Groin pain is common among athletes, with up to 18 percent of male soccer players reporting adductor-related pain every year. In theory, sports-related adductor pain should respond to active training programs designed to improve the coordination and strength of the muscles stabilizing the pelvis and hip joints. However, nonsurgical treatments have not been based on randomized clinical trials. Holmich and colleagues conducted a randomized clinical trial to compare an active training program with conventional physical therapy in 68 athletes with longstanding adductor pain.

Men 18 to 50 years of age who reported sports-related adductor pain of at least two months' duration and who wanted to return to active sports participation were eligible for the study if they met clinical criteria for adductor strain. Patients with alternative explanations for pain and those who missed more than one quarter of the treatment sessions were excluded from the study. One physician assessed the 68 patients using standardized techniques, a validated questionnaire to collect demographic and clinical data, and a standardized set of radiographs of the pelvis. Patients were then randomly assigned to treatment with either active training or physical therapy.

The active training program consisted of 90-minute training sessions three times weekly for up to 12 weeks. Patients were instructed to exercise on other days. The physical therapy group was treated by one physical therapist for 90 minutes twice weekly. Patients were asked to do stretching exercises on days between treatment sessions. Patients were banned from other therapies and from participation in any sports during the treatment period.

Patients were interviewed and examined one and four months after completion of treatment. The follow-up assessments were conducted by a single physician who was not informed of the treatment followed. The three principal outcome measures were a return to the same level of sports participation without groin pain; no pain on palpation of adductor tendons; and no pain on active adduction against resistance. Subjective global assessment of pain was also conducted before and after treatment.

In the active training group, 24 patients (79 percent) successfully returned to sports activity. The time to return to previous levels of activity ranged from 13 to 26 weeks (median: 18.5 weeks). Only four of the patients in the physical therapy group successfully returned to active sports participation. This difference, as well as improvement in adduction strength, showed the significant benefit derived from active training, compared with physical therapy. With regard to other outcome measures, trends in favor of active training did not reach statistical significance. In the subjective assessment, significantly more patients in the active training group than in the physical therapy group rated their condition as much better.

The authors conclude that the active training program was highly effective in returning athletes with longstanding adductor pain to full sports participation. A program aimed at improving muscle strength and coordination is more effective than the traditional physical therapy program and receives higher subjective ratings from patients.