It is an overuse injury of the lower abdominal and proximal thigh musculature, resulting in interruption of the insertion of the rectus tendon in the pubis and weakness of the posterior inguinal wall without clinically detectable hernia. It presents with chronic pain in the groin and adductor area. It is difficult to diagnose, both by physical examination and imaging test. It is more common in men.
Onset of insidious pain, usually unilateral, increasing towards the lower abdomen, deep groin area and proximal adductor.
It can also give symptomatology to coughing or sneezing. Pain may radiate to the adductor area, perineum, rectus muscles, inguinal ligament and testicular area.
It is usually unilateral, although it can also affect both hips at the same time.
The pain usually worsens with activity or sport, and improves with rest.
High demand sports for the hip, where kicking or turning is required, such as soccer or field hockey, it can also occur in runners, sports with explosive hip movements or that require changes of direction, and rapid accelerations or decelerations. Secondary to hip disorders that limit motion, such as femoroacetabular impingement. Cases of acute involvement are rare, although it may occur due to trunk hyperextension or hip hyperabduction.
The main goals of treatment are usually to relieve pain, eliminate inflammation, correct muscular decompensations, work on endurance, coordination and flexibility, strengthen hip stabilization and abdominal muscles and dynamic stabilization of the pelvic floor. NSAIDs may be recommended at the beginning of treatment, along with heat or ice and manual therapy. It usually requires relative rest, specific stretching exercises and strengthening of the hip adductors with personalized functional work adapted to the activity, to gradually return to daily activity. Relative rest and rest from sporting activity usually improves the symptoms, but usually reappears when resuming the activity, so a good preventive treatment is key to both establish the treatment and prevent acute problems in athletes. Generally, treatment can be divided into 4 phases: – Phase 1: Week 1 and 2, focusing on manual therapy and stretching. – Phase 2: Week 3 and 4, muscle strengthening. – Phase 3: Week 5, functional activities. – Phase 4: Week 6, return to activity. In approximately 10 to 12 weeks, the pain usually subsides completely. Due to the complexity of the disorder, a multidisciplinary approach is key. Surgical treatment is indicated when conservative measures fail.
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