The thought is that overuse paired with a strength imbalance of one’s overdeveloped hip adductors (groin muscle) and weak lower abdominal musculature (core) is the root cause.

Arian Foster's Groin Injury… What Happened?

Arian Foster underwent surgery that could have him out for half the 2015/16 NFL season. The details of the exact injury are a bit foggy. So I’ll give my best interpretation of one possibility of the issue at hand.

Athletic pubalgia also known as a sports hernia is a groin injury that presents as pain with athletic activity, one sided and gradually getting worse. This injury happens more frequently in athletic males in their 20s who are involved in sports that require: cutting, pivoting, kicking and sharp turns (i.e. football). During these movements, our hip adductors contract to stabilize the planted leg. 
The thought is that overuse paired with a strength imbalance of one’s overdeveloped hip adductors (groin muscle) and weak lower abdominal musculature (core) is the root cause. This then leads to deficiencies in hip and leg strength, coordination and functional balance, causing an increase in shear forces across the pelvis. 
Take a second and breathe. I may have gone a bit scientific for you too quickly. Let’s simplify.   

First- look at this picture

Second- think of kicking a soccer ball with a tug of war going on between your leg and your core. See that?  Good. Now think if one is much stronger than the other. There will be a breaking point. Most often, this breaking point is at the weakest of where our internal oblique muscle connects to our skeleton- the inguinal ligament and pubic tubercle.

Rehabilitation of this type of injury can take up to 10-12 weeks. Even still, the success rate is still very low and there is a high occurrence of re-injury. It usually begins with 6-8 weeks of rest then onto rehabilitation to resolve muscle imbalances between the hips and the core.

On the other hand, operative treatment has a relatively higher success rate with 83% of patients reporting excellent post surgical results. In 2008, Caudill and a few other researchers came up with a 6-week post surgical rehab program with a gradual pain relief and a return to injury. The key to success is to avoid and aggravation during the rehab component as it could potentially bring the athlete back to square one. 

Kachingwe and Grech proposed an algorithm on how to proceed with treatment of athletic pubalgia for athletes and the general public. You can check it out below:

My guess is that Mr. Foster falls into category #1. As he is a valuable commodity in the Houston franchise, surgical repair seems like the no brainer approach. It will be a tricky situation to get him to return to play. I’m sure the Houston Texans wants him back ASAP, however as mentioned before his rehab needs to be spot on or he risks re-injury.  

Side note: it’s interesting that this injury happened during the fully padded practice of the season. In a study on NHL players, it was found that groin strains are 20 times more apt to occur in the NHL preseason. It’s thought that off-season training programs may focus on overdeveloping leg strength, while core stability might take a bit of a back seat. So, for all you weekend warriors out there, in the gym you should be aiming to improve core stabilization and restore hip muscle imbalances. Toss in a few sumo squats and side lunges into your program.  It may help.   

As always, if you have any questions, concerns or comments, please post them below or stop by Satori or the Richmond Olympic Oval and we can grab a tea and chat about it all. 

Caudill P, et al. Sports hernias: a systematic literature review. Br. J. Sports Med. 2008;42;954-964

Kachingwe AF, Grech S. Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series. J Orthop Sports

Yuill, E., Pajaczkowski, J., Howitt, S. Conservative care of sports hernias within soccer players: a case series. Jbodyw Mov Ther. 2012; 16(4); 540-8