These are described as inguinal pain syndromes (Groin pain syndrome) because many types of groin area pain occur in football and other sports from various causes, making it difficult to identify the true cause.
Differential diagnoses include symphysis pubis inflammation, enthesitis of the adducent muscles of the femur, rectus femoris myositis, rectus abdominis enthesitis, iliopsoas myositis, and inguinal hernias.
Figure: Area of pain around the groin (Reference 1).
Cause and mechanism of onset
Cause of the injury
Muscle weakness, decreased flexibility, and contracture may be caused by injury or overuse in sports of the leg. And it seems to lead to pain around the inguinal region.
Repeated exercises, such as kicking and running, can inflame and hurt the groin, hip joint, and pelvis through mechanical stress. It also occurs when a person has a direct blow to the hip joint area, such as a tackle.
It is characterized by tenderness, motor pain, and sometimes pain radiating to the groin, medial thigh (adducent muscles insertion), or lower abdomen. Chronic pain always affects the groin. It is particularly likely to be triggered by activities that extend, raise, and abduct the lower extremities, resulting in limited range of motion and weakness muscles of the hip joint.
Soccer is the most common type of sport, and it is most common among male athletes around the age of 20, including, track and field, rugby, hockey, and weight lifting.
A definite diagnosis is difficult to make for pain around the groin.
Differential (similar) diagnosis
Symphysis pubis inflammation is inflammation caused by exercise stress on the cartilaginous disks that unite the pubic bones on both sides of the body. It is often a disorder caused by sports.
Typically, symphysis pubis inflammation causes bone lysis at the pubic junctions of the gracilis and adducent muscles, differences in the height of the right and left pubic bones, and deformities of the symphysis. It can also be seen on CT. However, changes to the bones are relatively uncommon.
Pubic stress fractures occur mainly in basketball and tennis, especially involving pain in the groin area.
These include buttock pain due to hamstring injury, iliotibial band syndrome with lateral thigh pain, and gluteal myositis.
Treatment and rehabilitation
Conservative therapy is the first choice in patients with acute disease or within the first six months of onset. People with severe pain may need to stop sports for about 2 weeks. Local bed rest, ice, sometimes heat therapy (hot packs), anti-inflammatory analgesics, and topical injections of steroid hormones (avoided for multiple uses) may be used, but exercise therapy may be effective in the long term.
Early rehabilitation begins with hip joint range-of-motion abduction exercises, muscle strengthening, and adducent muscle stretching, followed by underwater walking, exercise bike followed by jogging, and ball-kick exercises in 2 months. As the pain disappears, please do not judge to return to sports because it may lead to recurrence. Chronic disease requires long-term (more than 2 to 3 months) cessation of sports, so caution is needed.
Surgical treatment may be considered if the pain persists for a long time despite conservative treatment. However, conservative treatment has been successful, and rehabilitation is performed aggressively.
Reference: 1) Niga Sadao: Groin pain syndrome