Clinical and biomechanical outcomes of rehabilitation targetting intersegmental control in athletic groin pain: prospective cohort of 205 patients

Key points

1. 0173% of patients (150/205) returned to sport pain-free at a mean of 9.9 weeks (SD 3.5)
2. 02All six HAGOS subscores improved significantly, with effect sizes ranging from 0.59 to 1.78
3. 0394% of those re-tested (105/112) achieved pain-free squeeze at 0, 45, and 90 degrees on return to play
4. 04Post-rehabilitation 3D cutting analysis showed reduced trunk side flexion (ES 0.79) and increased pelvic rotation toward travel (ES 0.76), both associated with better cutting performance
5. 05Return-to-play time did not differ by anatomical diagnosis (p=0.56), supporting a diagnosis-agnostic rehabilitation approach

How it was conducted

Design

Prospective single-arm cohort (case series), STROBE-compliant

Participants

205 male athletes with athletic groin pain, mean age 24.9 years (SD 5.1), median symptom duration 32 weeks (IQR 20-52)

Diagnoses

Pubic aponeurosis 64%, adductor 17%, hip 15%, iliopsoas 4%; 20% bilateral

Intervention

Three-level intersegmental control programme: Level 1 strength and control, Level 2 linear running mechanics, Level 3 multidirectional and sport-specific drills

Primary outcome

Hip and Groin Outcome Score (HAGOS) pre- and post-rehabilitation

Secondary outcomes

Pain-free return-to-play rate and time, adductor squeeze test (0, 45, 90 degrees), 3D biomechanical analysis of a 110-degree cutting manoeuvre (n=112)

What they found

• HAGOS Sports subscale improved from 50.7 to 86.3 (mean change 35.6, ES 1.78, p<0.001)
• HAGOS Symptoms subscale improved from 60.3 to 89.1 (mean change 28.8, ES 1.68, p<0.001)
• HAGOS QoL subscale improved from 36.5 to 66.0 (mean change 29.5, ES 1.36, p<0.001)
• HAGOS Pain subscale improved from 72.9 to 88.0 (mean change 15.1, ES 0.96, p<0.001)
• Pain-free return to play: 73% (150/205) at mean 9.9 weeks (SD 3.5)
• Squeeze test maximum pressure at 0 degrees improved from 123 to 135 mmHg (ES 0.68, p<0.001); at 45 degrees from 223 to 234 mmHg (ES 0.65, p<0.001); at 90 degrees from 177 to 209 mmHg (ES 0.46, p<0.001)
• Ipsilateral trunk side flexion reduced (ES 0.79) and pelvic rotation toward travel increased (ES 0.76) during cutting post-rehabilitation
• Total ankle work increased (29.57% to 34.84%, ES 0.68) and total hip work decreased (30.00% to 26.28%, ES 0.48) post-rehabilitation
• No difference in return-to-play time by anatomical diagnosis (p=0.56) or by initial biomechanical cluster (p=0.57)
• No correlation between prior symptom duration and return-to-play time (p=0.17)

Limitations

• No control group or randomisation; cannot exclude natural recovery or regression to the mean
• 27% loss to follow-up for HAGOS and a further 14% without final 3D biomechanical reassessment, introducing potential bias toward better outcomes
• Study included only male athletes from a single sports medicine clinic, limiting generalisability to women and other settings
• Causal relationship between biomechanical changes and clinical improvement was not established

Why it matters

For patients

Athletes with chronic groin pain may benefit from a movement-focused rehab programme that addresses whole-body mechanics rather than a single muscle, with roughly 3 in 4 returning to sport pain-free in around 10 weeks.

For clinicians

This cohort supports using intersegmental control as a unifying rehabilitation framework across varied anatomical groin diagnoses, with 3D motion analysis providing objective targets; randomised comparison against anatomy-specific protocols is still needed.

For readers

The study introduces cutting-task biomechanics as a measurable outcome in groin pain rehabilitation, showing that clinical recovery coincides with movement pattern changes that may reduce hip loading.