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Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review

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Groin injury is a common musculoskeletal complaint for athletes competing in a variety of sports. The extent to which exercise interventions incorporating external load are an appropriate option for the treatment and prevention of groin injury in athletes is not yet clear.


The aim of this review was to describe and evaluate exercise therapy interventions and outcomes for the treatment and prevention of groin injury with specific attention to application of external load.

Data Sources

The databases Medline, PubMed, SPORTDiscus, Web of Science, and Cochrane were searched on 18 April 2016.

Study Eligibility Criteria

This review was registered as PROSPERO CRD42016037752 and a systematic search was conducted with the following inclusion criteria: any study design evaluating exercise interventions for the prevention or treatment of groin pain in athletes.

Data Analysis

Two independent authors screened search results, performed data extraction, assessed risk of bias using the modified Downs and Black appraisal tool and determined strength and level of evidence. Reporting standards for exercise interventions were assessed using the Consensus for Exercise Reporting Template (CERT).


A total of 1320 titles were identified with 14 studies satisfying the inclusion criteria, four (29%) of which demonstrated low risk of bias. Ten (71%) studies utilised external load as a component of the exercise intervention. Reporting standards for exercise intervention scores ranged from 0 to 63%.


There is limited evidence from level 2 and 3 studies indicating exercise therapy may reduce the incidence and hazard risk of sustaining a groin injury in athletes. There is strong evidence from level 4 studies indicating exercise therapy is beneficial as a treatment for groin injury in athletes in terms of symptom remission, return to sport and recurrence outcomes. However, there are limited studies with low risk of bias, and exercise interventions for the treatment of groin injury are poorly described.

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  1. Werner J, Hägglund M, Walden M, et al. UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med. 2009;43:1036–40.

    Article  CAS  PubMed  Google Scholar 

  2. Orchard JW, Seward H, Orchard JJ. Results of 2 decades of injury surveillance and public release of data in the Australian Football League. Am J Sports Med. 2013;41:734–41.

    Article  PubMed  Google Scholar 

  3. Emery CA, Meeuwisse WH, Powell JW. Groin and abdominal strain injuries in the National Hockey League. Clin J Sports Med. 1999;9:151–6.

    Article  CAS  Google Scholar 

  4. Drew MK, Lovell G, Palsson TS, Chiarelli PE, Osmotherly PG. Do Australian Football players have sensitive groins? Players with current groin pain exhibit mechanical hyperalgesia of the adductor tendon. J Sci Med Sport. 2016;19(10):784–8.

    Google Scholar 

  5. Whittaker JL, Small C, Maffey L, et al. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med. 2015;49:803–9.

    Article  PubMed  Google Scholar 

  6. Mosler AB, Agricola R, Weir A, et al. Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis. Br J Sports Med. 2015;49:810.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Holmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet. 1999;353:439–43.

    Article  CAS  PubMed  Google Scholar 

  8. Machotka Z, Kumar S, Perraton LG. A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes. Sports Med Arthrosc Rehabil Ther Technol. 2009;1:5.

    PubMed  PubMed Central  Google Scholar 

  9. Glasziou P, Meats E, Heneghan C, et al. What is missing from descriptions of treatment in trials and reviews? BMJ. 2008;336:1472–4.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hoffmann TC, Erueti C, Glasziou PP. Poor description of non-pharmacological interventions: analysis of consecutive sample of randomised trials. BMJ. 2013;347:f3755.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Peterson MD, Rhea MR, Alvar BA. Maximizing strength development in athletes: a meta-analysis to determine the dose–response relationship. J Strength Cond Res. 2004;18:377–82.

    PubMed  Google Scholar 

  12. Cormie P, McGuigan MR, Newton RU. Adaptations in athletic performance after ballistic power versus strength training. Med Sci Sports Exerc. 2010;42:1582–98.

    Article  PubMed  Google Scholar 

  13. Rhea MR, Alderman BL. A meta-analysis of periodized versus nonperiodized strength and power training programs. Sport Res Q Exerc. 2004;75:413–22.

    Article  Google Scholar 

  14. Pizzari T, Coburn PT, Crow JF. Prevention and management of osteitis pubis in the Australian Football League: a qualitative analysis. Phys Ther Sport. 2008;9:117–25.

    Article  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med. 2009;151(4):264–9.

    Article  PubMed  Google Scholar 

  16. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49:768–74.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lloyd RS, Faigenbaum AD, Stone MH, et al. Position statement on youth resistance training: the 2014 International Consensus. Br J Sports Med. 2014;48:498–505.

    Article  PubMed  Google Scholar 

  18. Downs SH, Black N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Community Health. 1998;52:377–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  19. Munn J, Sullivan SJ, Schneiders AG. Evidence of sensorimotor deficits in functional ankle instability: a systematic review with meta-analysis. J Sci Med Sport. 2010;13:2–12.

    Article  PubMed  Google Scholar 

  20. Van Tulder M, Furlan A, Bombardier C, et al. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine. 2003;28:1290–9.

    PubMed  Google Scholar 

  21. Reurink G, Goudswaard GJ, Moen MH, et al. Myotoxicity of injections for acute muscle injuries: a systematic review. Sports Med. 2014;44:943–56.

    Article  PubMed  Google Scholar 

  22. Phillips B, Ball C, Sackett D, et al. Oxford centre for evidence-based medicine levels of evidence. 2001. Accessed 16 May 2016.

  23. Slade SC, Dionne CE, Underwood M, et al. Consensus on exercise reporting template (CERT): explanation and elaboration statement. Br J Sports Med. 2016;50:1428–37.

    Article  Google Scholar 

  24. Ekstrand J, Ringborg S. Surgery versus conservative treatment in soccer players with chronic groin pain: a prospective randomised study in soccer players. Eur J Sports Traumatol Relat Res. 2001;23:141–5.

    Google Scholar 

  25. Holmich P, Larsen K, Krogsgaard K, et al. Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scand J Med Sci Sports. 2010;20:814–21.

    Article  CAS  PubMed  Google Scholar 

  26. Jarosz BS. Individualized multi-modal management of osteitis pubis in an Australian Rules footballer. J Chiropr Med. 2011;10:105–10.

    Article  PubMed  PubMed Central  Google Scholar 

  27. McAleer SS, Gille J, Bark S, et al. Management of chronic recurrent osteitis pubis/pubic bone stress in a Premier League footballer: evaluating the evidence base and application of a nine-point management strategy. Phys Ther Sport. 2015;16:285–99.

    Article  PubMed  Google Scholar 

  28. Rodriguez C, Miguel A, Lima H, et al. Osteitis pubis syndrome in the professional soccer athlete: a case report. J Athl Train. 2001;36:437–40.

    PubMed  PubMed Central  Google Scholar 

  29. Tyler TF, Nicholas SJ, Campbell RJ, et al. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002;30:680–3.

    Article  PubMed  Google Scholar 

  30. Verrall GM, Slavotinek JP, Fon GT, et al. Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury. Am J Sports Med. 2007;35:467–74.

    Article  PubMed  Google Scholar 

  31. Vijayakumar P, Nagarajan M, Ramli A. Multimodal physiotherapeutic management for stage-IV osteitis pubis in a 15-year old soccer athlete: a case report. J Back Musculoskelet Rehabil. 2012;25:225–30.

    Article  CAS  PubMed  Google Scholar 

  32. Weir A, Jansen J, van de Port IGL, et al. Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Man Ther. 2011;16:148–54.

    Article  CAS  PubMed  Google Scholar 

  33. Weir A, Jansen J, van Keulen J, et al. Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: a case series. Phys Ther. 2011;12:99–103.

    Google Scholar 

  34. Wollin M, Lovell G. Osteitis pubis in four young football players: a case series demonstrating successful rehabilitation. Phys Ther. 2006;7:153–60.

    Google Scholar 

  35. Woodward JS, Parker A, Macdonald RM. Non-surgical treatment of a professional hockey player with the signs and symptoms of sports hernia: a case report. Int J Sports Phys Ther. 2012;7:85–100.

    PubMed  PubMed Central  Google Scholar 

  36. Yuill EA, Pajaczkowski JA, Howitt SD. Conservative care of sports hernias within soccer players: a case series. J Bodywork Mov Ther. 2012;16:540–8.

    Article  Google Scholar 

  37. Tyler TF, Nicholas SJ, Campbell RJ, et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001;29:124–8.

    Article  CAS  PubMed  Google Scholar 

  38. Kraemer WJ, Ratamess NA, French DN. Resistance training for health and performance. Curr Sports Med Rep. 2002;1:165–71.

    Article  PubMed  Google Scholar 

  39. Flik K, Lyman S, Marx RG. American collegiate men’s ice hockey: an analysis of injuries. Am J Sports Med. 2005;33:183–7.

    Article  PubMed  Google Scholar 

  40. Cox MH, Miles DS, Verde TJ, et al. Applied physiology of ice hockey. Sports Med. 1995;19:184–201.

    Article  CAS  PubMed  Google Scholar 

  41. Kraemer WJ, Ratamess NA. Fundamentals of resistance training: progression and exercise prescription. Med Sci Sports Exerc. 2004;36:674–88.

    Article  PubMed  Google Scholar 

  42. Delahunt E, Thorborg K, Kahn KM, et al. Minimum reporting standards for clinical research on groin pain in athletes. Br J Sports Med. 2015;49:775–81.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Thorborg K, Holmich P, Christensen R, et al. The Copenhagen Hip and Groin Outcome Score (HAGOS): development and validation according to the COSMIN checklist. Br J Sports Med. 2011;45:478–91.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations



Paula Charlton, Michael Drew, Benjamin Mentiplay and Ross Clark planned the manuscript. All authors contributed to the interpretation of the data, writing, editing and approval of the manuscript.

Corresponding author

Correspondence to Paula C. Charlton.

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No sources of funding were used to assist in the preparation of this review.

Conflict of interest

Paula Charlton, Michael Drew, Benjamin Mentiplay, Alison Grimaldi and Ross Clark declare that they have no conflicts of interest relevant to the contents of this review.

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Charlton, P.C., Drew, M.K., Mentiplay, B.F. et al. Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review. Sports Med 47, 2011–2026 (2017).

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