In 91% of severe persistent groin pains, adductor tenotomy was found beneficial
nt J Sports Med. 2010 Nov 25. [Epub ahead of print]
Adductor Tenotomy in the Management of Groin Pain in Athletes.
Robertson IJ, Curran C, McCaffrey N, Shields CJ, McEntee GP abstract here
- 15% of sports injuries are groin ones
Differential diagnosis includes:
- ‘ Sportman ’ s Hernia ’ or ‘ Gilmore ’ s Groin ’
- osteitis pubis
- adductor tendinopathy
- ilio-inguinal and obturator nerve entrapmen
- iliopsoas bursitis
- hip joint pathology
Diagnosis based on local tenderness and positive squeeze test – comorbid osteitis pubis checked for.
- 109 male cases of adductor strain that failed steroid injection and “conservative management”
- Technique -adductor longus tendon origin was divided.
4 weeks post-op started on below rehab program:
Active Rehab Programme (coped verbatum)
Module I (first 2 weeks)
1 Static adduction against soccer ball placed between feet when lying supine; each adduction 30s, ten repetitions.
2 Static adduction against soccer ball placed between knees when lying supine; each adduction 30s, ten repetitions.
3 Abdominal sit-ups both in straightforward direction and in oblique direction; five series of ten repetitions.
4 Combined abdominal sit-up and hip flexion, starting from supine position and with soccer ball placed between knees (folding knife exercise); five series of ten repetitions.
5 Balance training on wobble board for 5 mins.
6 One-foot exercises on sliding board, with parallel feet as well as with 90º angle between feet; five sets of 1 min continuous work with each leg, and in both positions.
Module II (from this week; module II was done twice at each training session; 6 weeks)
1 Leg abduction and adduction exercises lying on side; five series of ten repetitions of each exercise.
2 Low-back extension exercises prone over end of couch; five series of ten repetitions.
3 One-leg weight-pulling abduction/adduction standing; five series of ten repetitions for each leg.
4 Abdominal sit-ups both in straightforward direction and in oblique direction; five series of ten repetitions.
5 One-leg co-ordination exercise flexing and extending knee and swinging arms in same rhythm (cross country skiing on one leg); five series of ten repetitions for each leg.
6 Training in sideways motion on a “Fitter”(rocking base curved on top and bottom; user stands on platform that rolls laterally on tracks on top of rocking base) for 5 mins.
7 Balance training on wobble board for 5 mins.
8 Skating movements on sliding board;five times 1 min continuous work.
9 No stretching adductors
10 Cycle or swimming ok
- Most achieved level 1 = optimum performance, no pain
- only complication was two hematomas that needed draining
Review of Treatment Literature found:
- “active training programme aimed at improving strength and coordination of the pelvic muscles but avoiding stretching the adductors was successful in as many as 79 % of patients “
- Entheseal cleft injection – relief for up to one year in some patients but, “for those with pre-injection enthesopathy on MRI, symptoms return at a mean of 5 weeks.” – I presume only one shot was given for fear of tendon tears at site – they would rather cut it later instead….
- Dextrose prolotherapy – 2 articles same author 92% recover
I discussed that here:|
Sore Pubic Joint – Osteitis Pubis How Does One Treat It?
present author complains no one has replicated the dextrose study but I note he didn’t bother trying it…
Comment – If you are just going to cut tendon anyway, there should be no moratorium on just one steroid shot . I am not a believer in one shot wonders and feel it could take 3 shots to get results. Mind you, if shots are to be done, they need to be done early before significant peripheral and central sensitization sets in. With tennis elbow, you get local neurovascular growth, supinator radial tunnel activation, segmental activation (paraspinous, facet and multiple peripheral triggers), and central sensitization – at that stage all these factors need dealing with and a simple cortisone shot into lateral epicondyle is less likely to work.
any comments?