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Edwin Goedhart

Edwin Goedhart. Groin complaints in professional footballers. Epidemiology Elite level. Ekstrand e.a. – UCL Study 14% hip / groin region (1.1/1000hr). Overuse injuries. Adductor longus lesion. Painful sensation while shooting , scores but had to be substituted 5 minutes later

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Edwin Goedhart

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  1. Edwin Goedhart Groincomplaints in professional footballers

  2. EpidemiologyElite level • Ekstrand e.a. – UCL Study • 14% hip / groinregion(1.1/1000hr)

  3. Overuseinjuries

  4. Adductorlonguslesion Painfulsensationwhileshooting, scores but had to besubstituted 5 minutes later Return to play 7 days

  5. Distribution of muscleinjuriesduring a match

  6. Injurytime

  7. Sub-elite level • ♂ >♀ • Hölmich 0.4/1000hrs • Mainlyadductor and psoas-related • Abdominalrelated, inguinalrelated and hip related • 60% overuse • 68% dominant leg • Combinationabdominal and adductor: longstanding

  8. Anatomy • Robertson (2009) • ProximalattachmentAdductorlongus >60% muscular(Tuite, Straus) • Conjointtendon (lowerfibresTransversusabdominus and Internaloblique) (Hollinshead, Sandring) • 3% • 8% TA direct pubicattachment • 89% attachedintorectussheath • Adductorlongus and Rectusabdominis in continuity via capsular tissues pubicsymphysis(Schilder, Robinson)

  9. Osteitis pubisPubicbone stress injury • Robinson 2014 • Prospective MRI • BoneMarrowEdema, cleft, parasymphyseal capsule/tendonoedema in asymptomaticplayers • The presence of abnormalimaging features didnotpredictfuturesymptoms • Paajanen 2010 • 40 athletes, 20 controles • 48% athletesgrade 1 BME • 20% athletesgrade 2 BME • 50% controles grade 1 BME

  10. Risk factors • Previousinjury • Weakadductormuscles • Age • LimitedAbduction ROM exo/endo • Cuttingsports • Soccer • Football • Icehockey

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

  12. Prevention / intervention • Exercise: Multi-interventionapproach • Hübscher 2013 • Eccentricstrengthening hip adductor training • Jensen, 2012 • Adductortenotomy • Robertson 2010 • 68% + result (amateur level) severe cases • Compression shorts • Chaudhari, 2014

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

  14. Bursitis

  15. Avulsionfractures

  16. 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

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