitofemoral nerve
• iliohypogastric nerve

A pinched nerve may give:

• Burning sensation, sometimes stabbing in the groin region
• Sharp presence when changing position or coughing or sneezing
• Unable to sleep well on the side
• Negative impact on sex life, pain during sex
• On the scar is a clearly recognisable sharp pain
• Skin feels dull or less sensitive

When it comes to groin pain after surgery, further examination and treatment by a doctor is necessary.

The groin region is very complex there are many anatomical structures that could potentially cause the pain. This makes it difficult to identify the actual cause. It is necessary to arrive at a correct diagnosis before treatment is initiated. Are you suffering from groin pain and not sure what to do with it? Then take contact with us via the registration form for your first appointment at Physio Fitaal.