Groin and Hip Pain vs. Athletes

 In Latest News, Physcial Therapy

One symptom reported by athletes to myself and my colleagues at Cray Physical Therapy is pain in the groin and front of the hip. These symptoms may wrap around the outside of the hip into their buttock or back. Other symptoms may include sensations of clicking, locking, and perceived stiffness in the hip; among others.

Often with this presentation, the athlete will report pain during certain movements or positions, such as moving into, or at, the bottom of a squat; or as they approach the limits of their hip range of motion. It’s not uncommon for an athlete to feel fine during intense training/competition, but develop these symptoms following activity. Symptoms can range from mild to severe, although symptoms have generally started to impact the athlete’s participation in sport/athletic activities by the time they walk into our clinic.

Of note, less active or sedentary individuals can present with similar symptoms; potentially manifested by sitting, driving, or following activity.

Certain populations of athletes that may be more likely to report these symptoms include those participating in:

  • Barbell sports (i.e. weightlifting, powerlifting, Crossfit)
  • Vigorous sports (i.e. hockey, football)
  • Sports dependent on a high level of mobility like gymnastics, dance, and cheerleading

The diagnosis most commonly associated with the above description is Femoroacetabular Impingement Syndrome, or FAI Syndrome. The 2016 Warwick Agreement on FAI Syndrome defined it as a “motion-related clinical disorder of the hip with a triad of symptoms, clinical signs and imaging findings.”

A notable point regarding the imaging findings present in diagnosed FAI Syndrome is that they have a high rate (~37-54.8%) of prevalence in asymptomatic athletes, which tells us that the expression of pain is not entirely dependent upon bony changes shown on imaging.

Regarding management of FAI Syndrome, the 2016 Warwick Agreement said: “FAI syndrome can be treated by conservative care, rehabilitation, or surgery. Conservative care may involve education, watchful waiting, lifestyle and activity modification. Physiotherapy-led rehabilitation aims to improve hip stability, neuromuscular control, strength, range of motion and movement patterns.”

At the time of publication the panel didn’t have high-level evidence to support any of the above treatments over another, but acknowledged that the prognosis with treatment (physical therapy or surgical) frequently involves symptom improvement and return to full activity. As such, they encouraged a shared-decision making process between the athlete and healthcare team. In 2018, the UK FASHIoN Study demonstrated improvement with both physical therapist-led “hip therapy” and following hip arthroscopic surgery.

The most important aspects of a “comeback plan” for athletes following the diagnosis of FAI Syndrome, utilizing conservative treatment and physical therapy, are:

  • Education.
  • Temporary activity modification, as needed.
  • Finding a tolerable entry point to activity/exercise, and progressing as tolerated.
  • Conditioning of the athlete to facilitate improved resiliency, durability, and performance.

Following surgery the principles stated above still apply, but within the context of the surgeon’s post-surgical rehab protocol. According to Stanford Health Care, return to full and unrestricted activity following most procedures to treat FAI requires 4-6 months, but is dependent on many factors. The athlete’s surgical and rehabilitation team will assist the athlete throughout this process.

Whether it’s the onset of pain and decreased function/performance that results in the initiation of the rehab process, or following surgical management of FAI Syndrome; the therapists at Cray Physical Therapy are excited to help guide you back toward a high-level of athletic competition in a positive rehabilitation atmosphere. Give us a call today!

References:

Griffin DR, Dickenson EJ, O’Donnell J, et al. The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med. 2016;50(19):1169-1176. doi:10.1136/bjsports-2016-096743

Frank JM, Harris JD, Erickson BJ, et al. Prevalence of Femoroacetabular Impingement Imaging Findings in Asymptomatic Volunteers: A Systematic Review. Arthroscopy. 2015;31(6):1199-1204. doi:10.1016/j.arthro.2014.11.042

Griffin DR, Dickenson EJ, Wall PDH, et al. Hip arthroscopy versus best conservative care for the treatment of femoroacetabular impingement syndrome (UK FASHIoN): a multicentre randomised controlled trial. Lancet. 2018;391(10136):2225-2235. doi:10.1016/S0140-6736(18)31202-9

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