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Edwin Goedhart. Groin complaints in professional footballers. Epidemiology Elite level. Ekstrand e.a. – UCL Study 14% hip / groin region (1.1/1000hr). Overuse injuries. Adductor longus lesion. Painful sensation while shooting , scores but had to be substituted 5 minutes later

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edwin goedhart

Edwin Goedhart

Groincomplaints in professional footballers

epidemiology elite level
EpidemiologyElite level
  • Ekstrand e.a. – UCL Study
  • 14% hip / groinregion(1.1/1000hr)
adductor longus lesion
Adductorlonguslesion

Painfulsensationwhileshooting, scores but had to besubstituted 5 minutes later

Return to play 7 days

sub elite level
Sub-elite level
  • ♂ >♀
  • Hölmich 0.4/1000hrs
  • Mainlyadductor and psoas-related
  • Abdominalrelated, inguinalrelated and hip related
  • 60% overuse
  • 68% dominant leg
  • Combinationabdominal and adductor: longstanding
anatomy
Anatomy
  • Robertson (2009)
  • ProximalattachmentAdductorlongus >60% muscular(Tuite, Straus)
  • Conjointtendon (lowerfibresTransversusabdominus and Internaloblique) (Hollinshead, Sandring)
    • 3%
    • 8% TA direct pubicattachment
    • 89% attachedintorectussheath
  • Adductorlongus and Rectusabdominis in continuity via capsular tissues pubicsymphysis(Schilder, Robinson)
osteitis pubis pubic bone stress injury
Osteitis pubisPubicbone stress injury
  • Robinson 2014
  • Prospective MRI
  • BoneMarrowEdema, cleft, parasymphyseal capsule/tendonoedema in asymptomaticplayers
  • The presence of abnormalimaging features didnotpredictfuturesymptoms
  • Paajanen 2010
  • 40 athletes, 20 controles
  • 48% athletesgrade 1 BME
  • 20% athletesgrade 2 BME
  • 50% controles grade 1 BME
risk factors
Risk factors
  • Previousinjury
  • Weakadductormuscles
  • Age
  • LimitedAbduction ROM exo/endo
  • Cuttingsports
    • Soccer
    • Football
    • Icehockey
slide12

Physical

More accelerations / decelerations

Higher load musculotendinous system

More pivoting moments

prevention intervention
Prevention / intervention
  • Exercise: Multi-interventionapproach
    • Hübscher 2013
  • Eccentricstrengthening hip adductor training
    • Jensen, 2012
  • Adductortenotomy
    • Robertson 2010
    • 68% + result (amateur level) severe cases
  • Compression shorts
    • Chaudhari, 2014
sportsman hernia
Sportsman hernia
  • Same risk factors as for adductor related injuries
  • Conservative therapy 6 wks.
  • Surgery
    • Laparoscopic repair faster return than open repair
slide17

Groin injuries incidence 0.4 – 1.1 /1000 hr.

  • mainly adductor related, tendency for fast recovery, (8%>1 month), Adductor and abdominal : longstanding
  • There is a drirect anatomical relationship between abdominals, pubic bone and adductors
  • Weak adductors and previuos injury are proven riskfactors, Multi exercise intervention appraoch reduces the injury risk
  • The value of MRI in the diagnosis of longstanding groinpain is questionable.
  • Laporoscopic repair of a sportsman’s hernia ensures a faster recovery than open procedure