Ask the Experts - Injury

Answers from Sean Fyfe:

Q. I have a persistant adductor pain problem. It flared up accutely a year ago probably due to speed work and particularly doing hills ( for triathlon/duathlon). Tests apparently discounted Oestitis Pubis and any neural component due to lumbar disc degeneration L3/4. The closest physio diagnosis got, was to suggest weak glut Medius allowing femoral head to translate forward.

Anterior and deep hip pain also seems to occur as a secondary symtom. Stretching and Massage to trigger points and tender attachments and muscle belly didnt seem to alleviate next session.

When I resumed training it felt more like a hamstring niggle which didnt worsen although recently with step up in training it has been more noticeable, but quickly eases with a day of rest. It dramatically deteriorated last week when orienteering over a steep course! Pain even to walk has persisted for several days. Very frustrating

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I’m sure that most sports injury practitioners would agree that pain in the adductor region is probably the most difficult pain to manage, the reason being that there are so many structural sources of pain that can be responsible for the same site and type of pain. I would never pretend to be able to solve your problem with this response, however I do believe I can point you in the right direction.

In your letter, you mentioned that testing had discounted osteitis pubis and L3/4 disc degeneration as diagnosis, but there are many other areas of pain that need to be investigated. So here is a list of other differential diagnoses that need to be considered for a chronic adductor pain such as yours:

• Adductor tendionpathy
• Neuropathy – obturator, ilioinguinal, genitofemoral
• Hip joint – chronic labral tear, anterior femoral head displacement causing hip joint irritation, cartilage dysfunction, osteoarthritis
• Hernia – inguinal, posterior inguinal wall weakness, tear of external oblique aponeurosis, Gilmore’s groin
• Stress fracture of neck of femur
• Lumbar spine
• Sacroiliac joint

The fact that your pain has varied from anterior groin pain to pain in hamstring or pain in the posterior hip region, it must be possible for the structure diagnosed as the painful source to produce these symptoms. So I would imagine that further testing will probably reveal a lumbopelvic region (lumbar spine or SIJ) or maybe a hip joint dysfunction. You have only had one source of pain from the lumbar spine ruled out.

The thoracolumbar junction, commonly refers pain to the groin. Subtle lumbar spine instabilities which can cause neural or joint irritation also commonly refer pain to the areas you describe. Don’t forget it is possible that there are two separate injuries which can be the case if an athlete has been suffering from an injury for a long time.

So my advice is this. First consult a Sports Physician for any further investigations he or she deems necessary. Then depending on the outcome, I think you will probably have to find a top notch Sports Physiotherapist who can assess the SIJ in depth and perform advanced lumbar spine testing including muscle function of the entire core system.

So good luck and it is definitely going to take some patience and hard work on your behalf.