Hip and groin pain due to various pathologies is a common problem in soccer players. Many present as overuse injuries with fluctuating long-standing symptoms, making “time-loss” definitions of incidence a poor reflection of the true problem. Using patient reported outcomes can shed further light on the extent to which soccer players are bothered by hip and groin pain.
The Copenhagen Hip and Groin Outcome Score (HAGOS) has been designed and validated for use in a young active population to assess hip and groin pain. Normal reference values are required, however, to make meaningful judgements. Thorborg et al studied 444 sub-elite male soccer players (average age 23.6) who were free of groin or hip pain. Initial analysis showed lower scores in 143 players who reported hip or groin pain in the previous season. These players were thus excluded from the calculation of reference values, leaving 301 players.
Reference range (5-100%) for HAGOS sub-scales in injury-free soccer players-
- Pain 80-100
- Symptoms 64-100
- ADL 80-100
- Sport / rec 72-100
- QOL 75-100
A score of 100 indicates the best function, with no hip or groin problems, and 0 indicates severe hip and groin problems. The symptoms sub-scale results in lower scores, indicating that some symptoms are likely to occur in injury free players. This is also the case in the symptom sub-scale of the KOOS knee score.
What these figures suggest is that it is ‘normal’ to have some level of symptoms from the hip and/or groin in active soccer players, even with no history of groin injury. This is certainly some thing I experience in my role at a professional soccer club in Australia. It is important to recognise this and explaining this to non-athletic patients can help provide perspective, reassurance and hope that their level of symptoms may not be as bad as they fear.
