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Hip and groin pain in soccer players can be bad enough to put them on the sidelines. These areas bear extremely high loads in sports since it is involved in all the running, kicking, and rapid changes in direction. Hence, it is prone to injuries that can result in acute or chronic discomfort.
The hip joint is a complex region where uncomfortable symptoms can easily come from more than one area. This makes it challenging to clinically justify one diagnosis because it’s common for multiple conditions to exist at a time. Clearly, there is a lot to be considered since these conditions exhibit symptoms in the same area, but the management differs greatly.
In this blog, we will take a closer look into this problem, the usual risk factors, how it is sustained, and what can be done to address it.
Risk Factors for Hip and Groin Pain in Soccer Players
The common risk factors that make soccer players vulnerable to hip and groin pain include the following:
- Previous injury
- Greater strength ratios between abductor muscles (responsible for moving your leg away from your body’s midline) to adductor muscles (moves the leg back towards your body’s midline)
- Core muscle fatigue or weakness
- Decreased pre-season sport specific training
- Inadequate stretching of the adductor muscle complex
Common Causes of Hip and Groin Pain
The risk factors mentioned above are an indication that there are several reasons why your hip and groin hurts. Pain can stem directly from the hip and groin itself, or the sensation may have radiated from other areas. But when it comes to soccer players, here are some of the usual reasons behind hip and groin pain.
1. Groin Strain
A groin strain is sustained when you stretch your leg out to kick, or when you slide to tackle an opponent in soccer. It happens when any one of the groups of muscles found at the top of the thigh, called adductor muscles, is partially or completely torn. That is because the muscles are stretched beyond its normal range of motion.
This is felt as a sharp pain to the groin that starts abruptly. Usually, this painful sensation is accompanied by muscle spasms and leg weakness. They are graded from a scale of 1 to 3, depending on the severity of the injury:
- First degree: Pain without significant loss of strength or range of motion
- Second degree: Pain with loss of strength
- Third degree: Complete disruption of muscle or tendon fibers with loss of strength
Besides soccer, a groin strain is also common in sports such as basketball, tennis, figure skating, baseball, horseback riding, karate, and softball.
In adductor strains, most cases can be managed conservatively. Initial management will include relative rest from sports, ice, compression, pain medications, and physical therapy. The rehabilitation process should include stretching your range of motion and strengthening of the affected leg and core accompanied by a gradual return to the field.
2. Overuse Injury
Overuse injuries are also common in the adductor region of the hips which triggers pain that is concentrated in the pubic region or groin. Pain results after a period of continued soccer playing. Through time, overcompensation and muscle imbalance can cause the adductor muscles to get wound up a little tight and this develops painful points
A stress fracture is also a type of overuse injury that occurs when muscles become fatigued and unable to keep up with the forces acting on the bone. As the muscles get overwhelmed by the overload of stress, part of the pressure gets transferred to the bone causing tiny cracks called stress fractures.
Stress fractures are further classified into fatigue fracture, insufficiency fracture, and a combination of the two. Fatigue fractures are thought to develop through an accumulation of micro traumas and the inability of the bone to keep up with skeletal repair. Insufficiency fractures develop when there is inadequate bony remodeling in response to normal stressors. These types of injuries are characterised by an aching groin that persists with activity and is relieved by rest. Symptoms are often observed after a recent increase in the level of activity.
The original cause of overuse of the adductors involves a range of problems such as:
- muscular pelvic instability
- decreased range of motion in the hip joint
- generalized poor physical condition compared to the level of physical activity
- pain/injury elsewhere leading to compensatory movements affecting the pelvis
- dysfunction related to the lower back
Based on the available evidence, overuse injuries can be managed nonoperatively. Primary treatment should include removal from offending activity, normalizing regional muscle strength/length imbalances, and addressing nutritional deficiencies. It’s also important to mitigate training errors through proper education of the athlete and training staff.
3. Hip Pointer
Contusions are also common injuries sustained by soccer players, and this is referred to as a hip pointer. It occurs when there is an impact to the iliac crest, which is the fan-shaped or crescent-shaped top of the hip bone. It can also be sustained when you fall onto your side and land on a hard surface. A soccer helmet, knee, or shoulder hitting the hip joint are the common reasons for hip pointers.
Contusion to the pelvic bone is painful because it is usually accompanied by tearing or stretching of the surrounding muscles. This causes immediate and intense pain that is accompanied by a localized tenderness over the hip bone. Bruising and swelling can also be observed around the front, outer portion, and inside of the hip. All these affect your range of motion and it can result in weakness.
Additional padding to the pelvic area may help limit this type of injury. Padding must be sized and positioned properly. Maintaining proper flexibility of all the muscles attached around the pelvis is also recommended.
With hip pointer injuries, treatment begins with rest, ice and compression to the site of the injury. These can help reduce inflammation and control the swelling. Groin or hip pain may make it difficult to walk, crutches may be of assistance until full weight bearing can be achieved without discomfort. Soft tissue massage can help improve range of motion of the hip joint, reduce swelling and prevent scar tissue. Athletes can progress to range of motion, flexibility and progressive strengthening exercises as tolerated.
Read: 7 Signs That A Hip Replacement Surgery Might Be Needed
4. Adductor Tendinopathy
This type of injury stems from chronic overuse of an adductor tendon. Tendinopathy can develop from over training or overload, poor technique, or following a previous injury like a muscle strain.
Pain can be felt at the top of the groin and radiates down the leg. You may also feel pain on a specific bone in the groin. This can cause stiffness in the morning and difficulty in flexing the hip. As a result, your sports performance can suffer because that pain can make it difficult for you to run and sprint. Your kick will not be as strong because you will also experience leg weakness.
A tendinopathy can cause degenerative wear and tear changes to the tendon fibres. They are slow to heal after an injury because tendons have poor blood supply.
A cold compress can help alleviate the pain. You have to avoid strenuous activities for a while, especially those that stretch the adductor muscles. In the long term, you need to have load modification, adjust training schedules, and manage muscle imbalances.
5. Osteitis pubis
This a sports injury caused by the overuse of the hip and leg muscles rather than a specific incident. It can be due to instability in your pelvic bones aggravated by asymmetrical loads placed on the pelvis such when you run or kick. It can also be due to poor control of your lower back and pelvis.
Osteitis pubis is common in soccer, distance running, and other sports that involve kicking, pivoting, and changing direction. It is often associated with a history of groin injury, low back pain, or ‘sportsman’s hernia’.
Discomfort is felt where the right and left pubic bones meet at the lower front part of the pelvis. It also shoots referred pain into the groin. Sit-ups, coughing, and even sneezing can already cause pain. Players with groin pain frequently have to stop sporting activities for many months and long absence from sports is not feasible for high level athletes.
Conservative treatments like rest, cold compress, and medications can help relieve the pain. This is often followed by a rehabilitation program to correct muscular imbalance. But if these measures are not enough to address the situation, surgery can be the next course of action.
Why History Matters
When you seek professional care, your account of the predisposing factors are critical to the care plan that your doctor will prepare. As mentioned earlier, diagnosing this area can be challenging due to its structure, so the doctor would also have to rely on what you share.
If athletes are unable to recall any acute incident, doctors would often look into the activities in the period preceding the injury as well as how the symptoms developed. Here are some important questions that you can expect:
- Did you change the load of activities?
- More work, sport or other physical activity?
- Was the load increased by longer distances or heavier weights?
- Change of equipment, surface or technique?
- How was the development of problems correlated to the change of load?
- Did you have any previous problems of the same kind, perhaps an underlying biomechanical abnormality? Have the symptoms changed?
Beside diagnostic testing like X-rays, MRIs and other relevant scans, your personal information is crucial during an evolution because it will give a clear description of:
- Did you change the load of activities?
- More work, sport or other physical activity?
- Was the load increased by longer distances or heavier weights?
- Change of equipment, surface or technique?
- How was the development of problems correlated to the change of load?
- Did you have any previous problems of the same kind, perhaps an underlying biomechanical abnormality? Have the symptoms changed?
Here’s When to Seek Professional Help
Whether it is your first bout of groin pain or it’s experienced every season, soccer players should get it checked each time by their doctor. Not addressing your groin issues can seriously affect your ability to play soccer and function with everyday life.
You can seek help from an orthopaedic doctor who specialises in sports injuries. It pays to have a specialist on board especially with overuse or training injuries, chronic conditions, or when you are a likely candidate for surgery.
If you have similar concerns or other questions related to sports injuries, never compromise future performance and seek the right help. Find a trusted specialist in your area, or you can get into a non-obligatory consultation with A/Professor Andrew Dutton. Just drop your details here.
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