Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes

randomised trial

Holmich, Per
Uhrskou, Pernille
Ulnits, Lisbeth
Kanstrup, Inge-Lis
Nielsen, Michael Bachmann
Bjerg, Anders Munch
Krogsgaard, Kim

Clinic of Sports Medicine, Department of Orthopaedic Surgery, Amarger University Hospital (P Holmich MD); Departments of Rheumatology (P Uhrskou PT, L Ulnits PT) and Clinical Physiology (I-L Kanstrup DMedSci), Herlev University Hospital; Departments of Radiology, Glostrup University Hospital (M Bachmann Nielsen PDMedSci); and Copenhagen Trial Unit, Centre of Clinical Intervention Research, Institute of Preventive Medicine, University of Copenhagen, Denmark (A Munch Bjerg MSc, K Krogsgaard DMedSci)
Correspondence to: Dr Per Holmich, Clinic of Sports Medicine, Department of Orthopaedic Surgery, Amager University Hospital, DK-2300 Copenhagen S, Denmark

The Lancet 353(9151):p 439-443, February 6, 1999.

Summary

Background Groin pain is common among athletes.A major cause of long-standing problems is adductor-related groin pain. The purpose of this randomised clinical trial was to compare an active training programme (AT) with a physiotherapy treatment without active training (PT) in the treatment of adductor-related groin pain in athletes.

Methods 68 athletes with long-standing (median 40 weeks) adductor-related groin pain-after examination according to a standardised protocol-were randomly assigned to AT or PT. The treatment period was 8-12 weeks. 4 months after the end of treatment a standardised examination was done. The examining physician was unaware of the treatment allocation. The ultimate outcome measure was full return to sports at the same level without groin pain. Analyses were by intention to treat.

Findings 23 patients in the AT group and four in the PT group returned to sports without groin pain (odds ratio, multiple-logistic-regression analysis, 12.7 [95% CI 3.4-47.2]). The subjective global assessments of the effect of the treatments showed a significant (p=0.006) linear trend towards a better effect in the AT group. A perprotocol analysis did not show appreciably different results.

Interpretation AT with a programme aimed at improving strength and coordination of the muscles acting on the pelvis, in particular the adductor muscles, is very effective in the treatment of athletes with long-standing adductor-related groin pain. The potential preventive value of a short programme based upon the principles of AT should be assessed in future, randomised, clinical trials.

Lancet 1999; 353

439-43