Anatomy: The various muscles of the abdominal wall are penetrated by the inguinal canal, which contains nerves (N ilioinguinalis and the genital branch of N genitofemoralis) and in men the spermatic cord (funilicus spermaticus). In women the inguinal canal instead contains a small fibrous ligament. Where the inguinal canal penetrates the abdominal wall weak spots arise (anulus inguinalis superficialis and anulus inguinalis profundus).

Symptoms: Pain in the groin without any detectable swelling in the groin or any other explanation for the pain.

Examination: There are no examinations (X-ray, ultrasound, MRI-scan, scintigraphy), that can detect the sportsman’s hernia (article). Previously used attempts with X-ray contrast in the abdominal cavity (herniography) showed “sportsman’s hernia” in 49% of healthy subjects, which naturally renders the examination unusable.

Treatment: Before you choose to be operated for “sportsman’s hernia”, all non-operative possibilities should be attempted, including sufficient relief and rehabilitation of the most tender structures and muscles.

Training of the muscles around the groin, stomach and loin before possible surgery.

Complications: Since it may be difficult to make a correct diagnosis in athletes with long-term groin pain (article). A multidisciplinary approach, it should be supplemented with, amongst other things, ultrasound scan and consideration of X-ray scintigraphy and possibly MRI-scan. You should of course consider the correctness of the diagnosis and amongst other things consider the following:

• Inflammation of the adductor muscle of the thigh
• Rupture of the adductor muscle of the thigh
• Inflammation of the pubic joint (osteitis pubis)
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Other bursitis
• Fluid accumulation in the hip joint
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Inguinal hernia
• Stress fracture in the femoral neck
• Nerve entrapment
• Lumbago
• Piriformis syndrome

Anatomy: The bones in the knee joint comprise the thigh bone (femur), shin bone (tibia) and the knee cap (patella). There is furthermore a small joint between the shin bone and the calf bone (fibula). The knee joint is strengthened by a joint capsule which is in turn strengthened on the sides by an outer and an inner collateral ligament (ligamentum collaterale laterale (LCL) and ligamentum collaterale mediale (MCL)). Inside the knee there are two ligaments, the anterior and posterior cruciate ligaments (ligamentum cruciatum anterius and ligamentum cruciatum posterius).

Symptoms: Usually a snap can be heard or felt and continued sports activity must be aborted. The knee can swell within the first few hours, after which the knee can not bend completely. You can subsequently often sense that the leg gives way (knee failure).

Acute treatment: Click here.

Examination: If a partial or complete rupture of the cruciate ligament is suspected, you should seek medical attention (casualty ward) immediately, to obtain a diagnosis. The doctor can perform various tests on the knee (rear drawer looseness) to examine the stability of the knee. It should be noted that the looseness in the knee can often only be demonstrated after two weeks. It is often necessary to supplement the examination with a MR-scan, ultrasound scan (Ultrasonic image) (article), or arthroscopy to make the diagnosis with certainty.

Treatment: Treatment of a rupture of the posterior cruciate ligament usually comprises relief and rehabilitation. It is only in cases of pronounced looseness, or if the rupture is combined with other ligament ruptures, that surgery is recommended (article).

An intensive rehabilitation period of at least six months is to be expected.

Bandage: Hinge bandages (Don-Joy) can be utilised the first few weeks. Tape treatment of cruciate ligament ruptures in the knee has no sure effect.

Complications: If smooth progress is not achieved, it should be considered whether the diagnosis is correct or whether complications have arisen. Amongst others the following should be considered:

• Tendinitis
• Fluid accumulation in the joint (traumatic arthritis/synovitis)
• Bursitis
• Anterior collateral ligament rupture
• Meniscus lesion
• Cartilage damage (osteochondral lesions)
• Bone membrane tear (periosteal avulsion)
• Inflamed mucous fold (plica synovialis)

Special: Since there is a risk that the injury can cause permanent disability, the injury should be reported to your insurance company.

Anatomy: The femur and the hip bone form the hip joint.

Symptoms: Pain in the hip when applying pressure (direct and indirect tenderness) and when under load (walking, running).

Examination: X-ray. Since many stress fractures cannot be seen early in the course of events, X-ray examination can be repeated after a few weeks. Scintigraphy, CT- and MRI and ultrasound scan can often diagnose stress fractures far earlier than X-rays (Ultrasonic image). 
It is imperative for the result of the treatment that the diagnosis is made as early as possible (article).

Treatment: Relief. In some cases surgery is necessary (article).

Rehabilitation: The rehabilitation is completely dependent on the type of fracture and treatment (conservative or operative).
Also read rehabilitation, general.

Complications: If progress is not smooth, you should be re-examined to ensure that the fracture heals according to plan. In some cases a false joint can be formed (pseudoarthrosis), which requires surgical treatment.

Special: Shock absorbing shoes or inlays will reduce the load.

Anatomy: The superficial hip flexor (the forward straight thigh muscle, musculus quadriceps femoris) originate from the front edge of the hip (processus spinosus anterior inferior) and from the upper edge hip joint socket (acetabulum). The muscle is joined by three of the other thigh muscles and is attached in a common joint muscle tendon (quadriceps) on the upper edge of the kneecap (patella). The function of the superficial hip flexor is to stretch the knee and bend in the hip.

Symptoms: In light cases a local tenderness is felt after the load (“muscle strain”, “imminent pulled muscle”, “tendinitis”). The symptoms can often decrease after a thorough warm-up, only to return when the sports activity has ceased. In severe cases a sudden shooting pain is felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a sudden snap is felt rendering the muscle unusable (“total muscle rupture”). With muscle injuries the following three symptoms are characteristic: pain when applying pressure, stretching and activation against resistance. In total ruptures a defect in the muscle can often be seen and felt, and a swelling is felt above or below the rupture (the contracted muscular belly and the bleeding).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness and no discomfort with ordinary walking, medical examination is not necessarily required. The extent of the tenderness is, however, not always a mark of the degree of the injury. In cases of more pronounced pain or tenderness, medical examination is required to ensure the correct diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed (Ultrasonic image). X-ray examination is recommended when it is suspected that the bone on which the muscle tendon fastens has been torn off.

Treatment: The treatment usually comprises relief and rehabilitation. Only in very rare cases is surgery indicated (e.g. total ruptures in the muscle tendon, close to the fastening). Even large ruptures in the femoral muscle can usually be rehabilitated without resulting in functional harm (but often cosmetic damage, with an irregular femoral muscle). If the condition concerns tendinitis where there has been no sensation of a “snap” in the muscle, and smooth improvement has not been achieved after relief and gradually increasing rehabilitation, treatment can be supplemented with rheumatic medicine (NSAID) oand possibly injection of corticosteroid in the area surrounding the inflamed part of the muscle attachment point. If it concerns ruptures, (“total or partial muscle rupture”) the injection of corticosteroid is not indicated.

Complications: If the treatment does not progress according to plan, it should be considered whether the diagnosis is correct or whether complication have arisen. In particular the following should be considered:

• Complications for muscle ruptures
• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Degenerative arthritis in the hip joint
• Rupture of the deep hip flexor (ruptura musculus iliopsoas)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic synovitis/coxitis)
• Stress fracture in the femoral neck
• Nerve entrapment

Anatomy: The deep hip flexor (M iliopsoas) consists of two muscles. The Psoas muscle originate from the lumbar vertebra and the Iliacus muscle from the inside of the hip bone. The two muscles fuse and are both fastened on the inside of the femur (trochanter minor). The iliopsoas is the strongest flexor muscle of the hip joint.

Symptoms: In light cases a local tenderness is felt after the load (“sprained muscle”, “imminent pulled muscle”) e.g. kicking a ball with the instep. In severe cases a sudden shooting pain is felt in the muscle (“partial muscle rupture”, “pulled muscle”) and in the worst case a violent snap is felt, rendering the muscle unusable for e.g. walking up stairs (“total muscle rupture”). With muscle injuries the following three symptoms are characteristic: pain upon pressure, stretching and activation against resistance. In some cases the bleeding can be so great that it entraps the nerve to the bone (nervus femoralis) with increasing pains, reduction of power and symptoms into the leg (article).

Acute treatment: Click here.

Examination: In light cases with only minimal tenderness and no discomfort when walking normally (“sprained muscle”, “imminent pulled muscle”), medical examination is not necessarily required. The severity of the tenderness is, however, not always a measure of the extent of the injury. In case of more pronounced tenderness or pain medical examination is required to ensure the correct diagnosis and treatment. A normal medical examination is usually sufficient in order to make the diagnosis, however, if there is any doubt concerning the diagnosis an ultrasound scan can be performed. It is known that the larger the bleeding is assessed in the ultrasound scan, the longer the rehabilitation period (Ultrasonic image), (article).

Treatment: The treatment usually consists of relief and careful rehabilitation (article). Only in very rare cases is surgery indicated (e.g. in case of total ruptures or very heavy bleeding).

Complications: In case of lack of progress it should be considered if the diagnosis is correct or whether complications have arisen. In particular the following should be considered:

• Bursitis on the front of the hip joint (bursitis iliopectinea)
• Degenerative arthritis in the hip joint
• Rupture of the superficial hip flexor (ruptura musculus rectus femoris)
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the joint (traumatic synovitis/coxitis)
• Stress fracture in the femoral neck
• Complications for muscle ruptures

Anatomy: The large posterior thigh muscles (hamstring muscles) have a common muscle tendon fastening on the ischiatic bone (tuber ischiadicum). The posterior thigh muscles flex the knee and stretch the hip.

Symptoms: Pain in the ischiatic bone can occasionally radiate down into the rear of the thigh. The pain is aggravated when applying pressure on the bone (e.g. sitting position), stretching and activating the posterior thigh muscles (flexing the knee against resistance).

Acute treatment: Click here.

Examination: In slight cases with only minimal tenderness and no discomfort with walking, medical examination is not necessarily required. The extent of the tenderness is, however, not always a mark of the degree of the injury. In cases of more pronounced pain or tenderness, medical examination is required to ensure the correct diagnosis and treatment. The diagnosis is usually made on the basis of a normal medical examination, however, if there is any doubt concerning the diagnosis, this can be confirmed by ultrasound scanning or MR scanning (article).

Treatment: The treatment usually comprises relief, stretching and rehabilitation (article). If the rehabilitation does not progress satisfactorily, medicinal treatment in the form of rheumatic medicine (NSAID) can be considered, or corticosteroid injection in the area surrounding the inflamed tendon fastening on the ischiatic bone. As the injection of corticosteroid is always an element in the long term rehabilitation of a very serious, chronic injury, it is vital that the rehabilitation period lasts over several months in order to reduce the risk of a relapse or ruptures. The tendon can naturally not sustain maximal load after a long-term injury period and only a short-term rehabilitation period. If the diagnosis is made by use of ultrasound scanning, the injections are performed under guidance of ultrasound, and the rehabilitation is progressed in accordance with the guidelines mentioned, then the treatment involving corticosteroid injections has very few risks connected. If satisfactory progress is not made following the rehabilitation and medicinal treatment, surgical intervention can be considered. Long-term results of operations are often disappointing, despite publication of a minor series with good results (article).

Complications: If the treatment does not progress according to plan, it should be considered if the diagnosis is correct or whether complications have arisen. The following should in particular be considered:

• Bursitis at the ischiatic bone
• Muscle rupture of the tendon fastening on the ischiatic bone
• Bursitis at the outer femoral bone projection (bursitis trochanterica)
• Piriformis syndrom
• Degenerative arthritis in the hip joint
• Outer snapping hip
• Inner snapping hip
• Fluid accumulation in the hip joint
• General complications of muscle ruptures
• Lumbago
• Slipped disc