Conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain.

Musculoskeletal, ligamentous and osseous groin injuries are common in athletes and can result in a delay of several months before returning to sports. Even then, this may not be at the former level of sport activity. The treatment of exercise-related groin pain is primarily conservative (non-surgical), using interventions such as exercises, electrotherapy, manual therapy and steroid injections. Therefore the authors conducted this review in order to assess the effects (benefits and harms) of conservative interventions for treating exercise-related musculotendinous, ligamentous and osseous groin pain. Two studies, involving a total of 122 participants who had experienced adductor-related groin pain for at least two months, were included in this review. All but one of the participants were male athletes aged between 18 and 50 years old. Both studies were assessed as ‘high risk of bias’ for at least one source of bias domain. The ‘successful treatment’ result reported in both studies was based primarily on pain measures. One study, based on an intention-to-treat analysis, discovered a significant difference favouring exercise therapy (strengthening with an emphasis on the adductor and abdominal muscles and training muscular co-ordination) compared with ‘conventional’ physiotherapy (stretching exercises, electrotherapy and transverse friction massage) in successful treatment at 16-week follow-up. Similarly, of those followed-up significantly more athletes treated by exercise therapy returned to sport at the same level. Although still favouring the exercise group, the differences between the two groups in patients’ subjective global assessment at 16 weeks and successful treatment at 8 to 12 years follow-up were not statistically significant. The second study (54 participants) found no significant differences at 16-week follow-up between a multi-modal treatment (heat, manual therapy and stretching) and exercise therapy (the same intervention as in the above study) for the outcomes of successful treatment  and return to full sports participation. Those returning to full sports participation returned on average 4.5 weeks earlier after receiving multi-modal therapy  than those in the exercise therapy group. This study reported that there were no complications or side effects found in either intervention group.

The authors’ concluded that the available evidence from the randomized trials was not sufficient to advise on any specific conservative modality for addressing exercise-related groin pain. While still low quality, the best evidence is from one trial which found that exercise therapy (strengthening of hip and abdominal muscles) in athletes improves short-term outcomes (based primarily on pain measures) and return to sports compared with physiotherapy consisting of passive modalities. They suggested that due to the poor quality of the available evidence from both included trials, further randomized trials are necessary to support their findings.