Injuries in the pelvis, groin, hip and thigh

Abstract

Pelvis, groin, hip and thigh injuries in sports include multiple, complex and longstanding conditions, causing great frustration among athletes and sports practitioners. Pain in these regions may originate from many anatomical structures such as the muscle, tendon, ligament, cartilage or bone. Acute groin and hamstring injuries are the most frequent injuries in the different football codes, where especially hip and groin injuries are very prevalent problems. Moreover, the recurrence rates of these acute injuries are very high and a major problem during the rehabilitation and return-to-sport phase. Basic understanding of the anatomy and biomechanics and its relation to specific injuries in this complex region is important to make relevant clinical choices concerning clinical examination and diagnostic imaging. Hip, pelvis and trunk muscles are all constantly involved in most sports activities contributing to a considerable amount of both eccentric and concentric work, including fast changes between these work forms. These muscles are highly important but also at risk of sustaining an injury. Acute muscletendinous injuries in the hip and groin region occur in the adductor muscles (usually the adductor longus), the hamstring muscles (often biceps femoris) and the quadriceps muscle (often the rectus femoris), often during forceful eccentric contractions such as accelerating and decelerating movements, kicking and extreme positions. In the athlete with long-standing hip and groin pain symptoms often seem to be contradictory and confusing. In up to 1/3 of patients with longstanding hip and groin pain, multiple causes can be found. The symptoms associated with an intra-articular hip problem can include pain, catching, locking, clicking, feeling of instability and giving way. A labral/cartilage injury in the hip commonly refers pain to the anterior groin. However, anterior groin pain is not specific for this injury but can be due to other intra-articular pathologies and/or extra-articular pathologies. Important differential diagnoses including stress fractures, referred pain or nerve entrapment and abdominal or gynaecological disorders are other possible causes of pain in these regions and should therefore also be considered.