Regenerative Injection of Elite Athletes with Career-Altering Chronic Groin Pain

Am J Phys Med Rehabil. 2008 Aug 6.
A Consecutive Case Series.
Topol GA, Reeves KD.

From the Physical Medicine and Rehabilitation Service, Jaime Slullitel Rosario Orthopedic and Trauma Institute, Argentina (GAT); Servicio de Medicina Física y Rehabilitación del Hospital Provincial de Rosario, Argentina (GAT); Team Physiatrist, Rosario Rugby Union, Argentina (GAT); Meadowbrook Rehabilitation Hospital, Gardner, Kansas (KDR); and Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas, Kansas (KDR).

Topol GA, Reeves KD: Regenerative injection of elite athletes with career-altering chronic groin pain who fail conservative treatment: a consecutive case series. Am J Phys Med Rehabil 2008. OBJECTIVE:: To obtain multisport and long-term outcome data from use of regenerative injection therapy on career-threatened athletes. DESIGN:: Consecutive enrollment of elite performance-limited athletes with chronic groin/abdominal pain who failed a conservative treatment trial. The treatment consisted of monthly injection of 12.5 dextrose in 0.5% lidocaine in abdominal and adductor attachments on the pubis. Injection of the nociceptive source was confirmed by repetition of resistive testing 5 min after injection. RESULTS:: Seventy-five athletes were enrolled. Seventy-two athletes (39 rugby, 29 soccer, and 4 other) completed the minimum two treatment protocol. Their data revealed a mean groin pain duration of 11 (3-60) mos. Average number of treatments received was 3 (1-6). Individual paired t tests for VAS of pain with sport (VAS Pain) and Nirschl pain phase scale measured at 0 and an average of 26 (6-73) mos indicated VAS Pain improvement of 82% (P < 10), and Nirschl pain phase scale improvement of 78% (P < 10). Six athletes did not improve following regenerative injection therapy treatment and the remaining 66 returned to unrestricted sport. Return to unrestricted sport occurred in an average of 3 (1-5) mos. CONCLUSIONS:: Athletes returned to full elite-level performance in a timely and sustainable manner after regenerative injection therapy using dextrose.

Groin pain in the soccer athlete: fact, fiction, and treatment

Clin Sports Med. 1998 Oct;17(4):787-93, vii.

Gilmore J.

Groin and Hernia Clinic, London, England, United Kingdom.Groin pain in the soccer athlete is a common problem accounting for 5% of soccer injuries. Groin distribution has proved to be the most common cause of groin pain. Other causes are direct trauma, ostetis pubis, muscle injuries, fractures, bursitis, hip problems, and hernia and referred pain. Soccer players with groin pain present a complex management problem that is discussed.

Long-standing groin pain in sportspeople falls into three primary patterns, a "clinical entity" approach: a prospective study of 207 patients.

Br J Sports Med. 2007 Apr;41(4):247-52; discussion 252. Epub 2007 Jan 29.

Hölmich P.

Department of Orthopaedic Surgery, Amager University Hospital, Copenhagen DK-2300 S, Denmark.

per.holmich@ah.hosp.dk

BACKGROUND: Groin pain remains a major challenge in sports medicine. AIM: To examine 207 consecutive athletes (196 men, 11 women) with groin pain using a standardised and reliable clinical examination programme that focused on signs that suggest pathology in (1) the adductors, (2) the ilopsoas and (3) the rectus abdominis. PATIENTS AND METHODS: Most patients were football players (66%) and runners (18%). In this cohort, the clinical pattern consistent with adductor-related dysfunction, was the primary clinical entity in 58% of the patients and in 69% of the football players. Iliopsoas-related dysfunction was the primary clinical entity in 36% of the patients. Rectus abdominis-related dysfunction was found in 20 (10%) patients but it was associated with adductor-related pain in 18 of these patients. Multiple clinical entities were found in 69 (33%) patients; of these, 16 patients had three clinical entities.
CONCLUSIONS: These descriptive data extend previous findings that physical examination for groin pain can be reliable. While underscoring the prevalence of adductor-related physical examination abnormality in football players, the data highlight the prevalence of examination findings localising to the iliopsoas among this cohort. Also, the fact that combinations of clinical entities were present has important implications for treatment. The finding of multiple abnormal clinical entities also raises the possibility that earlier presentation may be prudent; it is tempting to speculate that one clinical entity likely precedes other developing entities. These data argue for the need for a trial where clinical entities are correlated with systematic investigation including MRI and ultrasonography.