1. Hip and Groin Pain
Hip and groin pain can be complex in nature and the most common presentations are described below:
- Femoroacetabular impingement:
It is a painful condition in the groin due to underlying morphological abnormalities of the hip joint. However, underlying abnormalities may be present on radiological examination but without pain and it is common in the majority of population. A non-symptomatic femoroacetabular impingement is more likely to become symptomatic with athletes or due to changes in activities or training. The grading of the injury depends upon your clinical presentation and not on radiological imaging.
Symptoms include intermittent catching pain in the groin region with specific positions of the hip, such as flexion when the knee approximates to the chest or rotation, as in cycling. This condition rarely affects sleeping and it is normally pain-free soon after cessation of the aggravating activity or position. If the pathology has been present for a while, inflammation will result in more generalised pain that can become a constant ache and can affect other structures. It can also lead to morning stiffness or stiffness after a period of rest, which will ease off with a few minutes of walking. Pain control medication and especially anti-inflammatories can temporarily relieve the symptoms but it is important to understand that it will not cure the underlying condition. Signs of bruising or inflammation are rarely seen with a naked eye but examination will reproduce the symptoms. If there is a need for confirmation, further imaging may accompany the clinical examination.
- Labrum tear:
The labrum is a fibrocartilaginous structure that surrounds the joint and it is necessary for stability. Tears in the labrum are frequently seen in the athletic population but they also develop in the ageing population. A tear in the labrum is the most common cause of groin pain but it can also result in buttock pain.
Symptoms are similar to the latter and include intermittent catching pain in the groin region with specific positions of the hip, such as flexion when the knee approximates to the chest or rotation. This condition may affect sleeping and symptoms are likely to last for a few hours after cessation of the aggravating activity. Symptoms of locking, clicking, catching and giving way may be present in the symptomatic population. If the pathology has been present for a while, inflammation will result in more generalised pain that can become a constant ache and affect other structures. It can also lead to morning stiffness or stiffness after a period of rest, which will ease off with a few minutes of walking. Pain medication with anti-inflammatories may temporarily relieve the symptoms but it is important to understand that it will not cure the underlying condition. Signs of bruising or inflammation are rarely seen with a naked eye but examination will reproduce the symptoms. Confirmation requires further imaging which may accompany the clinical examination.
- Tendinopathy related groin pain
Pain in the groin area can be a result of adductor muscle tendinopathy or hip flexor tendinopathy. It is present normally with a sudden increase in activity or training levels or a result of secondary irritation in the presence of the above mentioned. Usually it presents as stiffness at the groin and pain appears at the beginning of the training but then is relieved with continuation of activity. If this condition has been present for a while it may not be relieved with continuation of aggravating activities and may even become painful with activities of daily life.
The management of the above is similar as they are interconnected. It includes a combination of activity modification to protect the affected area from further irritation and an evaluation of cycling posture will allow the clinician to advise you on changes that can be made according to your pain.
Followed by exercise rehabilitation beginning with simple exercises which are the basis for then progressing and loading the joint to allow for necessary adaptations in posture and structures in order for you to return to cycling. In addition, in the initial stages, ice or pain medication may be advised to allow for progression with exercise rehabilitation. Manual techniques may be used to decrease your pain and improve function. Other treatment modalities may be considered depending on your symptoms and rehabilitation is tailored towards each individual.
In severe cases surgery to the labrum and femoroacetabular impingement may be considered and it is very unlikely that this will be the choice for primary tendinopathy. Following your operation, the rehabilitation will begin with a combination of ice and pain medication as well as using crutches in the initial days. This will be combined with simple lying down or standing exercises to re-activate muscles that are now malfunctioning due to the operation. As you progress the pain from the operation will decrease and you will be able to tolerate walking and more exercises. Static cycling without resistance starts after you are able to normally walk unsupported. Then progressive exercise rehabilitation and manual techniques may be used as in the non-operative approach.