Groin Pain in the Athlete: Non-Bony Pathology Including Sportsman’s Groin

Abstract

Groin pain is a common complaint amongst sportsmen and women accounting for nearly 10% of all sports related injuries. This article focuses on non-bony causes of groin pain in sportsmen, particularly upon the condition commonly known as 'sportsman's hernia' or 'sportsman's groin'. It also highlights a new concept for the cause of groin pain in that the authors consider that many elite athletes with groin pain have pain arising from their inguinal ligament attachment. A new procedure known as the Lloyd Release Procedure has been specifically developed to treat this cause of groin pain. By performing a laparoscopic release of the inguinal ligament and reinforcing the groin with a mesh also placed laparoscopically, nearly all athletes are rendered pain free and most players can resume their activities within weeks. In a prospective study on over 140 elite athletes undergoing the Lloyd Release Procedure more than 90% of sportsmen returned to their normal sporting activities within four weeks of surgery. Groin pain is a common complaint amongst sportsmen and women, particularly those participating in sports involving kicking, rapid accelerations and deceleration, and sudden change of direction (1). It has been estimated that groin injuries account for between 0.5-6.2% of sports-related injuries, with the prevalence in sports such as football as high as 5-15% (2,3). Chronic groin pain can be difficult to diagnose, treat, and rehabilitate and is therefore responsible for a large proportion of time lost from sport and work in such athletes. This article focuses on non-bony causes of groin pain in athletes, particularly upon the condition commonly known as 'sportsman's hernia' or 'sportsman's groin'. The 'groin' comprises quite a large anatomical field from the lower abdomen and its muscles to the adductor muscle group insertion thereby encompassing the lower rectus abdominis muscle, the conjoined tendon, the superficial and deep inguinal rings, the tranvsversalis fascia, the inguinal and pectineal (Cooper's) ligaments, the pectineus muscle and fascia, adductor longus and brevis and even gracilis. Although many athletes are diagnosed with a so-called 'sportsman's hernia', careful clinical examination is important in these patients as most do not have a surgical 'lump' or hernia and they are more likely to have pain and tenderness of the ligamental attachments or tendinous insertions, particularly of the inguinal ligament, pectineal ligament and adductor tendon insertions. It must be remembered that all the insertions onto the pubic bone 'join together' and form an aponeurosis on the anterior aspect of the pubic bone (Fig. 1).