By Dr. Paco BAUTISTA Pt, DO, PhD

The prevention of osteitis pubis and groin pain, as well as other sports injuries due to overload, should be included as a matter of course in the training programs of any technical staff, especially in elite sports.
It is true that there are no prevention protocols that guarantee the reduction of the risk of injury, according to the current literature, which is also a problem for physiotherapists and clinicians.
However, we believe that there are some keys that can be followed in the prevention of sports injuries, including osteitis pubis or dynamic osteopathy of the pubis.

Groin pain

In order to clarify which practices reduce the risk of sports injuries in 2007, Aaltonen S., in a systematic review of the main databases, concluded that the use of external supports, as well as proprioceptive training programs appear to be effective in the prevention of sports injuries.

In this sense Markus, et al. in 2010 conducted a systematic review of high quality, average 6 (range = 5-8). The average sample size was 1078 subjects (range = 114-2020). All trials included as study population adolescents and young adult athletes aged 12-24 years. The sports activities regularly performed by these study participants were: school and sports club sports, basketball, volleyball, soccer, handball, as well as field hockey and futsal. The proprioceptive and neuromuscular exercises considered included in the training: balance, agility, stretching, plyometric exercises, running exercises, tumbling and strength training.

The objective of this review was to evaluate the effectiveness of proprioceptive/neuromuscular training in the prevention of sports injuries. Focusing on studies of high methodological quality, relative risks (RR) and 95% (CI) were used to estimate treatment effects.

From a total of 32 relevant studies, 7 methodologically well-conducted studies were considered for this review. Pooled analysis revealed that proprioception was effective in reducing the risk of lower limb injury significantly (p<0.01). Proprioceptive training being more effective in athletes with a history of injury than in those without a history. This is interesting because we know the high level of relapses that characterizes osteitis pubis and dynamic osteopathy, which is higher in men than in female athletes.

In conclusion, there is evidence that balance or multifaceted programs of proprioceptive and neuromuscular training (where we should not forget the study of neural mobility especially obturator, crural and sciatic), #neurodynamics, could be effective in preventing lower extremity injuries including pubalgia and groin pain, among adolescent and young adult athletes in sport, and especially in soccer.

Although it could be assumed that sensory-motor training sessions should be performed for at least 10 minutes, more than once a week for at least 3 months. The frequency of the programs considered is variable from 1 to 7 sessions per week and between 3 and 12 months (Markus et al. 2010).

Evidently, the results of this study require further studies that propose more defined proprioceptive and neuromuscular training programs, and of course the results cannot be generalized to high-risk sports or other specific sports not considered in this review.

From the study by Markus et al. we can therefore conclude that this review showed evidence of the effectiveness of proprioceptive/neuromuscular training in reducing the incidence of certain types of sports injuries among adolescent and young adult athletes during sports practice.

In a more recent 2014 review, Lauersen et al. under the title "The effectiveness of exercise interventions to prevent sports injuries: a systematic review and meta-analysis of randomised controlled trials", reach the following conclusions that confirm the above.
-Physical activity has been shown to effectively reduce sports injuries.
-Stretching has not shown any beneficial effect.
-Multiple proprioception and strength training programs, in that order, showed a trend toward prevention of sports injuries.

-Strength training reduces sports injuries by less than 1/3.

-Combining strength training with proprioceptive training could reduce the risk of injury by almost half.

Therefore, based on this we propose for the prevention of dynamic osteopathy of the pubis, several points to take into account:

-Include prevention programs based on proprioceptive and strength training, within the usual training programs, throughout the year from pre-season and with greater intensity in this phase.

-Previous and controlled biomechanical rebalancing of the athlete in a global way paying special attention to the lumbopelvic region, ASI, coxofemoral, thoracolumbar hinge and foot. Through manual therapy and osteopathy.

-Proprioception training through FNP including the main sporting gestures of the sport in question, at least 10 minutes/training session, more than once a week (up to 7) for at least 3 months, preferably continuously all year round.

-Treatment of muscular imbalances, first relaxation of hypertonic muscle groups and subsequent strengthening of those with a tendency to hypotonia. Assessment and compensation of agonist-antagonist imbalances.

-Strengthening of abdominals, spinal and gluteal muscles, adductors, hamstrings and quadriceps.
As always a pleasure to share.


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