**7. Groin muscle strain**

For example in soccer players the incidence of groin injury is approximately 5% to 6.2%, [7].

If we talk about the local anatomy, there are four muscles that converge at the same point and any of them could be torn or stretched so even though the symptoms may be closely related the source, pain could be localized to any of these muscles: rectus femoris, adductors, psoas major or sartorius.

Remember that these muscles are involved in hip flexion so in the physical examination, we must look for pain when the athlete is flexing the hip.

The athlete may have exacerbation and decrease in symptoms while in some cases the pain is only present when there are changes in the speed or change of direction. It is not unusual for the athlete to have no pain when running forward without changing direction.

The symptoms can be vague and often undefined because of the convergence of various anatomical structures. Pain could be due to a sport's hernia, osteitis pubis, nerve pain (neurally referred pain), bursitis, tumors, etc.

A physical examination can begin examining the painful area to rule out that pain that could be from a node or an inguinal hernia (in all the cases there is tenderness).If the lesion is muscular in origin, pain should increase when the athlete is asked the patient to perform hip flexion against resistance (figure 12).

**Figure 12.** With the knee flex at 90° ask the patient to raise it against resistance

**Figure 11.** The doctor´s hand is palpating the Mc Burney´s point which is painful at the pressure in appendicitis, all

PELVIC INFLAMMATORY DISEASE.-This disease occurs mostly in women who may have

GASTRITIS, COLITIS, ULCER.- Pain may have been present for many hours of duration coincident with swelling, presence of abdominal gas, bloating, and burning over the stomach

In abdominal pathologies unrelated to the muscle and if we have any doubt, it is best to refer the athlete to a specialist and not cause more damage by waiting and see if the symptoms disappear. This is a very valuable time if the cause is pain comes from an organ of the ab‐

For example in soccer players the incidence of groin injury is approximately 5% to 6.2%, [7]. If we talk about the local anatomy, there are four muscles that converge at the same point and any of them could be torn or stretched so even though the symptoms may be closely related the source, pain could be localized to any of these muscles: rectus femoris, adductors, psoas

Remember that these muscles are involved in hip flexion so in the physical examination, we

the other target points usually are just related to pelvic inflammation.

area. Pain can also be referred from the colon.

must look for pain when the athlete is flexing the hip.

dominal cavity.

144 Muscle Injuries in Sport Medicine

major or sartorius.

**7. Groin muscle strain**

a pelvic infection. Pain may be related to both iliac fossae.

Other provocative maneuvers are to have the athlete lift the leg (with the knee extended) (figure 13a), against resistance or the examiner takes the leg in extension and do some abduction movement (figure 13b, 13c). Si hacemos este movimiento de forma contralateral con la pierna no involucrada podremos ver que el rango de movimiento está limitado en la pierna afectada. Similar tests of the contralateral (uninvolved) leg will show just how much range of motion is limited in the affected leg.

(a) (b)

**Figure 14.** a) With the patient facing down palpate the paravertebral muscles all along; b) Ask the patient to rise the

The pubic adductor strain is a very common pathology in runners. Attached to the pubis are

This injury usually occurs suddenly after having made a sharp sprint or change of direction and speed. When this injury happens, the athlete suddenly suspends the exercise and seeks

In the physical examination, pain is referred to a specific area of the adductor region to the inner and upper part of the leg. Palpation of the area may reveal edema, increased temperature,

neck to provoke and discomfort; c) Ask the patient to rise the leg straighten

three muscle that converge: the adductor magnus, minimus and longus.

**9. Pubic adductor strain**

and in some cases a visible bruise (figure 15).

**Figure 15.** Palpate all over inguinal area searching for pain over the pubic bone

medical help.

)

(c)

147

Overview of Different Location of Muscle Strain

http://dx.doi.org/10.5772/56622

**Figure 13.** a) Ask the patient to rise the leg straighten against resistance; b) Take the leg straighten to an abduction position till the pain is triggered; c) Ask the patient to move the leg inward (adduction) against resistance

An initial recommendation is for rest to allow time for the symptoms to be minimized. Treatment is based on a good diagnosis and since here we encounter the convergence of various etiologies of pain, any misdiagnosis could lead to chronic pain that can result in limitation of the athlete´s sports performance
