As we discussed previously, adductor related groin pain is a common presentation in athletes who participate in sports that involve agility running and kicking. Depending on the chronicity of the presentation, changes to the bony structures around the pelvis may indicate more severe pathology and a prolonged period of rehabilitation. These bony changes may explain why some players are able to return quickly, while others are not.
Bone marrow oedema (BMO) can sometimes be seen on groin scans, where increased fluid is seen in an area of bone. BMO is thought to be the result of increased bony stress in the area often related to excessive kicking or change of direction running that is common in football. Clinically, increasing severity of BMO may be correlated with longer timeframes for rehabilitation.
For athletes with longstanding adductor groin pain, BMO may be seen in the bones of the pubis (anterior pelvis). In the image below, we can see BMO extending through the full thickness of the bone, and equally through the right and left pubic bones (shorter, thicker arrow indicating the right pubic bone).
How can you identify signs of bony stress?
- Careful assessment and palpation by your physiotherapist may help to identify signs of bony stress that may be contributing to your groin pain. Your physiotherapist may not ask you to have an MRI initially, but depending on your response to treatment this may be needed to rule out differential diagnoses and assess the severity of bony pathology. Early identification of excessive bony stress, targeted physiotherapy and modification of training loads may be helpful in preventing the progression toward bony stress fracture. Aching pain at night
- Pain that develops consistently at a certain exercise intensity or duration
- Pain that gradually worsens throughout prolonged exercise
- Soreness on palpation of the bones at the front of the pelvis