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Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

Purpose

The incidence of groin pain in athletes is steadily increasing. Symptomatic pubic overload with groin pain and aseptic osteitis pubis represent well-known and frequently misdiagnosed overuse injuries in athletes. This study investigated the benefits of standardised non-surgical treatment for swift return-to-football.

Methods

In a prospective double-blinded controlled study, 143 amateur football players with groin pain as well as radiological signs and clinical symptoms of pubic overload were analysed for 1 year. Two randomised study groups participated in an intensive physical rehabilitation programme, either with or without shock wave therapy. The control group did not participate in any standardised rehabilitation programme but only stopped participating in sports activity. Follow-up examinations took place 1, 3 months and 1 year after the beginning of therapy. Endpoints were visual analogue scale (VAS), functional tests, the time of return-to-football, recurrent complaints and changes in the MR image.

Results

Forty-four football players with groin pain and aseptic osteitis pubis were randomised into two study groups; 26 received shock wave therapy, 18 did not. Clinical examination showed pubic overload as a multi-located disease. Players receiving shock wave therapy showed earlier pain relief in the VAS (p < 0.001) and returned to football significantly earlier (p = 0.048) than players without this therapy. Forty-two of 44 players of both study groups returned to football within 4 months after the beginning of therapy and had no recurrent groin pain within 1 year after trauma. Fifty-one players of the control group returned to football after 240 days (p < 0.001), of whom 26 (51%) experienced recurrent groin pain. Follow-up MRI scans did not show any effect of shock wave therapy.

Conclusion

Non-surgical therapy is successful in treating pubic overload and osteitis pubis in athletes. Shock wave therapy as a local treatment significantly reduced pain, thus enabling return-to-football within 3 months after trauma. Early and correct diagnosis is essential for successful intensive physiotherapy.

Level of evidence

I.

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Acknowledgements

We would like to thank the co-initiator and responsible physiotherapist Shyrin Spreitzer (Physiodrom Regensburg, former physiotherapist of the German National Women’s Football Team) for participating in this study and for preparing the physiotherapeutic programme. The close interaction between Shyrin Spreitzer, the study participants and the study physician was fundamental for the successful realisation of this study. After the completion of the data sample for this study, Mrs. Spreitzer passed away unexpectedly on 13th December 2013 at the age of 46. Many thanks also to Dr. Andreas Harlass-Neuking, Dr. Bernd Meyer and Dr. Susanne Zimmermann for their support in recruiting study participants and to Mr. Pavel Novak/Storz Medical for his support in the novel application of shock wave therapy.

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Authors and Affiliations

  1. Clinic of Trauma Surgery, University Medical Centre Regensburg, Franz-Josef-Strauss-Allee 11, 93053, Regensburg, Germany

    M. Schöberl, J. Zellner, P. Angele, M. Nerlich & W. Krutsch

  2. Centre for Hand, Plastic and Reconstructive Surgery, University Medical Centre Regensburg, Regensburg, Germany

    L. Prantl

  3. Clinic of Paediatric Surgery, Clinic St. Hedwig, Regensburg, Germany

    O. Loose

  4. Centre for Clinical Studies, University Medical Centre Regensburg, Regensburg, Germany

    F. Zeman

  5. Physiodrom Regensburg, Regensburg, Germany

    M. Spreitzer

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  1. M. Schöberl
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Correspondence to W. Krutsch.

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None of the authors has any personal or financial relationship with other people or organisations involved in or targeted by this RCT. None of the authors has any competing interests.

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Schöberl, M., Prantl, L., Loose, O. et al. Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study. Knee Surg Sports Traumatol Arthrosc 25, 1958–1966 (2017). https://doi.org/10.1007/s00167-017-4423-z

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