The groin tendonitis
The athlete’s groin tendonitis was described by Spinelli in 1932 as the tendonitis of the fencer.
The groin tendonitis is a painful syndrome located in the pubical area. It can sometimes include several pathologies :
1 – disease of insertion of the rectus
Tendinitis of the rectus femoris and sartorius tendinitis are the most common tendonitis in the practice of dance as they represent 50% of hip tendonitis among dancers.
The pain is high and anterior, the pressure of the anterior iliac spine is painful as well as the passive stretching by extension of the thigh on the pelvis.
Forced isometric contraction is also painful :
For the rectus femoris : the upset flexion of the thigh on the pelvis, knee straight.
For the sartorius : External flexion-abduction- rotation of the thigh on the pelvis, knee flexed.
2 – micro-traumatic pubic osteoarthropathy
3 – Inguinal canal pathology
4 – Adductors’ insertion tendonitis
The groin pain is one of tendinitis, similar to tendinitis in the Achilles tendon.
Pubic pain spreads, imprecisely, gives an impression of fragility, and gives vivid radiations, more or less painful depending on the time of day.
The pubis is a muscular crossroad between the trunk and the thighs.
The pubis includes a joint, eighteen muscles and as many insertions, as well as six nerves. It is also a biomechanical crossroad where considerable constraints exercise, and through which forces go in the three directions of space.
The true groin tendonitis is a combination of an inguinal problem, a disease of the adductors and a pubic a osteoarthropathy caused by sports especially soccer. The soccer player uses his adductors in the race, the pass and the inner-side shoot.
Other sports with less risk are fencing, football, rugby, horse riding and martial arts.
The groin tendonitis is due to overwork in sports. A muscular imbalance occurs between the adductors and the muscles of the abdominal anterolateral wall, which creates a kind of friction, a set of micro-trauma leading to pain.
The diagnosis is relatively simple. The patient consults for a progressively increasing pain (rarely sudden), located in lower abdomen, pubis, or adductors and occurring after a sports practice.
- Irradiation of these pains are either towards the abdominal muscles, the perineum or the testicles.
- The pain may be increased by coughing, uplifting effort or sudden trunk flexion.
The groin tendonitis causes unbearable pain and is very handicapping, both for sports and personal and professional life.
Groin palpation :
In most cases, the pain is unilateral and radiates to one side. I look for the origins of the pain, in order to clarify my diagnosis.
I search for a pain on palpation of the pubical symphysis at the insertion of the adductor muscles and the inguinal orifice.
I test the different muscles involved : hamstrings, adductors, hip rotators, large right psoas, etc …
The complaint expressed by my patient will guide the diagnosis.
I also search for a spinal conflict.
A radiograph is an image confirming the groin with a typical image found in the context of adductor tendinitis, an irregularity with fuzzy microgeodes the bottom edge of the pubis.
The groin is a disease in high risk of recurrence. While the athlete thinks completely healed, the pain reappears, weeks or months later.
The clinical examination of the groin tendonitis
Anamnesis – questionnaire
I search for favorising factors. For example changes in the practice of sports (the field, the shoes, the warm-up…)
I also search for what triggers the pain of adductor tendonitis : rest, running, coughing, etc.
25 August 2018 - 10 h 45 min