DESCRIPTION
Athletic groin pain is an exercise-related chronic condition with a variety of potential root causes. These include weakness of the abdominal/inguinal wall and injuries to tendons, muscles, and ligaments within the pelvis. Athletic groin pain is typically defined as persistent groin pain during exercise in the absence of a clinically detectable hernia. This condition is referred to by many different terms, including, but not limited to, sportsman’s groin, incipient hernia, sports hernia, Gilmore’s groin, athletic pubalgia, inguinal disruption, core muscle injury, and inguinal-related pain. The condition most often affects male athletes.
The first line of treatment consists of conservative measures such as rest, physical therapy, and anti-inflammatory medications. For individuals who fail conservative treatment, a variety of surgical and non-surgical treatments are proposed with the goal of releasing tension and adding support to weak musculature.
POLICY
Treatments and surgeries for athletic groin pain (e.g., pelvic floor repair, repair or release of soft tissue, pulse-dose radiofrequency, intra-tissue percutaneous electrolysis) are considered investigational.
IMPORTANT REMINDERS
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ADDITIONAL INFORMATION
Evidence for surgical and non-surgical treatment for athletic groin pain consists of low-quality, non-blinded studies. Further study is needed to define which individuals would benefit from each treatment approach.
SOURCES
American Academy of Orthopaedic Surgeons. (2022). Sports hernia (athletic pubalgia). Retrieved June 14, 2023 from https://orthoinfo.aaos.org/en/diseases--conditions/sports-hernia-athletic-pubalgia.
Bisciotti, G. N., Chamari, K., Cena, E., Garcia, G. R., Vuckovic, Z., Bisciotti, A., et al. (2021). The conservative treatment of longstanding adductor-related groin pain syndrome: A critical and systematic review. Biology of Sport, 38 (1), 45-63. (Level 1 evidence)
BlueCross BlueShield Association. Evidence Positioning System. (3:2023). Surgery for groin pain in athletes (7.01.142). Retrieved June 14, 2023 from www.bcbsaoca.com/eps/. (18 articles and/or guidelines reviewed)
Hölmich, P., Nyvold, P., & Larsen, K. (2011). Continued significant effect of physical training as treatment for overuse injury: 8- to 12-year outcome of a randomized clinical trial. American Journal of Sports Medicine, 39 (11), 2447-2451. Abstract retrieved May 12, 2020 from PubMed database.
Kraeutler, M J., Mei-Dan, O., Belk, J W., Larson, C M., Talishinskiy, T., & Scillia, A J. (2021). A systematic review shows high variation in terminology, surgical techniques, preoperative diagnostic measures, and geographic differences in the treatment of athletic pubalgia/sports hernia/core muscle injury/inguinal disruption. Arthroscopy: The Journal of Arthroscopic & Related Surgery, 37 (7), 2377-2390. Abstract retrieved June 14, 2023 from PubMed database.
Masala, S., Fiori, R., Raguso, M, Ojango, C., Morini, M., Cuzzolino, A., et al. (2017). Pulse-dose radiofrequency in athletic pubalgia: preliminary results. Journal of Sports Rehabilitation, 26 (3), 227-233. Abstract retrieved May 12, 2020 from PubMed database.
Moreno, C., Mattiussi, G., & Núñez, F.J. (2016). Therapeutic results after ultrasound-guided intratissue percutaneous electrolysis (EPI®) in the treatment of rectus abdominis-related groin pain in professional footballers: a pilot study. Journal of Sports Medicine and Physical Fitness, 56 (10), 1171-1178. Abstract retrieved May 12, 2020 from PubMed database.
Moreno, C., Mattiussi, G., Núñez, F.J., Messina, G., & Rejc, E. (2017). Intratissue percutaneous electolysis combined with active physical therapy for the treatment of adductor longus enthesopathy-related groin pain: a randomized trial. Journal of Sports Medicine and Physical Fitness, 57 (10), 1318-1329. Abstract retrieved May 12, 2020 from PubMed database.
Paajanen, H., Brinck, T., Hermunen, H., & Airo I. (2011). Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman's hernia (athletic pubalgia). Surgery, 150 (1), 99-107. Abstract retrieved May 12, 2020 from PubMed database.
Paajanen, H., Montgomery, A., Simon, T., & Sheen, A.J. (2015). Systematic review: laparoscopic treatment of long-standing groin pain in athletes. British Journal of Sports Medicine, 49 (12), 814-818. Abstract retrieved May 12, 2020 from PubMed database.
ORIGINAL EFFECTIVE DATE: 9/1/2020
MOST RECENT REVIEW DATE: 8/10/2023
ID_BT
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