Pain provocation tests and clinical entities in male football players with longstanding groin pain are associated with pain intensity and disability

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Background: Clinical examination of male football players with longstanding groin pain can be considered difficult. Pain provocation tests are used to examine and classify longstanding groin pain into clinical entities as adductor-, iliopsoas-, inguinal-, and pubic-related. It is unknown if pain provocation tests and clinical entities are associated with pain intensity and disability. Objectives: To investigate if the number of positive pain provocation tests and clinical entities are associated with pain intensity and disability, measured by the Copenhagen 5-Second Squeeze Test (5SST) and the Copenhagen Hip and Groin Outcome Score (HAGOS), respectively. Design: Cross-sectional. Method: Forty male football players (age: mean 24 years [SD: 3.2]; height: mean 182 cm [SD: 5.7]; weight: mean 78 Kg [SD: 6.6]) with longstanding groin pain for a median of 8.5 months (IQR: 4–36) were included. The players underwent a bilateral groin examination with 33 pain provocation tests and were classified with clinical entities (0–7) based on the test findings. Results: The number of positive pain provocation tests (median 10, range 2–23) correlated with pain intensity (5SST: rs = 0.70 [95% CI: 0.50, 0.83]) and disability (HAGOS subscales Sport: rs =-0.62 [95% CI: -0.81, -0.36], Pain: rs = -0.38 [95% CI: -0.69, -0.06], Symptoms: rs = 0.52 [95% CI: -0.73, -0.24], ADL: rs = -0.48 [95% CI: -0.71, -0.18]). The number of clinical entities (median 3, range: 1–7) showed similar but weaker correlations to pain intensity and disability. Conclusions: In male football players with longstanding groin pain, the number of positive pain provocation tests and clinical entities shows weak to strong correlations with pain intensity and disability. Consequently, when pain intensity and disability are severe, a higher number of pain provocation tests may be positive, and more clinical entities may be present.

OriginalsprogEngelsk
Artikelnummer102719
TidsskriftMusculoskeletal Science and Practice
Vol/bind63
Antal sider10
ISSN2468-8630
DOI
StatusUdgivet - 2023

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The specific mechanisms which can explain the large numbers of positive pain provocation tests and clinical entities and their association with pain intensity and disability are unknown. One explanation could be that the number of positive pain provocation tests and clinical entities represents the extent of tissue injury and/or distinct pathology in the anatomical structures (Serner et al., 2022; Zuckerbraun et al., 2020). Supporting this, each clinical entity seems to have distinct anatomical representations in patients with only one type of clinical entity (Serner et al., 2022). However, clear relationships between tissue injuries/pathology and longstanding groin pain classified into clinical entities using pain provocation tests are still lacking (Drew et al., 2014; Ishøi et al., 2021). Furthermore, the associations between longstanding groin pain and abnormal radiological findings lack robustness, temporal validity, and consistency (Branci et al., 2013, 2015; Heerey et al., 2020; Massa et al., 2020; Paajanen et al., 2019; Robinson et al., 2015; Saito et al., 2021; Serner et al., 2021; Tsukada et al., 2018).

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