GROIN PAIN: FROM “NO MAN’S LAND” TO A SHARED CLINICAL LANGUAGE
The groin is a complex anatomical region where several medical disciplines intersect. For many years, it was regarded as a clinical “no man’s land”, approached differently by orthopaedic surgeons, sports physicians, general surgeons, radiologists and physiotherapists. Athletes with groin pain were consequently given multiple diagnoses, often based on imprecise and inconsistently applied terminology.
A decisive step forward was taken in Doha in November 2014, when 24 international experts from 14 countries gathered at Aspetar to establish greater clarity. Their work led to the Doha Agreement on terminology and definitions in groin pain in athletes, published in the British Journal of Sports Medicine in 2015. The agreement introduced a clinically based classification comprising defined clinical entities, hip-related groin pain and other causes. It provided clinicians and researchers with a shared language based principally on history and physical examination. More than a decade later, the Doha Agreement remains an essential foundation. However, our understanding of groin pain continues to evolve. Classification is the beginning of clinical reasoning, not its endpoint. Two athletes with similar symptoms may have different underlying problems, while athletes with the same clinical diagnosis may demonstrate very different movement strategies, loading capacities and rehabilitation needs. The clinical picture may also involve several coexisting entities rather than one isolated structure. Aspetar groin pain pathway emphasizes this variability and the need to translate classification into individualized clinical pathways. With that question in mind, I ask my prestigious colleagues Prof. Enda King and Dermot Simpson to be guest editors of this targeted topic on Groin pain rehabilitation in athletes This targeted issue reflects that progress.
Prof. Enda King and Dermot Simpson assembled a team of experts from Aspetar as well as authors from all corners of the globe to clarify progress we did in past 10 years. Aspetar can be proud of its contribution to transforming groin pain from an area of confusion into one of shared terminology, collaboration and scientific advancement. This issue is confirmation of this next step to convert past knowledge into earlier recognition, more individualized care and a safer, more complete return to performance.
I would like to thank our Guest Editors Prof Enda King and Dermot Simpson as well as all authors for their generous contributions and hard work which made this issue possible. I would also like to extend my gratitude to Prof. Adam Weir for providing the history of the Doha agreement to remind us where it all began.
In addition to all these excellent papers I would like to draw your attention to the latest Al-Resalah that present The Art of Al-Misbah where our Journalist Fai explores the history and artistry of Al-Misbah, along with its quiet reminder to pause and slow down. Perhaps this wisdom feels more relevant than ever today.
I hope you enjoy reading this issue.
Prof Nebojsa Popovic MD PhD
Editor-in-Chief