Skip to main content

Injuries of the obturator muscles in professional soccer players



Obturator externus and internus muscular tears are uncommon injuries. Only a few case reports exist, mainly in high-level athletes. Our aim is to describe a series of obturator externus and internus muscular tears in professional soccer players.


Injury data from four teams from the First Division of the Spanish Soccer League were collected over a total of four seasons. Any soccer player who sustained an injury to either the obturator externus or internus identified on magnetic resonance (MRI) was included. All injured players were treated non-operatively with a goal of returning to play as fast as possible.


Sixteen players sustained injuries to the obturator externus and internus during matches or training sessions. The main complaint was anterior hip pain with a physical examination showing pain during internal rotation or external rotation of the flexed hip. The MRI documented 12 muscular tears of the obturator externus, and 4 muscular tears of the obturator internus. All injuries were treated conservatively based on physical therapy, analgesic medications, and underwent a symptoms-based rehabilitation protocol. Mean return to play was 11.5  ±  8.8 days.


Although uncommon, tears of the obturator externus and internus occur in professional soccer players. The MRI scan was essential to the location, classification, and evaluation of the injury size. The clinical relevance of our investigation is based on the relatively benign prognosis of these injuries.

Level of evidence


This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2


  1. Delayed Onset Muscle Soreness.


  1. Aung H, Sakamoto H, Akita K, Sato T (2001) Anatomical study of the obturator internus, gemelli and quadratus femoris muscles with special reference to their innervation. Anat Rec 263:41–52

    Article  PubMed  CAS  Google Scholar 

  2. Blanch P, Gabbett TJ (2016) Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player’s risk of subsequent injury. Br J Sports Med 50:471–475

    Article  PubMed  Google Scholar 

  3. Brukner P, Connell D (2016) ‘Serious thigh muscle strains’: beware the intramuscular tendon which plays an important role in difficult hamstring and quadriceps muscle strains. Br J Sports Med 50:205–208

    Article  PubMed  Google Scholar 

  4. Brukner P, Nealon A, Morgan C, Burgess D, Dunn A (2014) Recurrent hamstring muscle injury: applying the limited evidence in the professional football setting with a seven-point programme. Br J Sports Med 48:929–938

    Article  PubMed  Google Scholar 

  5. Cass SP (2015) Piriformis syndrome: a cause of nondiscogenic sciatica. Curr Sports Med Rep 14(1):41–44

    Article  PubMed  Google Scholar 

  6. Delp SL, Hess WE, Hungerford DS, Jones LC (1999) Variation of rotation moment arms with hip flexion. J Biomech 32(5):493–501

    Article  PubMed  CAS  Google Scholar 

  7. Dias EP, Marchiori E, Coutinho Jr AC, Domingues RC, Domingues RC (2000) Avaliacao por resonancia magnetica das injurias musculares traumaticas. Radiol Bras Brasil 34:327–331

    Article  Google Scholar 

  8. Dimmick S, Rehnitz C, Weber MA, Linklater J (2013) MRI of muscle injuries. In: Weber M (ed) Magnetic resonance imaging of the skeletal musculature, medical radiology, diagnostic imaging. Springer, Berlin Heidelberg, pp 187–219

    Chapter  Google Scholar 

  9. Dostal WF, Soderberg GL, Andrews JG (1986) Actions of hip muscles. Phys Ther 66(3):351–361

    Article  PubMed  CAS  Google Scholar 

  10. Ekstrand J, Hägglund M, Waldén M (2011) Epidemiology of muscle injuries in professional football (soccer). Am J Sports Med 39:1226–1232

    Article  PubMed  Google Scholar 

  11. Gonçalves H, Osório F, Da Silva L, Trápaga R, Cury D (2011) Injury of the external obturator muscle in professional soccer athletes. Rev Bras Med Esporte 17(1):36–39

    Article  Google Scholar 

  12. Griffin DR, Dickenson EJ, O’Donnell, Agricola R, Awan T, Beck M, Clohisy JC, Dijkstra HP, Falvey E, Gimpel M, Hinman RS, Hölmich P, Kassarjian A, Martin HD, Martin R, Mather RC, Philippon MJ, Reiman MP, Takla A, Thorborg K, Walker S, Weir A, Bennell KL (2016) The Warwick Agreement on femoroacetabular impingement syndrome (FAI syndrome): an international consensus statement. Br J Sports Med 50:1169–1176

    Article  PubMed  CAS  Google Scholar 

  13. Groh M, Herrera J (2009) A comprehensive review of hip labral tears. Curr Rev Musculoskelet Med 2:105–117

    Article  PubMed  PubMed Central  Google Scholar 

  14. Gudena R, Alzahrani A, Railton P, Powell J, Ganz R (2015) The anatomy and function of the obturator externus. Hip Int 25(5):424–427

    Article  PubMed  Google Scholar 

  15. Hamilton B, Valle X, Rodas G, Til L, Pruna R, Gutierrez JA, Tol J (2015) Classification and grading of muscle injuries: a narrative review. Br J Sports Med 49:306

    Article  PubMed  Google Scholar 

  16. Hodges P, McLean L, Hodder J (2014) Insight into the function of the obturator internus muscle in humans: Observations with development and validation of an electromyography recording technique. J Electromyogr Kinesiol 24:489–496

    Article  PubMed  Google Scholar 

  17. Jarvinen TAH, Jarvinen TlN, Kaariainen M, Kalimo H, Jarvinen M (2005) Muscle injuries: biology and treatment. Am J Sports Med 33:745–764

    Article  PubMed  Google Scholar 

  18. Khodaee M, Jones D, Spittler J (2015) Obturator internus and obturator externus strain in a high schoolquarterback. Asian J Sports Med 6(3):e23481

    Article  PubMed  PubMed Central  Google Scholar 

  19. Lee YC, Callary SA, Howie DW, Thewlis D, Solomon LB (2012) The effect of hip position on the length of trochanteric muscles: potential implications for early postoperative management of hip arthroplasty. J Arthroplasty 27:953–960

    Article  PubMed  Google Scholar 

  20. Meknas K, Kartus J, Letto J, Christensen A, Johansen O (2009) Surgical release of the internal obturator tendon for the treatment of retro-trochanteric pain syndrome: a prospective randomized study, with long-term follow-up. Knee Surg Sports Traumatol Arthrosc 17:1249–1256

    Article  PubMed  Google Scholar 

  21. Moen M, Reurink G, Weir A, Tol JL, Maas M, Goudswaard GJ (2014) Predicting return to play after hamstring injuries. Br J Sports Med 48:1358–1363

    Article  PubMed  CAS  Google Scholar 

  22. Mueller-Wohlfahrt H-W, English B, Kerkhoffs GM, Goedhart E, McNally S, Haensel L, Orchard J, Schamasch P, Ueblacker P, Mithoefer K, C van Dijk N, Blottner D, Ekstrand J, Swaerd L (2013) Terminology and classification of muscle injuries in sport: the Munich consensus statement. Br J Sports Med 47:342–350

    Article  PubMed  Google Scholar 

  23. O’Brien S, Bui-Mansfield LT (2007) MRI of quadratus femoris muscle tear: another cause of hip pain. AJR 189:1185–1189

    Article  PubMed  Google Scholar 

  24. Oka M, Monu J (2004) Prevalence and patterns of occult hip fractures and mimics revealed by MRI. AJR 182:283–288

    Article  PubMed  Google Scholar 

  25. Orchard J (2002) Biomechanics of muscle strain injury. NZ J Sports Med 30:92–98

    Google Scholar 

  26. Roche JJ, Jones CD, Khan RJ, Yates PJ (2013) The surgical anatomy of the piriformis tendon, with particular reference to total hip replacement: a cadaver study. Bone Joint J 95B:764–769

    Article  Google Scholar 

  27. Roy RR, Kim JA, Monti RJ, Zhong H, Edgerton VR (1997) Architectural and histochemical properties of cat hip ‘cuff’ muscles. Acta Anat 159(2–3):136–146

    Article  PubMed  CAS  Google Scholar 

  28. Safran M, Ryu J (2014) Ischiofemoral impingement of the hip: a novel approach to treatment. Knee Surg Sports Traumatol Arthrosc 22:781–785

    Article  PubMed  Google Scholar 

  29. Shrier I (2015) Strategic assessment of risk and risk tolerance (StARRT) framework for return-to-play decision-making. Br J Sports Med 49:1311–1315

    Article  PubMed  Google Scholar 

  30. Solomon LB, Lee YC, Callary SA, Beck M, Howie DW (2010) Anatomy of piriformis, obturator internus and obturator externus: implications for the posterior surgical approach to the hip. J Bone Joint Surg Br 92(9):1317–1324

    Article  PubMed  CAS  Google Scholar 

  31. Vaarbakken K, Steen H, Samuelsen G, Dahl H, Leergaard T, Stuge B (2015) Primary functions of the quadratus femoris and obturator externus muscles indicated from lengths and moment arms measured in mobilized cadavers. Clin Biomech 30:231–237

    Article  Google Scholar 

  32. Ward SR, Winters TM, Blemker SS (2010) The architectural design of the gluteal muscle group: implications for movement and rehabilitation. J Orthop Sports Phys Ther 40(2):95–102

    Article  PubMed  Google Scholar 

  33. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, Lovell G, Meyers WC, Muschaweck U, Orchard J, Paajanen H, Philippon M, Reboul G, Robinson P, Schache AG, Schilders E, Serner A, Silvers H, Thorborg K, Tyler T, Verrall G, Jan de Vos R, Vuckovic Z, Hölmich P (2015) Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 49:768–774

    Article  PubMed  PubMed Central  Google Scholar 

  34. Willick SE, Lazarus M, Press JM (2002) Quadratus femoris strain. Clin J Sport Med 12:130–131

    Article  PubMed  Google Scholar 

  35. Yoo S, Dedova I, Pather N (2015) An appraisal of the short lateral rotators of the hip joint. Clin Anat 28(6):800–812

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Manuel Wong-On.

Ethics declarations

Conflict of interest

All authors declare that they have no conflict of interest.


This study was not funded by any company of grant.

Ethical approval

All authors confirm that this study meets the highest ethical standards, and all procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation and with the Helsinki Declaration of 1975, as revised in 2008.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 89423 KB)

Supplementary material 2 (MP4 58476 KB)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Wong-On, M., Turmo-Garuz, A., Arriaza, R. et al. Injuries of the obturator muscles in professional soccer players. Knee Surg Sports Traumatol Arthrosc 26, 1936–1942 (2018).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Obturator muscles
  • Professional football
  • Lateral hip rotators
  • Muscle injury.