The groin area is located at the same place in men and women, which is at the junction where the upper body or abdomen meets the thigh. It is an area of the hip and is comprised of five muscles that work together to move your leg. The groin area can become very painful and cause great discomfort because of physical activities and sports.
A Gilmore’s groin (also referred to as athletic pubalgia, slap shot gut, and sportsman’s hernia) is an uncommon, although commonly missed cause of groin pain in high-level athletes. Unfortunately, Gilmore’s groin is often misunderstood and poorly defined in medical terms, therefore, it is very difficult to identify based on the history and physical exam of an athlete with groin pain. Gilmore’s groin occurs when there is a weakening of the muscles or tendons of the lower abdominal wall. This part of the abdomen is the same region where an inguinal hernia occurs, called the inguinal canal.
When an inguinal hernia occurs, there is sufficient weakening of the abdominal wall to allow a pouch, the hernia, to be felt. In the case of a Gilmore’s groin, the problem is due to a weakening of the same abdominal wall muscles, but there isn’t any visible hernia. Anatomically, the injury generally occurs at the junction of the leg and torso. It involves the area known as aponeurosis where the abdominal muscles converge to form the inguinal ligament. The external oblique muscle has an archway through which several nerves and vessels pass. In Gilmore’s groin, a groin muscle tear causes this archway to open up much wider. Further tears in the oblique muscles cause them to lift up and away from the inguinal ligament. Therefore, this leaves the transverse abdominus muscle unsupported.
Furthermore, Gilmore’s groin is usually classified into three separate strains, such as:
- Grade 1 – Grade 1 includes mild or partial stretch or a tear of a few muscle fibers. The muscle is tender and painful but maintains its regular strength. The use of the leg isn’t impaired, and walking is normal.
- Grade 2 – Moderate stretch, or tearing of a greater percentage of the muscle fibers. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. The use of the leg is noticeably impaired, and limping when walking is common.
- Grade 3 – Severe tear of the muscle fibers, sometimes a complete muscle tear. A popping sound may be heard or felt when the injury occurs. Bruising may be visible, and sometimes a dent in the muscle may be seen under the skin at the site of the tear. The use of the leg is severely difficult and putting weight on the leg is very painful.
Causes & Symptoms
Gilmore’s groin tends to happen in most vigorous sports events, such as soccer, football, wrestling, and ice hockey. These sports involve twisting your pelvis when your feet are planted. This can cause the soft tissue of your groin or lower abdomen to tear. Other types of situations that may cause this core muscle injury include the following:
- Forceful hip movements that you repeatedly perform. This includes jumping, kicking, and twisting.
- Weak abdominal muscles.
- Lack of proper sports conditioning.
- Abdominal and hip exercises that are severe and unsafe.
- A sudden difference in strength between your abdominal and hip muscles.
The symptoms of Gilmore’s groin can easily mimic those of many other types of common groin injuries, and there is no definitive diagnostic test, which makes it a difficult condition to diagnose. Symptoms can also be vague, with most athletes left confused as to why they have suddenly or gradually seen a drop in their athletic performance. Below are several symptoms of Gilmore’s groin that may be present:
- Groin pain that is relieved with rest but returns during sports activity.
- Severe groin pain at the time of the injury.
- Groin pain that is more often felt on one side of the groin area only, rather than on both sides.
- Pain that only appears during twisting movements.
- Tenderness or bruising in the upper thigh and lower abdomen.
- Groin pain that increases from intermittent to constant.
Who gets Gilmore’s Groin?
Specific causes and risk factors regarding Gilmore’s groin injuries include:
- Lack of rest – If an athlete plays through the pain rather than taking an appropriate break from the sport that contributed to the groin problem, an acute groin injury can become chronic.
- Gender – Most Gilmore’s groin injuries are targeted against males. The condition is very rare among female athletes.
- Weaker core muscles – Oftentimes, having core muscles that are considerably weaker in comparison to the upper thigh muscles is a risk factor for Gilmore’s groin, because it increases damaging torque potential on the torso during sudden movements or stops.
- Sports intensity – Players of vigorous sports that involve intense running, jumping, cutting/slicing, or twisting movements are most at risk for a Gilmore’s groin injury. Some sports that cause these factors include ice hockey, soccer, wrestling, and rugby.
- Military training – Military recruits undergoing basic training and athletes increasing the number and intensity of their training sessions frequently experience stress fractures.
How does it affect you? How serious is it?
Physicians who recommend surgical treatment plans for Gilmore’s groin may adhere to either a repair surgery or additional surgeries along the way. Of course, all surgeries require incisions, therefore, this means there is a minimal chance of infection but with a low percentage of it happening. When infections do arise, they are considered serious. Other complications during a repair surgery may include:
- Nerve or blood vessel damage – During surgery, there is a slight chance that the nerves, veins, or tissue around your groin can be damaged. Damaged nerves or blood vessels can cause numbness, pain, or lower blood flow around the area.
- Persistent pain – Some patients tend to continue to have persistent pain after surgery. When this occurs, your doctor will work with you to create a treatment plan, which may include additional physiotherapy or medicines to help you recover regularly.
- Long-term stiffness – Long-term stiffness is usually caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
Recommended Treatment & Rehabilitation
Because Gilmore’s groin symptoms can mimic those of several other types of groin injuries, diagnosing the condition requires an accurate medical evaluation that may take more than one doctor’s visit or test to complete. Therefore, your doctor will use a three-step process for diagnosing Gilmore’s groin, such as the following:
Determining the exact mechanism of the injury, whether it was a specific event or the result of many weeks, months, or years of overuse during sports, is important for arriving at a Gilmore’s groin diagnosis. Therefore, your doctor will most likely spend some time asking about your most recent sports performance, when the onset of pain and / or tenderness first occurred, and whether the pain grew worse suddenly or gradually.
Your doctor will conduct a thorough exam of the lower abdomen, pubic area, and legs. Firstly, your doctor will palpate these specific areas and inspect them visually with you sitting or lying down, searching for tenderness and other signs of tissue injury. Secondly, you may be involved to attempt one or more exercises, such as standard and oblique sit-ups. You may also be asked to do one or more thigh-contraction exercises as well. These exercises can help your doctor determine the source of the pain during exertion, evaluate the range of motion, and other factors that can help identify which tissue is injured.
One or more diagnostic imaging scans may be performed to help your doctor confirm the diagnosis, and / or to determine the exact locations of tissue injury. Magnetic resonance imaging (MRI) is the most common test used to identify Gilmore’s groin.
After a diagnosis has been done, physiotherapy may be advised to further recover your groin injury. A physiotherapist will design a specific treatment program for you based on your condition and goals. Your plan may include treatments to:
Reduce your pain
Your physiotherapist may use different types of treatments and technologies to manage and reduce your pain, including ice, heat, ultrasound, electrical stimulation (TENS), taping, exercises, and hands-on therapy, such as massage. These treatments can lessen the need for pain medication, including opioids.
Improve your strength
Certain exercises will benefit healing at each stage of recovery; your physiotherapist will choose and teach you the most appropriate exercises to steadily restore your strength and agility. These may include using cuff weights, resistance bands, and cardio exercise equipment.
Improve your motion
Your therapist will decide which specific activities and treatments can help restore regular movement in the leg and hip. These might start with passive motions that your physiotherapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you perform yourself.
Boost your recovery
Your physiotherapist is trained and experienced in choosing the correct treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you’re likely to do on your own.
Return to your activities
Your physiotherapist will work with you to decide on your recovery goals, including your return to work or sport, and will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your therapist will also apply hands-on therapy, such as massage, and teach you exercises and work retraining activities. Your physiotherapist may also teach you sport-specific techniques and drills to help you achieve sport-specific goals.
Your therapist may recommend a home-exercise program to strengthen and stretch the muscles around your hip, upper leg, and abdomen to help prevent re-injury of your groin. These may include strength and flexibility exercises for the leg, hip, and core muscles.
After your pain has subsided, you can start to gradually perform exercises to heal your groin injury. Typically, you can start these exercises within a few days of your initial injury, however, it depends on the severity of your condition. Here are some exercise examples you can try on your own time:
Position yourself on your back near a doorway. Then, extend your unaffected leg in front of you on the floor of the doorway. Place your affected leg along the wall next to the doorframe. Hold this position for up to 30 seconds before repeating 3 times a day.
Hip adductor stretch
Lie on your back with bent knees. Next, press your feet into the floor while allowing your knees to drop open to the sides. Press the soles of your feet together. Hold this position for up to 30 seconds. Return to your knees to the starting position before repeating 3 times.
Resisted hip flexion
Stand with your back to a door. Make a loop and place the resistance band around the ankle of your affected leg. Place the other end of the resistance band around an anchor point. Engage the front of your thigh and keep your leg straight as you extend your leg forward. Slowly go back to the starting position before repeating 2 times a day.
Alternative & Homeopathic Treatment
Homeopathic treatments for groin strains will vary depending on the severity. Therefore, the following are possible treatment plans for athletic groin injuries:
- Rest – Many mild to moderate groin injuries will resolve with rest. This is the most commonly prescribed activity reduction, but some injuries will require crutches or otherwise reduced weight-bearing.
- Ice application – In addition to rest, athletes are advised to ice the affected area using a cloth-wrapped ice pack. Ice can be applied for 20-30 minutes every 2-4 hours until the pain and swelling subside.
- Compression – To provide compression, you can wrap your thighs and/or groin with elastic bandages or use athletic tape to help reduce swelling and stabilize the injury.
- Elevation – Elevating the groin area above the level of the chest by reclining over a pillow or bolster for a few hours each day can help reduce swelling and boost your recovery process.