#009 – 5 Lessons After 5 Years of Treating Groin Pain

Athletic groin pain is one of my favourite conditions to treat. I wanted to share some of my biggest lessons I’ve learned since beginning my career. 

 

I used to really struggle with treating groin pain. It might be one of the harder areas to treat because there is so many structures in a small area. There also isn’t a ton of good research on the best way to approach treating groin pain. Over the years, I’ve learned some valuable lessons. I hope you can find value in my learning that will help you better treat groin pain. 

 

Now, let’s dive in.

 

 

Getting an accurate clinical diagnosis for groin pain is tough!

 

I used to believe that everyone needed a specific diagnosis. When I was a student on clinical rotation, my instructor taught me that a diagnosis is nice but not necessary. Rather than focusing on getting a diagnosis, focus on function. You know that structures are irritated. If you can figure out WHY they’re irritated, you’ve solved the biggest piece of the puzzle. Find the suboptimal – it could be strength, movement patterns, mobility, stability – and change that. I bet you have much more success in treating groin pain.

 

 

Adductor-to-abductor strength ratios are often used as an assessment of groin injury risk. But this is a very small part of a much bigger picture.
 

There’s still uncertainty in research around the value these numbers provide. I still like to see how strong people are and how balanced that strength is, but I don’t hang my hat on one test. Like the red paint on Picasso’s colour palate, I use it to paint a bigger picture.
 

 

Groin strength is important. But we’ve gotten very tunnel visioned on strengthening the groin to solve groin pain. 

 

I treated a basketball player once who couldn’t play because of groin pain. He did zero direct groin strengthening during rehab. You read that right. NO DIRECT GROIN STRENGTH WORK. And he returned pain free. Instead, we focused on lessons #4 and #5 to reduce stress on on his groin muscles. I realize this is one case, but it shows that groin strength isn’t the solution to all groin pain.

 

Most athletes with groin pain are playing multidirectional sports. Yet, we rarely ever look at how they move outside the sagittal plane.

 

I think a lot of overuse groin pain is caused by poor cutting and change of direction mechanics. They could have the strongest groins ever. But if they are putting undue stress on the groin during a change of direction, they can end up with groin pain.

 

In most sports, the hip is relied on to produce power. The foot is the only body part interacting with the ground. All power developed in the hip is transferred to the ground through the foot to generate movement.

 

When people would come in with groin pain, I used to only look at the hip. Now I look at the hip last. I find myself looking a lot more either at the ankle/foot or the trunk. I still treat the hip and groin, but in conjunction with where the force of the hip is transferred through.

 

 

I hope you found some value from me sharing these. They were important lessons for me and have changed my approach to treating groin pain.