EFFECT OF THE COPENHAGEN PROTOCOL AND HOLMICH PROTOCOL FOR CHRONIC GROIN PAIN IN YOUNG ADULT FOOTBALL PLAYERS FOR IMPROVEMENT IN PAIN, STRENGTH AND PERFORMANCE - A COMPARATIVE STUDY

Background: Groin injuries often exhibit major problems, such as high rates of recurrence [3],prolonged durations of absence from sports [1], unclear prognosis [4], and its chronicity [4, 5]. This causes time loss and some of the biggest losses in the performances of the players. Thus it has been a challenge for physiotherapists as well as players who suffer from the injury. Only some advances in the exercise therapy has successfully reduced the time loss and provided significant improvement in the performances later on. Studies done by Holmich et al. and Haroy et al. have provided impressive results in treatment of the players suffering from chronic groin pain and overall reduction of adductor related groin injuries. Testing of this exercise therapy protocols on the parameters of the pain reduction, strength and performance improvement and comparing the results amongst each other is yet to be done on the quantitative and qualitative analysis. Aim: To study and compare the effects of the Holmich protocol and Copenhagen protocol in pain reduction strength improvement and performance improvement among young adult footballers with chronic groin pain. 61 footballers with the Method: chronic groin pain complaints were selected as study subjects. Total sample size was then divided into two groups by odd and even method to form two intervention groups for both the protocols (Group A and Group B). Prevalence was tested on the basis of VAS MMT and Hip and Groin Outcome Scale (HAGOS). These intervention groups performed adductor strengthening protocols during their warm up sessions or as a treatment when the players were unable to play for their respective teams. In our studies we have compared the results Results: of the pre interventional findings with post interventional results in two groups of football players (Group A and Group B). The data was then analyzed for inter-group and intra-group analysis and comparison was done statistically. The results from the studies showed 1) Copenhagen protocol was significantly better in terms of the reducing the pain in subjects. 2) Holmich protocol was significantly better in terms of improvement of the strength in subjects. 3) Copenhagen protocol was significantly better in improvement of the performance of the subjects. Conclusion: Both the adductor strengthening protocols have shown significant improvement in terms of treating the subjects but on the basis of pain reduction and performance improvement Copenhagen protocol showed better success rates. Whereas Holmich protocol has excelled in terms of strength improvement amongst the subjects.

Dolor de cadera en adolescentes: estudio y tratamiento / Hip pain in adolescent: assessment and treatment

En adolescentes que consultan por dolor de cadera o pelvis, es crucial una adecuada historia clínica para orientarnos sobre la etiología del dolor y comprender los mecanismos que lo generan. Es importante conocer y realizar un exhaustivo examen físico, con especial énfasis en la cadera, incluyendo pruebas específicas para diferentes patologías, además de comprender las indicaciones de los diferentes estudios de imágenes, para así lograr un correcto diagnóstico.Entre las causas más frecuentes de coxalgia en adolescentes debemos considerar la epifisiolisis, el pinzamiento femoroacetabular con o sin roturas del labrum, las lesiones avulsivas de la pelvis, la coxa saltans, entre otras. Aunque son poco frecuentes, patologías sistémicas como reumatológicas y oncológicas también deben ser descartadas en adolescentes. Un diagnóstico de certeza nos permitirá realizar una adecuada estrategia de tratamiento, a fin de lograr una rehabilitación precoz y evitar futuras complicaciones.

In adolescents presenting with hip or pelvis pain, an adequate medical history is crucial to guide the etiology and understand the mechanisms that generate it. It is important to know and carry out an exhaustive physical examination, with special attention to the hip, including specific tests for different pathologies, in addition to understand the indications of the different imaging studies, in order to achieve a correct diagnosis. Among the most frequent causes of hip pain in adolescents, we must rule out slipped capital femoral epiphysis, femoroacetabular impingement with or without labral tears, avulsion lesions of the pelvis, snapping hip, among others. Although rare, systemic pathologies such as rheumatologic and oncologic diseases must also be ruled out in adolescents. An accurate diagnosis will allow us to carry out an adequate treatment strategy, in order to achieve early rehabilitation and avoid future complications.

Forty-Five Cases of Chronic Testicular Pain and Groin Pain Treated with Kampo Medicine / 日本東洋医学雑誌

We examined Kampo treatment given to 45 patients with chronic testicular pain and groin pain. Thirty-three of 45 cases were healed with anti-percussive agents including keishibukuryogan, tokishakuyakusan. In addition to testicular pain, when the pain and numbness in the femoral lesion appeared, hachimijiogan and goshajinkigan were effective. If coldness in the lower body is an aggravating factor, tokishakuyakusan is considered appropriate as the first choice. We should notice the sign of qi-blood-fluid, especially, static blood, to select medicine for chronic testicular pain and groin pain.

Abordaje multidisciplinario del dolor inguinal crónico luego de hernioplastia inguinal / Multidisciplinary approach to chronic postoperative inguinal pain

RESUMEN Antecedentes: el dolor inguinal crónico posoperatorio representa una complicación que altera la ca lidad de vida después de la hernioplastia inguinal. Su incidencia es variable con informes de hasta el 16%. Objetivo: describir el tratamiento y los resultados en pacientes con dolor inguinal crónico luego de una hernioplastia inguinal con malla. Material y métodos: estudio descriptivo, observacional y retrospectivo. Se definió como dolor ingui nal crónico posoperatorio la presencia de dolor inguinal por daño nervioso o afectación del sistema somatosensorial tisular que persiste por más de 6 meses luego de la cirugía inicial. Se revisaron las historias clínicas de los pacientes que cursaban el posoperatorio de hernioplastia inguinal convencio nal y laparoscópica en el período 2010-2018. Se realizó la encuesta EuraHS Quality of life score antes y después del abordaje terapéutico multidisciplinario para evaluar cambios en el dolor y restricción de la actividad física. Los resultados fueron analizados y comparados. Resultados: se identificaron 8 pacientes con dolor inguinal crónico posoperatorio grave. El 100% fue evaluado por el Servicio de tratamiento del dolor y requirieron 3 o más fármacos para manejo del do lor. Posteriormente requirieron bloqueo guiado por tomografía computarizada a causa de la persisten cia de los síntomas. Se realizaron 3 (50%) exploraciones quirúrgicas con retiro de material protésico y 2 triples neurectomías. Se observó una disminución estadísticamente significativa (p < 0,05) en el dolor en reposo, dolor durante la actividad y dolor que experimentaron en la última semana. Conclusión: el abordaje multidisciplinario y escalonado permitiría seleccionar a los pacientes que se beneficiarán con el tratamiento quirúrgico.

ABSTRACT Background: Chronic postoperative inguinal pain represents a complication that alters the quality of life after inguinal hernioplasty. Its incidence is variable with reports of up to 16%. Objective: To describe the treatment and results in patients with chronic inguinal pain after an inguinal hernioplasty with mesh. Material and methods: Descriptive, observational and retrospective study. The postoperative chronic inguinal pain was defined as the presence of inguinal pain due to nerve damage or involvement of the somatosensory tissue system that persists for more than 6 months after the initial surgery. The medical records of patients in the postoperative period of conventional and laparoscopic inguinal hernioplasty in the period 2010-2018 were reviewed. The EuraHS Quality of life score pre and post multidisciplinary therapeutic approach was used to evaluate changes in pain and restriction of physical activity. The results were analyzed and compared. Results: 8 patients with severe chronic postoperative inguinal pain were identified. 100% were eva luated by the pain management service and required 3 or more drugs for pain management. Sub sequently, they required block guided by computed tomography due to persistence of symptoms. 3 (50%) surgical examinations were performed with removal of prosthetic material and 2 triple neurec tomies. A statistically significant decrease (p <0.05) was observed in pain at rest, pain during activity and pain experienced in the last week. Conclusion: The multidisciplinary and step up approach would allow selecting the patients who will benefit from the surgical treatment.

Comparative study of preservation versus elective division of ilioinguinal nerve on chronic groin pain after lichtenstein tension free inguinal hernia repair

Background: Post-hernioplasty chronic groin pain is one of the most important complications encountered after inguinal hernia repair. Routine ilioinguinal nerve excision has been proposed to avoid chronic post-hernioplasty neuralgia. The study aimed to evaluate the effect of routine ilioinguinal nerve excision compared to nerve preservation on chronic groin pain and other sensory symptoms in lichtenstein inguinal hernia repair.Methods: The study was conducted in the department of general surgery, at S.P. Medical College and PBM Hospital, Bikaner for duration of 15 months from august 2018 to November 2019. A total of 60 patients of uncomplicated inguinal hernia, who met the inclusion criteria, planned for lichtenstein hernioplasty were randomly divided into 2 groups with 30 cases with ilioinguinal nerve preservation (group A) and 30 cases with elective division of the nerve (group B). Follow up was done upto1 year and patients were inquired regarding pain, hypoesthesia and numbness and data was compared and analysed.Results: The incidence of post-operative neuralgia was 23.33% vs 6.67% (p=0.05) at 1 year in group A and group B respectively. The difference in pain was significant in both groups. The incidence of post-operative hypoesthesia was 10% vs 16.67% (p>0.05) at 1 year follow up in group A and group B respectively. The incidence of numbness was 11.11% vs 16.67% (p>0.05) at 1 year in group A and group B respectively. No statistically significant difference was found in both groups.Conclusions: The prophylactic exicision of ilioinguinal nerve during lichtenstein mesh repair decreases the incidence of chronic groin pain after surgery.

Comparative Effect of Static Stretching and Mulligan Stretching on Hip Adductor Flexibility in Footballers - A Two Group Trial

Groin pain due to adductor strain is commonly seen in footballers. Many methods of stretching a muscle likeballistic stretching, static stretching etc are used to increase flexibility of hip adductors and prevent groinstrain. Static hip adductor stretching till now is more favored technique whereas mulligan adductor stretchingis very new and popular method of increasing muscle flexibility. The present study was undertaken to comparethe effectiveness of 2 stretching programs i.e. Mulligan adductor stretching and static stretching on tight hipadductor. In this trial, 42 athletes who fulfilled the selection criteria were selected and then divided into twogroups based on block randomization. Group-1 received Mulligan’s adductor stretching while Group-2 receivedstatic stretching of hip adductors for 3 alternative days. Hip abduction range of motion (Abd-ROM) wasmeasured on baseline, after first day treatment and finally after third day treatment by a universal goniometer.Mean difference of Abd-ROM within groups on baseline, 1st day after treatment and 3rd day after treatmentwere -8.07, -12.76, -4.69 which shows highly significant difference (p = 0.00) between 3 sessions. MeanAbd-ROM between two groups has not shown significant different (F = 2.99, p > 0.05). It is concluded thatMulligan’s adductor stretching and static stretching both are equally effective in increasing Abd-ROM

Conservative management of an iliopsoas hematoma causing walking difficulty in an elderly patient on anticoagulation therapy: a case report

Spontaneous iliopsoas hematoma is a rare complication in patients suffering from bleeding disorders like hemophilia, Von Willebrand’s disease or those taking blood thinners like aspirin and clopidogrel or anticoagulant medications like warfarin for atrial fibrillation or post-thrombotic status. It can present as severe pain, muscle dysfunction, difficult walking or neurological dysfunction due to compression on femoral nerve or lumbar plexus. A high index of suspicion with early blood and radiological investigations like contrast enhanced computed tomography (CECT) or magnetic resonance imaging (MRI) of the part is immensely helpful in diagnosis and prompt management of such patients. A low hemoglobin or hematocrit level and a high INR is supportive while CECT or MRI of the abdomen and pelvis is confirmatory. Management in a hemodynamically and neurologically stable patient include immediate withdrawl of the anticoagulant, bed rest, infusion of I.V. fluids, vitamin K, fresh frozen plasma and packed red cell transfusion, which ensures complete recovery in most of the cases. However angio-embolization to control ongoing arterial bleeding is lifesaving when feasible or emergent open decompression and bleeding control surgery can save the life or prevent permanent neurological damage to the limb. Decompression of the hematoma by ultrasound or computed tomography guided catheter drainage is helpful alternative in few selected cases. We report an elderly patient on warfarin, who suddenly developed difficulty in walking within hours of a strained defecation, diagnosed to suffer from left iliopsoas hematoma and responded to conservative management with complete resolution of symptoms by 3 weeks.

Clinics in diagnostic imaging (197). Left ischiofemoral impingement syndrome

A 48-year-old woman presented with progressive left hip pain over six months, along with left lower limb weakness for two weeks. Magnetic resonance imaging of the left hip showed narrowing of the left ischiofemoral space, oedema of the left quadratus femoris muscle and left sciatic nerve, and mild bone marrow oedema of the left ischial tuberosity. The diagnosis of left ischiofemoral impingement syndrome was made. The imaging features of ischiofemoral impingement syndrome and the associated aetiologies and complications are discussed.

Tension-free vaginal tape-Abbrevo procedure for female stress urinary incontinence: a prospective analysis over 22 months

<p><b>INTRODUCTION</b>We aimed to study the efficacy and safety of the tension-free vaginal tape (TVT)-Abbrevo procedure for female stress urinary incontinence (SUI).</p><p><b>METHODS</b>This was a prospective cohort study that aimed to determine the subjective and objective cure, improvement of SUI and incidence of complications among women who underwent TVT-Abbrevo for SUI during a period of 22 months from September 2011 to June 2013.</p><p><b>RESULTS</b>A total of 76 patients, with a mean age of 48.2 ± 8.1 years, underwent TVT-Abbrevo during the study period. Among them, 86.8% had vaginal delivery and 5.3% had instrumental delivery. Mean parity was 2.3 ± 0.8 and mean body mass index was 27.0 ± 5.0 kg/m. 11 (14.5%) patients had previously tried physiotherapy. Mean follow-up duration was 12.3 ± 5.6 months. The subjective cure rate for SUI at one-month, six-month and one-year follow-up was 95.7%, 90.8%, and 90.6%, respectively. Among the nine patients who completed the two-year follow-up, 88.9% reported either cure or improvement of SUI. At six months, the proportion of patients with objective cure was 86.8%, and the rates of postoperative groin pain and complications were low. In addition, overactive bladder symptoms disappeared in 76.3% of patients.</p><p><b>CONCLUSION</b>Our results are comparable with those of other studies, although long-term results remain to be seen.</p>

La ecografía en el estudio del dolor inguinal sin alteraciones concluyentes al examen físico / Echography in the study of groin pain with no conclusive alterations in the physical examination

En el Hospital Militar Central "Dr. Carlos J. Finlay" consultan pacientes, fundamentalmente jóvenes con dolor inguinal sin alteraciones al examen físico y resulta complejo tratarlos adecuadamente al no poder precisarse la causa del dolor. Objetivo: determinar la utilidad de la ecografía en la determinación de las causas del dolor. Métodos: se desarrolló un estudio prospectivo y longitudinal con 30 pacientes que consultaron por síndrome doloroso inguinal. Se les realizó ecografía inguinal, crural, del cordón, del escroto con su contenido o labios mayores de la vulva, y se relacionaron los hallazgos con lo encontrado en la intervención quirúrgica o la evolución clínica si no fueron intervenidos durante los tres meses posteriores a la primera consulta. Resultados: el promedio de edad fue de 21,2 años con predominio de los hombres (96,7 %). Se sospecharon por ecografía enfermedades en 29 regiones inguinocrurales (93,5 %) en las que no se habían encontrado alteraciones al examen físico y dos cuyo ecograma se consideró normal. De ellas, en 18 se informó sospechas de hernias inguinales, siete adenomegalias, dos varicoceles, un quiste del cordón y uno de Nuck. Se operaron todos los pacientes con hernias, uno con varicocele y dos con quiste, en los que se confirmó el diagnóstico. Conclusiones: la ecografía constituye una herramienta útil cuando el examen físico no justifica el dolor inguinal...

Patients, most of them young, present at Dr. Carlos J. Finlay Central Military Hospital with groin pain without any alterations in the physical examination. Since the source of the pain cannot be determined accurately, it is difficult to indicate an effective treatment. Objective: determine the usefulness of echography in establishing the causes of the pain. Methods: a prospective longitudinal study was conducted with 30 patients presenting with groin pain syndrome. Echography of the groin, crus, cord and scrotum was performed, including its content or vulvar labia majora. Results were compared with those found in surgical interventions or the clinical evolution or those who were not operated on during the three months following the first consultation. Results: mean age was 21.2 with a predominance of the male sex (96.7 %). Echography revealed 29 cases of suspected inguinocrural disease (93.5 %) in which no alterations had been found in the physical examination, and two whose echogram was considered to be normal. Of these, 18 were reported as suspected groin hernia, seven as adenomegaly, two as varicocele, one as a cord cyst and one as a Nuck cyst. All patients with hernias, one with varicocele and two with cysts underwent surgery, and the diagnosis was confirmed. Conclusions: echography constitutes a useful tool when the physical examination does not reveal the cause of groin pain...

The comparison of treatment outcome of Transobturator tape and Tension-free vaginal tape obturator as the treatment of stress urinary incontinence / 대한산부인과학회지

OBJECTIVE: The aim of this study was to compare the treatment outcome of Transobturator tape (TOT) and Tension-free vaginal tape obturator (TVT-O) as the treatment of stress urinary incontinence (SUI). METHODS: This prospective study included 332 women who were urodynamically diagnosed as stress urinary incontinence from April 2005 to January 2007. Patients showing pelvic organ prolapse higher than stage II by the Pelvic Organ Prolapse Quantification system or patients with detrusor overactivity were excluded from this study. The patients were alternatively selected to undergo TOT (n=192) or TVT-O (n=140) procedure and followed up at 1, 3, 6, 12 months postoperatively to compare the treatment outcome. Three hundred and six of them were available at 1 year follow up, 185 had the TOT operation, 121 the TVT-O procedure. The student t-test, chi square test were used for statistical analysis. RESULTS: There were no statistically significant differences in general characteristics between two groups. No differences were found between 2 groups in the cure rates, postoperative complication such as voiding difficulty, De novo urgency, urinary tract infection, vaginal mesh erosion except groin pain. The groin pain rate of two groups showed significant difference. (TOT; 3.78% vs TVT-O; 9.92%, P=0.030). CONCLUSIONS: This study indicates that the TOT and TVT-O procedures are safe and effective treatments for female stress urinary incontinence. However, TVT-O shows high incidence of groin pain rate and it may be related to nerve irritation by inflammation of surrounding tissue around the pudendal and obturator nerve, according to anatomical differences of the tape position in two procedures.