Pain provocation tests and clinical entities in male football players with longstanding groin pain

Key points

1. 01The number of positive pain provocation tests correlated strongly with pain intensity and moderately with sports disability.
2. 02The number of clinical entities showed similar but weaker correlations with pain and disability.
3. 03The number of clinical entities was very closely tied to the number of positive tests (rs = 0.865).
4. 04Players reporting symptoms on both sides had more positive tests, more clinical entities, more pain, and worse disability than those with one-sided symptoms.
5. 05Iliopsoas-related groin pain was the most common clinical entity, classified 43 times in 31 of 35 players.

How it was conducted

Design

Cross-sectional study using data collected in 2011/12 from a larger cohort of 700 sub-elite Danish male football players

Participants

40 male football players (mean age 24 years) with longstanding groin pain (pain over 6 weeks), median symptom duration 8.5 months

Examination

Bilateral groin exam with 18 pain provocation tests (up to 33 positive results across both legs), classified into 0 to 7 clinical entities by the 2015 Doha agreement

Primary outcomes

Pain intensity by the Copenhagen 5-Second Squeeze Test (5SST, 0 to 10) and disability by the HAGOS Sport subscale

Analysis

Spearman rank correlations and univariate linear regression with bootstrapping (1000 samples), alpha 0.05

What they found

• Number of positive pain provocation tests: median 10 (IQR 7 to 16, range 2 to 23).
• Positive tests correlated with pain intensity (5SST: rs = 0.70 [95% CI 0.50, 0.83]) and with HAGOS Sport disability (rs = -0.62 [95% CI -0.81, -0.36]).
• Positive tests vs other HAGOS subscales: Pain rs = -0.38 [95% CI -0.69, -0.06], Symptoms rs = 0.52 [95% CI -0.73, -0.24], ADL rs = -0.48 [95% CI -0.71, -0.18].
• Number of positive tests explained variance in 5SST (R2 = 0.430, beta = 0.3 [95% CI 0.2, 0.5]) and HAGOS Sport (R2 = 0.407, beta = -2.0 [95% CI -2.8, 1.2]).
• Number of clinical entities: median 3 (IQR 1 to 4, range 1 to 7); 118 entities in 21 unique combinations across 35 players.
• Clinical entities correlated with disability (HAGOS Sport rs = -0.47) and pain intensity (5SST rs = 0.62), and with the number of positive tests (rs = 0.865 [95% CI 0.753, 0.928], p < 0.001).
• Bilateral vs unilateral symptoms (14/40, 35%): more positive tests (mean difference 8 [95% CI 5, 11], p < 0.001), more clinical entities (median 5 vs 3, p < 0.001), higher 5SST (mean diff 2.7 [95% CI 1, 5], p = 0.004), worse HAGOS Sport (mean diff 14.4 [95% CI 3, 26], p = 0.02).

Limitations

• Cross-sectional design shows association only and cannot establish cause or direction.
• Small single-center sample (40 players, 35 with at least one entity) limits precision, reflected in wide confidence intervals.
• Retrospective entity classification used data collected in 2011/12 by a single physiotherapist.
• Findings apply to male sub-elite football players with longstanding groin pain and may not generalize to other patients.

Why it matters

For patients

If you are a footballer with longstanding groin pain that reproduces on many tests or affects both sides, it likely reflects more severe pain and greater limitation in sport.

For clinicians

A higher count of positive provocation tests or clinical entities, and bilateral symptoms, should be read as markers of greater pain intensity and sports disability when planning assessment and care.

For readers

This small study links more positive groin tests and more clinical entities to worse pain and function, but as a cross-sectional analysis it cannot prove one causes the other.