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Introduction

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I’ve had groin issues in the past and came back a couple of times too early so instead of missing two weeks you end up missing a month. It’s important to take your time and make sure you’re over 100 per cent ready. And I think for me it has something to do with my hips being tight. When your hips are tight, then the groin has a tendency to overcompensate and that’s why you see all the hip surgeries in goalies, it’s all related.

National Hockey League goalie Jean-Sebastien Giguere appreciating the link between groin pain and hip problems (December 2010, www.theglobeandmail.com)

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Groin pain is an extremely common presentation in sports and exercise medicine, particularly in footballers, yet it is poorly understood. The anatomy of the region is complex; the load on this region is extremely high in sports that involve rapid change of direction and kicking, and the hip joint itself is not a superficial joint and therefore is hard to examine.

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Acute injuries to this region are relatively common and usually involve a partial tear of one of the adductor muscles. Longstanding groin pain is also extremely common, and presents much more of a clinical challenge.

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With the advent of MRI and hip arthroscopy, it has become clear that problems associated with the hip joint are far more common than originally thought. The hip plays an important role in groin pain (Chapter 28). The hip can be the primary cause of the athlete’s groin pain,1 or an underlying hip abnormality such as femoroacetabular impingement can be a significant contributing factor to the development of another groin pathology.

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Before we explore the interrelationship further, it is important to understand the anatomy of the groin.

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Anatomy

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The groin region can be thought of as where the abdomen meets the lower limbs via the pelvis. Understanding the groin region requires an appreciation of the anatomy of the musculoskeletal, digestive, and urogenital systems. Important structures in the groin region include the lower abdominal muscles and abdominal viscera, the inguinal canal and its contents, the pubic bones and the pubic symphysis, the hip adductor muscles, and pelvic viscera and genitalia. The iliopsoas, sartorius, rectus femoris, and the hip joint itself are also common sources of groin pain.

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The anatomy of the groin area is pictured in Figure 29.1).

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Figure 29.1

Anatomy of the hip and groin area

(a) Muscles of the abdominal wall

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(b) Normal anatomy at the site of “sports hernias”. Compare with pathology (Fig. 29.10)

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(c) Deep layers revealing transversus abdominis muscle showing usual site of tears

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