Which factors differentiate athletes with hip or groin pain from those without?

·29 min·2 clips

A systematic review of 2,251 articles reveals the five physical exam factors most strongly linked to athletic hip and groin pain.

The episode begins with a promotional offer for a free sports hernia recovery guide. Host Dr. Sebastian Gonzalez introduces the podcast's focus on evidence-based movement practices. He states the episode will cover a 2015 systematic review titled 'Which Factors Differentiate Athletes with Hip and Groin Pain from Those Without?'. The review initially screened 2,251 articles, narrowed to 17, and finally included 10 high-quality studies. Gonzalez explains the review categorizes evidence as strong, moderate, or limited. He details the five factors with strong evidence: patient-reported outcome scores, pain on adductor squeeze test, lack of hip internal rotation, limited bent knee fallout, reduced adductor squeeze strength, and altered trunk muscle function. For the adductor squeeze test, he explains its potential to predict pain recurrence when returning to sport. Regarding hip internal rotation, he discusses possible causes like pain, muscle spasm, or capsular scarring, and shares a clinical anecdote where back treatment improved range. On bent knee fallout and adductor strength, he frames them as measurable opportunities for improvement independent of surgery. The segment on altered trunk muscle function delves into three supporting studies. One used EMG to show delayed transverse abdominis activation relative to the rectus femoris in those with pain. Another ultrasound study found a thinner transverse abdominis at rest in the pain group. A third found lower abdominal and back extensor strength. Gonzalez connects this to sports hernias and the importance of deep core conditioning. He then shifts to factors with moderate evidence, primarily imaging-based. He discusses pubic bone edema, citing contradictory studies: one found it in asymptomatic junior soccer players, another found none in asymptomatic controls. He also mentions the secondary cleft sign on MRI as a marker of adductor attachment injury. Factors with limited evidence include other pain-provoking tests, hip external rotation, x-ray abnormalities of the pubic bone, radiology features of femoral acetabular impingement (FAI), and biomarkers like COMP and CRP. He notes FAI findings are common in both athletic and pain populations, so they shouldn't be overinterpreted. The biomarkers showed elevated levels in symptomatic athletic males. Gonzalez concludes by summarizing key takeaways: a thorough physical exam is crucial, most people don't need imaging to start care, and targeted exercises addressing the strong evidence factors can reduce flare-ups. He offers a discovery session for listeners and provides contact information.

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