Groin and Hip Complexities: Is Prevention viable?

Groin and Hip pain is a well-recognised complaint among active young and middle-aged active adults. The groin, an anatomical region where diagnosis and symptoms are often confusing, may also represent a "Bermuda Triangle" for clinicians to disappear in vortices of suppositions and assumptions. Traditionally, there has been little International consensus regarding terminology, definitions and classification of groin pain in athletes. Consequently, there is minimal understanding of diagnosis, pathophysiology, investigation or management, although during the past decade the field has evolved and an evidence-based understanding is now emerging.As the diagnosis is multifactorial, one of the key points is to understand the entire anatomy and most importantly, the functional anatomy. Groin and hip physical testing of impairments, function, and performance have been documented. However, many of the studies are of poor quality and the results of research difficult to interpret and implement into practice. The prevalence of Radiographic groin and hip abnormalities is considerable and requires identification of the relationship between these radiographic abnormalities and the clinically symptomatic pathologies. There is no consensus regarding the optimum conservative management or for the ideal operating technique. Further research is required in relation to nonsur¬gical and surgical management-and the timing of these management approaches.The methods used in this thesis consists of drawing upon personal professional experience, attending National and International conferences, interactions at these conferences andevaluating various evidence sources. Translating and applying this ongoing knowledge into meaningful prevention and rehabilitation protocols has been practically undertaken and subsequently presented in the thesis. In spite of minimal evidence-based medicine and general lack of consensus, it seems the most pertinent point is that many of the groin/hip pathologies may be averted by an understanding of all the complexities involved. By exploring all the knowledge (scientific and practical) of hip and groin pathologies, a prevention strategy in the first place seems plausible, with specific pre-habilitation, bearing in mind the entire kinetic chain and taking into account the neuro - motor control thereof. Thus this thesis establishes a lack of consensus and a need for a robust hip/groin injury and pain prevention strategy.