Predicting return to sport
Although the researchers found several clinical symptoms which led to a longer recovery time after an acute groin injury, they concluded that it was difficult to predict return to sports accurately. Athletes who experienced pain on palpation of the proximal insertion of the adductor longus and/ or had a palpable defect required significantly more time than athletes in which this was not the case. On average, they resumed training between four and eleven weeks after the injury. This was also the case for athletes who on an MRI-scan had visible damage at the bone-tendon junction.
When the pain was not localised on the insertion – i.e., the attachment of the tendon to the bone – an extensive physical investigation offered little targets for therapy and an MRI-scan did not predict return to sports better. Most of the athletes with these non-insertional groin complaints, resumed with the first full training within two to four weeks.
Usefulness of an MRI
The researchers conclude that an MRI does hardly offer added value in predicting return to sport in acute groin injuries. An MRI only had added value when damage was visible on the insertion. And even then, this value was very limited: while physical examination explained between 63 and 74 percent of the variation in recovery time, adding an MRI increased that percentage with only 7 percent at best.
Athletes got the opportunity to rehabilitate five times a week under supervision of a sports physiotherapist. Before they started with sports specific on-field training, the physiotherapist simultaneously progressed three forms of exercise therapy: groin exercises, gait training and individual sports specific exercise therapy. The groin exercises started with active flexibility drills; after that, the therapist increased the forces in several ways to end with drills including high velocity and force. The gait training was also progressed in a specific way: first, athletes started with several gait forms on low speed, such as skipping and exercises on the speed ladder, after that variations with more velocity, sideway movements, change of directions and sprints followed. In the individual sports specific exercises, the sports physiotherapist added extra exercises, taking into account the type of sports and the injury history of the athlete. The therapist instructed the athlete to have a maximal pain score of 2 on a scale of 10 during all training sessions. The three forms of exercise therapy progressed independently. A full description of the programme can be found in the article of Serner et al. , of which the full text is available online for free.