Midseason screening for groin pain, severity, and disability in 101 elite American youth soccer players: a cross-sectional study

Key points

1. 0122% of academy players reported groin pain at midseason screening, nearly all without time loss from sport
2. 02Adductor-related groin pain was most common, accounting for 64% of cases
3. 03The Copenhagen 5-second squeeze test distinguished groin pain, tenderness, and no groin pain groups (p < 0.001)
4. 04Four HAGOS subscales (pain, symptoms, sport/recreation, QOL) differentiated players with and without groin pain (p < 0.001)
5. 05The Hip Outcome Score (HOS) did not differentiate groups, likely because most pain was extra-articular rather than intra-articular

How it was conducted

Design

Cross-sectional observational study

Setting

Elite American soccer academy at midseason (January 2020), youth system of a Major League Soccer club

Participants

101 male elite youth soccer players, mean age 14.3 years (SD 1.8), all non-time-loss except 2 known time-loss pubic apophyseal injuries

Classification

Doha agreement taxonomy used to categorize groin pain into adductor-related, iliopsoas-related, inguinal-related, pubic-related, and hip-related entities

Primary outcomes

Copenhagen 5-second squeeze test (5SST) for pain severity; HAGOS (6 subscales, 0-100%) and HOS (ADL and Sport subscales) for disability

Analysis

Kruskal-Wallis nonparametric tests comparing groin pain, tenderness, and no groin pain groups; post hoc pairwise comparisons with adjusted p-values

What they found

• 22% (22/101) of players subjectively reported groin pain; 20 were non-time-loss
• Adductor-related groin pain was most common (n = 14, 64% of cases); iliopsoas-related (n = 3, 14%); multilocational (n = 3, 14%)
• 39 players (39%) had tenderness to palpation without groin pain complaints
• 5SST differentiated groups (H(2) significant, p < 0.001; mean ranks: groin pain 80.6, tenderness 50.5, no groin pain 34.3); groin pain group had greater pain than tenderness group (p = 0.011) and no groin pain group (p < 0.001)
• HAGOS-Pain, HAGOS-Symptoms, HAGOS-Sport/Recreation, and HAGOS-QOL all significantly differentiated groups (p < 0.001 for each)
• Pain during soccer rated mean 4.9/10 (SD 1.3); pain at rest 1.61 (SD 1.66) on NPRS
• HAGOS subscale medians for groin pain group: Symptoms 82.61, Sport/Recreation 86.60, QOL 85.60, all significantly worse than no groin pain group (p < 0.001)
• 50% of players with groin pain had a positive FADIR test vs 26% in the tenderness group and 10% in the no groin pain group
• FADIR test has poor specificity for intra-articular pathology (sensitivity 0.96, specificity 0.11)
• HOS-ADL and HOS-Sport subscales did not significantly differentiate groups

Limitations

• Single-club, cross-sectional design limits generalizability to other populations and cannot establish causation or temporal trends
• All examinations performed by one physical therapist, introducing potential researcher bias
• Study included only male players from one MLS academy, so findings may not apply to female players or other competition levels
• HOS not validated specifically in youth athletes, and FADIR low specificity means positive findings must be interpreted alongside full clinical picture

Why it matters

For patients

Youth soccer players experiencing groin discomfort during play but not missing training should know this is common and can be identified and monitored with short clinical tests.

For clinicians

The Copenhagen 5-second squeeze test combined with the HAGOS questionnaire provides a practical, valid midseason screening battery to detect non-time-loss groin pain and guide targeted monitoring or intervention in youth academy settings.

For readers

Most groin pain in youth soccer is adductor-related and occurs without time loss, reinforcing the need to capture beyond injury-registry data and use validated functional measures rather than the FADIR test alone.