Institute for Medical Research and Occupational Health
Abstract
Entezitis tetiva aduktora longusa i/ili trbušnih mišića definiramo kao sindrom bolne prepone. Jedan od čestih uzroka nastanka sindroma bolne prepone jest slabost trbušne stijenke. Za nj danas postoji uvriježeni naziv sportska hernija. Sindrom bolne prepone najčešće se pojavljuje u nogometaša (u Hrvatskoj 6,24%). Inicijalno se pojavljuju mukle boli u području preponske regije kao rezultat opterećenja tokom sportske aktivnosti. U kliničkom pregledu osobito je važan aduktorski test. Liječenje sindroma bolne prepone je složeno, kao i uzroci nastanka sindroma. U početku treba smanjiti intenzitet treninga ili potpuno prestati sa sportskom aktivnošću. Primjenjuju se nesteroidni protuupalni lijekovi i miorelaksansi. Provode se vježbe istezanja i jačanja aduktora, trbušne muskulature, iliopsoasa, kvadricepsa te mišića stražnje lože natkoljenice. Ako konzervativno liječenje ne dovodi do poboljšanja, potrebno je kirurško liječenje.Groin pain is defined as tendon enthesitis of adductor longus muscle and/or abdominal muscles that may lead to degenerative arthropathy of pubic symphisis in an advanced stage. Pubic region is a point where kinematic forces cross. The balance between the adductor and abdominal muscles is of great importance, as well as the elasticity of pubic symphisis which enables movement of up to 2 mm and rotation of up to 3 degrees. The weakness of the abdominal muscle wall, known as the sportsman\u27s hernia, is the most common cause of painful groin. Groin pain is the most common in soccer players (6.24% in Croatia). Most authors believe that the main cause of groin pain is the adductor muscle overload. When active, sportsmen start to feel a dull pain in the groin region. The adductor test is of great importance for physical examination; the patient should be lying supine with his hips abducted and flexed at 80 degrees. The test is positive if the patient, while attempting to pull his/her legs against pressing in the opposite direction, feels a sharp pain in the groins. The treatment of groin pain is complex and individual, as its causes may vary from patient to patient. Gradual physical therapy combined with pharmacotherapy should be effective in most cases. The latter includes nonsteroid anti-inflammatory drugs and muscle relaxants. A physical therapy programme usually involves stretching and strengthening of adductor muscles, abdominal wall muscles, iliopsoas muscle, quadriceps, and hamstrings. In case that physical therapy and pharmacotherapy fail, surgery is needed, depending on the cause
