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Groin pain is today a major and probably an increasing problem in several sports that require cutting and change of direction activities, such as football (soccer), ice hockey, team handball and rugby. This may be related to more frequent match playing, increased training intensity and shorter time for recovery. The increasing importance of preventive action has been pointed out by many.
The problems associated with long‐standing groin pain are often related to the fact that the symptoms seen in athletes with groin pain are often vague and diffuse. It is often difficult to identify the exact cause for the groin pain. The complex anatomy of the hip and groin region, combined with the frequently varying symptoms, makes an accurate diagnosis and appropriate management difficult. It is often a challenge to make the correct diagnosis. This requires clinical experience and a sound knowledge of possible differential diagnoses and of evidence‐based medicine in the field. This paper by Hölmich is therefore a very timely paper of a very complex and difficult clinical problem. The author presents an innovative and well thought‐out approach to make a correct diagnosis, which can be instrumental and valuable for sport physicians.
Because of the difficulties in making a correct diagnosis and with the complex aetiology of the injury causing groin pain, there is a clear trend for both athletes and the physicians to loose their patience and look for a quick solution. This has resulted in a changed management, especially in professional sports as many today recommend the use of early surgery. This is done sometimes before the physician has secured a well‐founded diagnosis. This fact makes the Hölmich study even more valuable.
It is important to be well educated and to have a good knowledge and experience of different differential diagnoses around the groin. Multiple tissues may be involved in generating the injury causing the pain in the groin. The authors have used a very standardised and validated approach to making the diagnosis. This technique is very valuable for locating the specific muscle–tendon problems around the groin. These are important to exclude. The muscle–tendon problems are often associated with other common causes of groin pain, such as incipient sports hernia associated with insufficient posterior inguinal wall and osteitis pnbis. In these cases, the history combined with a directed and systematic clinical examination may be very helpful. This article by Hölmich is a valuable step forward in the management of the very difficult and increasing clinical problem of long‐standing groin pain.