Pubalgies du sportif

Abstract

Groin pain in sportsmen corresponds to a difficult clinical diagnosis which imposes first of all to eliminate uro-genital or digestive diseases. Physiopathology remains badly known even if the role of muscular imbalances between the rectus/obliquus abdominis and/or hip adductors/abductors is favored. The scheduled examination of the pubis allows to evaluate pain, the hips and back range of motion, and to measure the muscular force in particular of hip adductors and abdominal muscles (rectus and obliquus abdominis). If inguinal hernia may lead to surgical procedure, isolated pain of the inguinal canal must be carefully distinguished from other muscular-tendinosis-bone's pains. Clinical examination allows the diagnosis, even if MRI is a key imaging in the high-level sportsman. Treatment is based on the muscular and joint deficiencies analysis. It consists of hip range of motion gain and/or analytical muscular strengthening to restore the dynamics of the pubic joint and to allow the resumption of infra-painful sport training. Progress has to be made step by step. Indeed sport should not be resumed to early since recurrence of pain or even chronicity of pain would occurr. According to well-managed treatment, sport resumption at the same level is possible within 3 months in 80% of cases. When rehabilitation fails, a surgical indication to repair the different walls of the inguinal canal can be suggested with good results in 65 to 95% of cases. Secondary prevention must be set up to keep muscular balances of the pubis.