Doha agreement meeting on terminology and definitions in groin pain in athletes

Adam Weir, Peter Brukner, Eamonn Delahunt, Jan Ekstrand, Damian Griffin, Karim M Khan, Greg Lovell, William C Meyers, Ulrike Muschaweck, John Orchard, Hannu Paajanen, Marc Philippon, Gilles Reboul, Philip Robinson, Anthony G Schache, Ernest Schilders, Andreas Serner, Holly Silvers, Kristian Thorborg, Timothy Tyler, Geoffrey Verrall, Robert-Jan de Vos, Zarko Vuckovic, Per Hölmich, Adam Weir, Peter Brukner, Eamonn Delahunt, Jan Ekstrand, Damian Griffin, Karim M Khan, Greg Lovell, William C Meyers, Ulrike Muschaweck, John Orchard, Hannu Paajanen, Marc Philippon, Gilles Reboul, Philip Robinson, Anthony G Schache, Ernest Schilders, Andreas Serner, Holly Silvers, Kristian Thorborg, Timothy Tyler, Geoffrey Verrall, Robert-Jan de Vos, Zarko Vuckovic, Per Hölmich

Abstract

Background: Heterogeneous taxonomy of groin injuries in athletes adds confusion to this complicated area.

Aim: The 'Doha agreement meeting on terminology and definitions in groin pain in athletes' was convened to attempt to resolve this problem. Our aim was to agree on a standard terminology, along with accompanying definitions.

Methods: A one-day agreement meeting was held on 4 November 2014. Twenty-four international experts from 14 different countries participated. Systematic reviews were performed to give an up-to-date synthesis of the current evidence on major topics concerning groin pain in athletes. All members participated in a Delphi questionnaire prior to the meeting.

Results: Unanimous agreement was reached on the following terminology. The classification system has three major subheadings of groin pain in athletes: 1. Defined clinical entities for groin pain: Adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain. 2. Hip-related groin pain. 3. Other causes of groin pain in athletes. The definitions are included in this paper.

Conclusions: The Doha agreement meeting on terminology and definitions in groin pain in athletes reached a consensus on a clinically based taxonomy using three major categories. These definitions and terminology are based on history and physical examination to categorise athletes, making it simple and suitable for both clinical practice and research.

Keywords: Consensus statement; Evidence-based; Groin; Hip; Injury.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

Figures

Figure 1
Figure 1
Defined clinical entities for groin pain.Adductor-related groin pain: Adductor tenderness AND pain on resisted adduction testing. Iliopsoas-related groin pain: Iliopsoas tenderness+more likely if pain on resisted hip flexion AND/OR pain on hip flexor stretching. Inguinal-related groin pain: Pain in inguinal canal region AND tenderness of the inguinal canal. No palpable inguinal hernia is present. More likely if aggravated with abdominal resistance OR Valsalva/cough/sneeze. Pubic-related groin pain: Local tenderness of the pubic symphysis and the immediately adjacent bone. No particular resistance tests to test specifically for pubic-related groin pain.

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