Soccer season is here! In this week’s blog, we look at one of the most common areas for injury in soccer players – the hip and groin.

Hip and groin pain is prevalent in soccer players due to the high biomechanical forces placed on the area during play. The rapid changes of direction, kicking and sprinting all contribute to the load undertaken by the hip and groin. The most common injury to the area for soccer players are muscle strains however, soccer players often present with other injuries involving the hip joint itself or other structures around it.

We will unpack two common injuries we see here at CSSM in soccer players.

Adductor (groin) strains

Soccer more than other kicking sports such as Australian Rules football often has players kicking across their body and using the inside of their foot. This increases the load on the groin (adductor) muscles when compared with straight line kicking which uses more of the quadriceps and hip flexor muscles. It has been shown that 10 to 18% of all injuries in soccer players are hip or groin related and of these, 62% are adductor (groin muscle) strains. These strains most commonly occur in the dominant kicking leg, however, can occur in either leg.

A strain is a disruption to the muscle fibers occurring when they are placed under a load or stress that they can not accommodate. Muscle strains vary greatly in severity and may be quite mild with the player missing minimal sessions, or very severe requiring long term rehabilitation. If you believe you may have a muscle strain, following the PEACE & LOVE protocol  should be your first step, followed by a consultation with a physiotherapist.

Femoroacetabular Impingement (FAI)

FAI is a commonly misunderstood hip condition which is common in soccer players. To be diagnosed, it requires a triad of tests- clinical signs, symptoms, and imaging. It involves bony changes to the hip joint, pain and/or locking/ catching of the hip and positive clinical tests such as loss of range of motion and pain reproduction when performed by a health professional. Many people will have underlying hip joint changes on imaging without any symptoms, so it is important to not solely go off scans when diagnosing hip joint pathology.

Most FAIs will be treated successfully with rehabilitation supervised by a physiotherapist. This condition also varies in severity and can lead to further issues if left untreated.

If severe or leading to further issues, surgery may be considered. It has been established that 87% of athletes return to sport after hip surgery for FAI, however only 57% at their preinjury level. While this is only one study, it is important to get multiple opinions before getting hip arthroscopies. In most cases, physiotherapist led rehabilitation should be trialed first.

 

Prevention

As with all musculoskeletal conditions, prevention is always the best option. A comprehensive strength program completed 2-3 times per week will reduce your risk of hip and groin pathology. Some exercises to get you started are as follows:

Copenhagen Adductor Exercise

  • Lie on your side with your top leg elevated on a chair or bench. To make it harder, have only your ankle on the chair, to make it easier have your knee/ thigh supported on the chair.
  • Push yourself up into a side plank position with your elbow directly below your shoulder.
  • Keeping shoulders, hips and ankles in line, lift your bottom leg up to meet your top one.
  • Repeat 8-10 times if you’re able.

Bridge variations

  • Lie on your back with your knees bent and feet flat on the floor.
  • Lift your hips up until they are in line with your shoulders and knees.
  • Slowly lower back down.
  • To make it harder, try a single leg version where your non-working leg floats in the air.
  • To make it harder again, elevate your working leg(s) on to a chair or box and push through your heel to lift higher.
  • Repeat 8-10 times if able.

Have a look at more video’s from Sally and CSSM Myotherapist Adele Agius.

 

 

Warming Up

The FIFA 11+ warm up was specifically designed for soccer players to prevent some of the most common injuries seen in the sport. It has been proven to reduce injury risk in soccer players by 30%! You can check it out here. 

Of course, there are many more causes of hip pain that we see, these are just two of the more common conditions. If you want a personalised program to prevent hip and groin injuries or if you are concerned about any hip or groin pain you are experiencing, book in with one of our CSSM physiotherapists today.

 

References

Candela, V., De Carli, A., Longo, U., Sturm, S., Bruni, G., Salvatore, G., & Denaro, V. (2019). Hip and Groin Pain in Soccer Players. Joints, 07(04), 182-187. doi: 10.1055/s-0041-1730978

Griffin, D., Dickenson, E., O’Donnell, J., Agricola, R., Awan, T., & Beck, M. et al. (2016). The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. British Journal Of Sports Medicine, 50(19), 1169-1176. doi: 10.1136/bjsports-2016-096743

Ishøi, L., Thorborg, K., Kraemer, O., & Hölmich, P. (2018). Return to Sport and Performance After Hip Arthroscopy for Femoroacetabular Impingement in 18- to 30-Year-Old Athletes: A Cross-sectional Cohort Study of 189 Athletes. The American Journal Of Sports Medicine, 46(11), 2578-2587. doi: 10.1177/0363546518789070

Sadigursky, D., Braid, J., De Lira, D., Machado, B., Carneiro, R., & Colavolpe, P. (2017). The FIFA 11+ injury prevention program for soccer players: a systematic review. BMC Sports Science, Medicine And Rehabilitation, 9(1). doi: 10.1186/s13102-017-0083-z

About the author

CSSM physio Sally Lynch has a love of all sports including soccer. In 2019, she moved to Melbourne to play for Collingwood in the VFLW. Channeling her philosophy in sport to her patients, Sally’s goal is to help every person reach their goals and return to doing what they love. Sally enjoys all aspects of physiotherapy but has a particular interest in the musculoskeletal side of the profession most and this interest has directed her career so far.