Groin Pain and Muscular Imbalance of Quadriceps and Hamstrings in an Elite Soccer Player – A Case Study

Abstract

Soccer and football players are exposed to a high risk of groin pain. In some cases, the pubic symphysis is the origin of the problems.

This article presents a case report of a young elite soccer player who, over a period of two years, suffered from pain in the groin and symphysis area. The right leg was the kicking leg. Imaging techniques did not reveal pathological findings. Sports hernia, osteomyelitis, enthesopathy, adductor tendonitis, and muscle sprains, as well as rheumatic or urogenital disorders were excluded.

A 3 D posture analysis was performed to examine the statics of the body and pelvis. The maximum isometric strength of the left and right leg adductors and abductors, as well as the knee flexors and extensors were measured.

We found a muscular imbalance resulting from the type of sport the athlete engaged in with an unfavourable ratio between the right knee extensor and flexor muscles. Comparing sides, an imbalance was also identified between the right and left knee extensor. This imbalance resulted in a one-sided forward tilt of the right hemi-pelvis. This pelvic torsion may lead to an increase in shear forces in the pubic symphysis, which we suspected to be the reason for the recurring problems.

After three months of specific training exercises, the pelvic position was harmonised and the muscular imbalances were significantly reduced. Even 6 months after completion of the specific training exercises, the player remained without complaints despite his unvaried soccer training intensity.

Causal treatment of functional pain in the groin or symphysis area should take into account the ipsilateral and contralateral strength ratios of the knee extensors and flexors as well as the three-dimensional position of the pelvis.

Zusammenfassung

Fußballspieler sind einem erhöhten Risiko von Leistenbeschwerden ausgesetzt. In einigen Fällen ist die Schambeinsymphyse Ursache der Beschwerden.

Der Artikel stellt ein Fallbeispiel eines jungen Profifußballers vor, der über einen Zeitraum von zwei Jahren regelmäßig unter Beschwerden in der Leiste und der Schambeinsymphyse klagte. Das rechte Bein war das Schussbein. Bildgebende Verfahren lieferten keine positiven Befunde. Eine Sportlerleiste, Osteomyelitis, Hernie, Insertionstendinosen sowie Zerrungen der Adduktoren oder der Bauchmuskulatur konnten ebenso wie rheumatische oder urogenitale Erkrankungen ausgeschlossen werden.

Eine 3D-Analyse der Körper- und Beckenstatik wurde durchgeführt. Die maximalen isometrischen Kräfte der linken und rechten Beinadduktoren, Beinabduktoren, Kniestrecker und Kniebeuger wurden gemessen.

Wir fanden eine sportartbedingte muskuläre Dysbalance mit einem ungünstigen Kraftverhältnis zwischen den rechten Knieextensoren und -flexoren. Im Seitenvergleich konnte eine starke Dysbalance zwischen rechtem und linkem Kniestrecker gefunden werden. Die Dysbalance führte zu einer einseitigen Vordrehung der rechten Beckenhälfte. Die dadurch entstandene Beckenverwringung kann zu einer verstärkten Scherkraftbelastung in der Schambeinsymphyse führen, die wir als Ursache für die berichteten Beschwerden vermuteten.

Nach einem dreimonatigen individuellen Training zur Beseitigung der muskulären Dysbalance waren die Beckenposition wieder symmetrisch normalisiert und die muskulären Ungleichgewichte deutlich reduziert. Auch 6 Monate nach Beendigung des individuellen Aufbautrainings war der Spieler weiterhin schmerzfrei trotz unverändert hoher Trainingsintensität im Fußball.

Die kausale Behandlung funktioneller Beschwerden im Leisten- oder Symphysenbereich sollte die ipsilateralen und kontralateralen Kraftverhältnisse der Knieflexoren und -extensoren im Blickpunkt halten, ebenso wie die dreidimensionale Beckenstellung.

Key words

groin pain - hip extension/flexion ratio - muscular imbalance - pelvic torsion - soccer

Schlüsselwörter

Leistenschmerz - Kraftverhältnis Hüfte - muskuläre Dysbalance - Beckenverwringung - Fußball

• References

• 1 Sedaghati P, Alizadeh MH, Shirzad E et al. Review of Sport-Induced Groin Injuries. Trauma Monthly 2013; 18: 107-112
• 2 Nicholas SJ, Tyler TF. Adductor muscle strains in sport. Sports Med 2002; 32: 339-344
• 3 Tyler TF, Silvers HJ, Gerhardt MB et al. Groin Injuries in Sports Medicine. Sports Health 2010; 2: 231-236
• 4 Angoules AG. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach. World Journal of Orthopedics 2015; 6: 672-679
• 5 Rodriguez C, Miguel A, Lima H et al. Osteitis Pubis Syndrome in the Professional Soccer Athlete: A Case Report. Journal of athletic training 2001; 36: 437-440
• 6 Ellsworth AA, Zoland MP, Tyler TF. Athletic pubalgia and associated rehabilitation. International Journal of Sports Physical Therapy 2014; 9: 774-784
• 7 Brukner P, Nealon A, Morgan C et al. Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. Br J Sports Med 2014; 48: 929-938
• 8 Thorborg K, Serner A, Petersen J et al. Hip adduction and abduction strength profiles in elite soccer players: implications for clinical evaluation of hip adductor muscle recovery after injury. The American journal of sports medicine 2011; 39: 121-126
• 9 Tyler TF, Nicholas SJ, Campbell RJ et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. The American journal of sports medicine 2001; 29: 124-128
• 10 Cooperstein R, Lew M. The relationship between pelvic torsion and anatomical leg length inequality: a review of the literature. Journal of Chiropractic Medicine 2009; 8: 107-118
• 11 Coombs R, Garbutt G. Developments in the use of the hamstring/quadriceps ratio for the assessment of muscle balance. J Sports Sci Med 2002; 1: 56-62
• 12 Le Huec JC, Aunoble S, Philippe L et al. Pelvic parameters: origin and significance. Eur Spine J 2011; 20 (Suppl. 05) 564-571
• 13 Workman JC, Docherty D, Parfrey KC et al. Influence of pelvis position on the activation of abdominal and hip flexor muscles. J Strength Cond Res 2008; 22: 1563-1569
• 14 Alvim FC, Peixoto JG, Vicente EJ et al. Influences of the extensor portion of the gluteus maximus muscle on pelvic tilt before and after the performance of a fatigue protocol. Rev Bras Fisioter 2010; 14: 206-213
• 15 Buchtelová E, Tichy M, Vaniková K. Influence of muscular imbalances on pelvic position and lumbar lordosis: a theoretical basis. Journal of Nursing, Social Studies, Public Health and Rehabilitation 2013; 1–2: 25-36
• 16 Garvey JF, Read JW, Turner A. Sportsman hernia: what can we do?. Hernia 2010; 14: 17-25
• 17 Mohammad WS, Abdelraouf OR, Elhafez SM et al. Isokinetic imbalance of hip muscles in soccer players with osteitis pubis. J Sports Sci 2014; 32: 934-939
• 18 Hansen HC, Helm S. Sacroiliac joint pain and dysfunction. Pain Physician 2003; 6: 179-190
• 19 Holmich P, Thorborg K, Dehlendorff C et al. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med 2014; 48: 1245-1250
• 20 Eckstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain: A prospective randomised study in soccer players. Eur J Sports Traumatol Rel Res 2001; 23: 141-145