1. Edwin Goedhart Groin complaints in professional footballers

2. Epidemiology Elite level –Ekstrand e.a. – UCL Study –14% hip / groin region (1.1/1000hr)

4. Overuse injuries

5. Adductor longus lesion Painful sensation while shooting, scores but had to be substituted 5 minutes later Return to play 7 days

6. Distribution of muscle injuries during a match

7. Injurytime

8. Sub-elite level – ♂ >♀ –Hölmich 0.4/1000hrs –Mainly adductor and psoas- related –Abdominal related, inguinal related and hip related –60% overuse –68% dominant leg –Combination abdominal and adductor: longstanding

9. Anatomy Robertson (2009) Proximal attachment Adductor longus >60% muscular (Tuite, Straus) Conjoint tendon (lower fibres Transversus abdominus and Internal oblique) (Hollinshead, Sandring) –3% –8% TA direct pubic attachment –89% attached into rectus sheath Adductor longus and Rectus abdominis in continuity via capsular tissues pubic symphysis ( Schilder, Robinson)

10. Osteitis pubis Pubic bone stress injury Robinson 2014 Prospective MRI BoneMarrowEdema, cleft, parasymphyseal capsule/tendon oedema in asymptomatic players The presence of abnormal imaging features did not predict future symptoms Paajanen 2010 40 athletes, 20 controles 48% athletes grade 1 BME 20% athletes grade 2 BME 50% controles grade 1 BME

11. Risk factors Previous injury Weak adductor muscles Age Limited Abduction ROM exo/endo Cutting sports –Soccer –Football –Icehockey

12. Physical More accelerations / decelerations Higher load musculotendinous system More pivoting moments

13. Prevention / intervention Exercise: Multi-intervention approach –Hübscher 2013 Eccentric strengthening hip adductor training –Jensen, 2012 Adductor tenotomy –Robertson 2010 –68% + result (amateur level) severe cases Compression shorts –Chaudhari, 2014

14. Sportsman hernia Same risk factors as for adductor related injuries Conservative therapy 6 wks. Surgery –Laparoscopic repair faster return than open repair

15. Bursitis

16. Avulsionfractures

17. Groin injuries incidence 0.4 – 1.1 /1000 hr. mainly adductor related, tendency for fast recovery, (8%>1 month), Adductor and abdominal : longstanding There is a drirect anatomical relationship between abdominals, pubic bone and adductors Weak adductors and previuos injury are proven riskfactors, Multi exercise intervention appraoch reduces the injury risk The value of MRI in the diagnosis of longstanding groinpain is questionable. Laporoscopic repair of a sportsman’s hernia ensures a faster recovery than open procedure