The Anatomical Basis of Groin Pain in Athletes
This thesis is the culmination of a program of research which initially began in 1995. It reflects a major professional interest in the imaging of sports injuries which developed gradually over the 10 year period between 1992 to 2001, based upon previous clinical experience and expertise in the management of musculoskeletal injuries and their anatomical and pathomechanical origins. The central theme of study relates to the use of cross-sectional imaging techniques to investigate the pathoanatomical basis for groin pain in athletes with particular reference to professional soccer players with chronic groin pain. The current thesis is based around two key postulates. Firstly, that most of the commonly diagnosed causes of groin pain in professional athletes are anatomically and functionally linked and, secondly, that modern cross-sectional imaging can demonstrate both the correct diagnosis and the underlying biomechanical causes. The program of study consists of three different but linked project themes. The first investigates the scope of the problem, i.e. the differential diagnosis and prevalence of groin pain in professional soccer players. The second investigates the precise "normal" anatomy, i.e. the gross topographical anatomy of the pubic symphysis and parasymphyseal regions as actually exists rather than the regional anatomy that appears in classical anatomical texts. The third builds upon the first two projects and, investigates the underlying pathomechanical processes using magnetic resonance imaging. The study results suggest that a unifying mechanism of injury exists which partly explains the diagnostic and therapeutic difficulties that occur in athletes with groin pain. It also demonstrates that better understanding of the true pubic symphyseal anatomy allows a more accurate diagnosis to be made and that magnetic resonance imaging can demonstrate the relevant underlying pathoanatomy. The thesis adds significantly to the body of scientific knowledge related to this important sports-related, clinical condition.
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