Groin pain: is flexibility always to blame?

Groin injuries are very common among field hockey players and, although they can be very incapacitating, they do not systematically lead to withdrawal from the game. In fact, in the NCAA from 2009 to 2015, 55.6% and 71.1% of groin injuries in men and women respectively did not result in a stoppage of competition(1). Although this type of injury is not always associated with a complete cessation of activity, it can be very disruptive to sporting activities. As a result, it can hinder performance and lead to negative repercussions such as aggravation of the injury, development of concomitant injuries and chronicization of pain(2). In the field hockey world, it’s often said that to avoid groin injuries, you need to stretch on a regular basis. Notwithstanding the fact that stretching can be part of an athlete’s daily routine, is lack of flexibility really linked to the onset of groin pain?

A systematic review collecting 17 works was conducted on the subject in 2016 and ruled that there would be three predisposing factors to the onset of groin pain. These are the result of reduced strength in three muscle groups: hip adductors, hip abductors and knee flexors. Hip adductor muscle flexibility and hip rotation range of motion are not risk factors in the development of groin pain. In fact, an increase in hip abduction amplitude can sometimes be observed following the onset of pain. It should be noted that in this systematic review, the criteria for qualifying groin injuries did not target any specific anatomical structure, but rather a region. In other words, all groin-related pathologies were included(2).

In the light of these results, it would seem preferable to focus on the strength of the various muscle groups rather than on flexibility to prevent the onset of groin pain. However, this does not mean that the daily stretching routine should be stopped. On the other hand, if this stretching routine is implemented to maintain the amplitudes of movement required to practice the sport in a specific way, stopping it can bring its share of problems.

As seen in a article, groin pain can be prevented by implementing a specific training program that targets the individual’s deficiencies(3). Assessing the strength of different muscle groups can help identify certain risk factors that can be modified with specific exercises. In the presence of weakness, it will be imperative to increase the strength of the hip abductors and adductors, as well as the knee flexors.

Written by 
Maxime Provencher

Sports physiotherapist at Peps Clinic, Laval University

<sub>References:
1.Dalton SL. et al. The epidemiology of hip/groin injuries in national collegiate athletic association men’s and women’s ice hockey: 2009-2012 through 2014-2015 academic years. Orthop J Sports Med. 2016 mar 4;4(3) 
2 Kloskowaks et al. Movement Patterns and Muscular Function Before and After Onset of Sports-Related Groin Pain: A Systematic Review with Meta-analysis.Sports Med. 2016 May 3
3. Tyler TF, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002 Sep-Oct;30(5):680-3</sub>.