HIP AND GROIN HEALTH AND PERFORMANCE IN
HOCKEY PLAYERS
FEATURE ARTICLE
GROIN/ADDUCTOR STRAIN
One of the most common groin injuries in athletes is the adductor
muscle strain and it is often of acute onset. This type of injury
often occurs in muscles during eccentric loading (1,2). The strain
can occur at the myotendinous junction, or the muscle belly,
and often occurs during the competitive season (4). A common
symptom of a groin strain is pain in the medial thigh, especially
during resisted adduction, but symptoms are not limited to just
this type of pain. Other abnormalities such as a palpable defect
and muscle weakness may be present depending on the severity
of the strain.
HIP LABRAL TEARS
During arthroscopy of the hip, one of the most common findings
is an injury to the acetabular labrum (10). The hip labrum acts like
a socket to hold the femoral head in place. It provides resistance
to motion of the femoral head within the acetabulum and helps to
limit fluid expression from the joint space to protect the cartilage
of the hip (10). Labral tears can occur at the fibrocartilaginous
labrum-cartilage junction (fraying) or can be an intrasubstance
tear (the labrum itself). However, the high rate of degenerative
acetabular labral tears in athletes is likely associated with
repetitive injury after the expression of symptoms. Femoral
acetabular impingement in athletes seems to be a leading cause of
the early occurrence of acetabular labral tears (5).
According to a study by Epstein, hip labral tears account for
nearly 70% of hip and groin injuries in elite hockey players (4). Hip
extension combined with thigh external rotation is the pattern of
movement most commonly associated with labral tearing, which
specifically puts hockey players at risk due to the biomechanics of
the skating stride. Common symptoms of a labral tear are pain in
the anterior region of the hip, pain in the groin region, restricted
range of motion, clicking, locking, and/or catching of the hip.
SPORTS HERNIA OR ATHLETIC PUBALGIA
Sports hernia is classified as a syndrome of chronic lower
abdominal and groin pain that is defined as weakness or tearing
of the rectus abdominus insertion to the superior pubic ramus
(6). Athletes with sports hernia usually experience dull, chronic
pain of the groin that may radiate to the perineum and inner thigh
that often intensifies with athletic activity (7). One of the main
issues with sports hernia is the diagnostic criteria, with physical
examination eliciting several non-specific findings (7). An actual
or definitive hernia is rarely found through examination and many
of the symptoms overlap with symptoms of other disorders of the
hip.
RISK FACTORS FOR DEVELOPING DISORDERS OF
THE HIP
When examining the disorders of the hip listed above, there are
several risk factors. These risk factors often overlap between the
various disorders/injuries. One of the most common risk factors to
developing a groin/adductor strain and/or sports hernia is a low
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