FIFA Women’s World Cup Series – The groin strain

FIFA Women's World Cup coming to Australia

The world will be watching Australia and New Zealand as both countries host the biggest sporting event scheduled for 2023, the Women’s FIFA World Cup, in just over 3 weeks.  Soccer (or football to most of the world) is also prominent in Ballarat with many junior and senior teams playing each weekend. 

Like in any sport, injuries can occur in soccer at any level.  Ballarat Sports Medicine’s elite independent practitioners can treat all forms of injuries and assist in recovery.  For more serious injuries they can refer directly to BallaratOSM’s specialized independent orthopaedic surgeons if needed.

Over the course of the tournament Ballarat Sports Medicine and BallaratOSM will bring you a series of common and not so common injuries that occur in soccer players.  In this blog we focus on The Groin Strain

Do you know the most common types of injuries on Soccer?

Tackles, head duels, landings, sudden changes of direction, accelerations, kicking and passing the ball – in soccer there are a lot of situations where you can get injured.

More than 75% of injuries in soccer occur in the legs. Head and facial injuries are also common. In general, injuries are divided into acute and overuse injuries.

Acute injuries occur suddenly and can be attributed to one single event during a training session or a game. Typical injuries are thigh contusions, hamstring muscle strains, knee injuries and ankle sprains.

Overuse injuries develop over time and cannot be attributed to a single event. It is typical for players with overuse injuries to be playing for several teams, not getting adequate rest. Symptoms are often ignored until they cannot be ignored any longer. Typical overuse injury sites are the groin and knee.

Soccer players can expect to have at least one ankle injury during their playing career.

Groin strain

A person who has suffered a groin strain is not usually in any doubt about what has happened. In some sports, such as football and ice hockey, it is one of the most common strain injuries. It is also an injury that is important to be taken seriously.

The most common acute injury in the pelvic, groin, and hip region is a strain in one of the muscles located on the inside of the thigh. These muscles are collectively known as the adductor muscles of the hip. Their function is to guide the leg inwards and stabilise the hip.

When a strain occurs, the muscles are partially or completely torn. In technical terms, this is known as a whole or partial rupture. Strain injuries most frequently occur in the adductor longus muscle.

Injury mechanism

Acute groin injuries usually occur in conjunction with shooting on goal, changes in direction, and tackles.

Signs and symptoms

A groin strain usually causes pain in that area. If it is a severe injury, pain might also be experienced on the inside of the thigh. Pain returns if the athlete continues the activity. There may also be swelling in the injured area, and in some cases bruising. This usually occurs two or three days after the incident.

Paradoxically, a total rupture where the muscles are completely torn can cause a lower degree of pain than a less severe injury. It is with a total rupture that bruising usually occurs.

Diagnosis

A doctor or a physiotherapist will confirm the diagnosis based on a description of the events leading to the injury, as well as signs and symptoms. The examiner can also check for pain by applying pressure to the injured area. Pain may also usually be felt when the musculature in the groin is tensed against resistance, and the injured person will have a reduced amount of strength. Imaging techniques such as MRI and ultrasound can also be useful in determining the extent of the injury, but a clinical examination is usually sufficient.

Risk factors

Having sustained a previous injury in the groin increases the risk of a groin strain. Other factors that increase the risk are a loss of strength and lacking sports specific training. It was previously believed that athletes at the elite level were especially susceptible to this type of injury, but newer research has shown that the risk is the same for all athletes regardless of their level.

Treatment

Acute treatment according to the PRICE principle (Protection, Rest, Ice, Compression, Elevation) should be followed as soon as possible after the injury occurs. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as Nurofen and Voltaren, can delay the body’s healing process. The inflammatory process that occurs following an injury, and which such medications counteract, is in fact an important part of the body’s repair system. Disrupting this can lead to the body needing more time to heal itself. You should avoid these medications for the first 48 hours after the injury.

No surgery – Surgical treatment is not recommended, even in the case of a total rupture.

As soon as the pain begins to subside, the athlete should commence with training exercises for the injured muscles. A gradual progression is necessary to return to sporting activity. The athlete’s progress should be followed up closely, and they should only train when feeling no or minimal pain. Progressing too quickly can cause new ruptures in the scar tissue of the muscle, and the problem can become long-term. The athlete can often start strength training of other muscles early as long as it doesn’t cause pain to the injured area.

After three or four days, the athlete should be able to begin with gentle stretching and flexibility exercises. The intention is to activate the injured muscles by performing many repetitions with a steadily increasing range of motion. When a full range of motion has been reached on both sides without causing pain, strength training can gradually be increased to a full load.

The aim is to regain full muscle length and strength before returning to sport. As soon as the pain allows, the athlete should commence with sensory-motor activities (balance training) in the hip and groin musculature. In addition, the athlete should complete a period of controlled and exercise specific training in the relevant sport before returning to full training and competition.

2023 Australian National Basketball Championships

2023 Australian National Basketball Championships

‘Motivating and preparing players in difficult climatic conditions with high levels of fatigue in a high pressure elite competition environment is the role of a Sports Physiotherapist’  

Ballarat Sports Medicine’s experienced APA Sports and Exercise Physiotherapist Luke Blunden recently returned to the National under 18 basketball tournament to support the Victorian Metropolitan Women’s basketball team as their team Physiotherapist.

The Foot Locker national under 18 basketball tournament was held in Brendale Queensland from the 9th to 16th of April this year with elite state teams from over the country competing.  The Victorian Women’s team had won the gold medal in 2022 and were looking to defend the championship with a new young team.

Michael Brookens led the team with his excellent coaching strategy to be undefeated in the regular pool games.  Vic Metro then played in a pool-final against Vic country and pushed on with a win to advance to the semi-final against a strong NSW Metro.  Vic Metro had an ideal start leading 12 to 0, however in a tough seesawing game NSW got back into the game, got the better and progressed to the gold medal game.  This meant the Vic team would play QLD south in the bronze medal contest.  In a tough physical encounter with stadium conditions sweltering in the Brisbane heat the QLD side narrowly won the contest and the bronze medal leaving Vic Metro in fourth.  South Australia Metro went on to win the gold medal.

The basketball tournament environment is an involved process as team Physiotherapist, which for Luke involved monitoring player sleep, wellness, soreness, fluid balance, weight and exercise load levels.  Luke’s Sports Physiotherapy service would provide pre game taping, warm up of players, game monitoring, cool down, recovery, treatment for injury and performance management.

This year there were many learning experiences with challenges motivating and preparing players in difficult climate conditions with high fatigue in a high pressure elite competition environment.

Games can be viewed on Kommunity TV.

Luke looks forward to his next elite Basketball Physiotherapy challenge.

Avoiding Narcotics

With the improvements in rapid recovery surgery using multimodal therapy, we’ve audited our tramadol usage, which has been accepted for publication in ANZ Journal of Surgery.

364 patients undergoing arthroplasty surgery 2018-19 were audited.  4.9% were not prescribed tramadol and a further 4.3% reported an adverse effect.  16% of the whole group were already on an antidepressant, but only two of these reported an adverse effect (one sweating, one constipation). LIA injections, meloxicam, paracetamol, and buprenophone patches usually provide the background analgesia.

We have subsequently taken to prescribing our tramadol as 50mg three hourly as necessary to minimise the incidence of side effects.  In patients already on a maximal dose of antidepressants SSRI or SNRI, or any dose of MOAI, it is necessary to individualise a solution.  Tapentadol may be a useful alternate.  We avoid oxycodone where-ever possible, but in the rare instances of prescribing it, suggest a slow-release narcotic at night-time to avoid waking in pain becoming a chronic pain behaviour.

Reference:

Yu Wen (Kevin) Wu, David James Mitchell. Tramadol as a patient-initiated component of multimodal pain management: a pilot study of 364 lower limb arthroplasty cases. ANZJS 2023. https://doi.org/10.1111/ans.18361

Ballarat Basketball Partnership

Ballarat Sports Medicine have again partnered with Ballarat Basketball to support the Mens’ and Womens’ Ballarat Miners teams for the next two years.  The extension of this partnership following a successful 2021/2022 was a priority to ensure that Ballarat’s elite basketballers have immediate local access to specialist Sport & Exercise Medicine care.  This includes early assessment and management of injuries, as well as performance-related issues such as diet and sports psychology. 

This year Ballarat Sports Medicine is proudly sponsoring Amos Brooks.  Amos is a 6’ 7” (201cm) centre in the Mens Miners team.  He attended Rend Lake College in Ina, Illinois, USA in 2020 before returning to Victoria to play for the Ballarat Miners since 2022. Amos recently took the time to visit Ballarat Sports Medicine at Novar and met with the team (pictured with Dr Greg Harris and Dr Jai Sharma).  We will be following closely as the Miners #20 takes to the court through 2023.  

Joining Amos courtside at home games for both the Mens’ and Womens’ teams at Selkirk stadium will be Dr Jai Sharma.  Jai is a Sport & Exercise Medicine Registrar, with several years of experience in orthopaedics and emergency medicine. The Miners are in good hands.

Exercise Physiology and Myotherapy is coming to Ballarat Sports Medicine

Grant McKechnie BEd(PE), DipM(RM), AdDip(Myo), GradDipHSc(ExRehab), MAppSci(Research), ProfCert(Pain NeuroSci/Edu)

Ballarat Sports Medicine is very excited to announce that Grant McKechnie is joining the team of practitioners consulting at Novar!

Grant is Ballarat’s (and possibly Australia’s) most experienced clinical exercise physiologist. Over a 24 year career in both public and private settings, he has an enormous depth and breadth of experience in rehabilitation, strength and conditioning, myotherapy and pain management. 

Having his expertise on site expands the ability to manage sports and other musculoskeletal injuries from start to finish. From getting the correct diagnosis, through our sports medicine team, surgery if needed, physiotherapy and now another element to the high-end rehabilitation and return to activity, the team can help patients at all steps in the process. 

Areas of Interest:

  • Persistent pain, pain science and pain education
  • Neuroplastic rehabilitation for all neurological conditions
  • Musculoskeletal conditions
  • Recalcitrant conditions
  • Sports science and athletic preparation

Grant began practicing in September 2000, working at The University of Ballarat’s (now Federation University Australia) – UniSports Exercise Rehabilitation Centre.  Whilst there he continued to study, gaining his Master of Applied Science as well as various soft tissue qualifications including Myotherapy. Grant was a lecturer in both undergraduate and Master’s programs; with a particular focus on the Masters of Rehabilitation anatomy program.

Since this time, Grant has written and delivered entire courses in Remedial massage and Myotherapy for the University of Ballarat and private colleges in Melbourne. These courses have a particular focus on the care, prevention and rehabilitation of musculoskeletal injuries.

Grant commenced Ballarat Sports & Exercise Rehabilitation Centre 2005, a multi-disciplinary clinic, which included Exercise Physiology and Myotherapy. Grant delivered in-house rehabilitation and professional development education for musculoskeletal, metabolic, neurological and cardiovascular conditions. 

Topics included

  • Lower back exercise rehabilitation
  • Adhesive capsulitis
  • Assessment and treatment of the TMJ (Temporomandibular Joint Disfunction)
  • Post-hip arthroscopic surgery rehabilitation
  • Neuroplasticity and rehabilitation

Grant has been successfully treating many conditions with a bias toward chronic pain and recalcitrant conditions that haven’t responded to standard methods of treatment. He continues to develop his practice and knowledge, currently pursuing the field of neurology and neuroplastic approaches to rehabilitation.

Grant is active in professional development for Myotherapy Association Australia where he has been the Chair of the project steering committee for the reaccreditation of the Myotherapy training package twice and was on the discussion panel for the direction of myotherapy at the biannual conference. Grant has presented at the Commonwealth International Sports Conference, as well as many various guest lecturer roles, including presenting at the Primary Health Network educating doctors on topics such as sarcopenia and exercise, and the neuroplasticity of pain. 

Grant has worked with both professional and semi-professional athletes. This has included development and implementation  of

  • Strength and conditioning programs
  • Athletic preparation
  • Full macrocycle plans
  • Biomechanical analysis
  • Athletic screening
  • Injury rehabilitation

The athletes include; Olympic and Commonwealth Games representatives in various sports, Professional Mixed Martial Arts & Brazilian Jujitsu fighters, Motocross, Cyclists, Ultra-distance and Marathon runners, Ironman and Triathlon, Rowing, Tennis, Badminton, Race-walking and AFL football. He has worked as a rehabilitation therapist at the North Ballarat Roosters VFL in 1999 and 2000, and has been a professional injury consultant for the AFL.

In 2017 Grant was awarded the Myotherapy Australia’s Tony Moynihan award regarding excellence in the field of myotherapy. In 2018 he presented at the international Neuro-Impulse Protocol symposium on how exercise can correct neurological dysafferentation.

In 2020 Grant was a recipient of a scholarship from the Pain Revolution, to study Pain Neuroscience and Pain Education at the University of South Australia. Grant has completed this study and is now forming the Pain Revolution’s  local pain collective for Ballarat and surrounding districts. The collective is to educate professionals and the community on contemporary pain neuroscience and how to better address the growing issue of  persistent pain in the community.

Grant will be consulting at NOVAR, 109 Webster Street Lake Wendouree, from Wednesday to Friday, commencing 12/04/2023, and alternate Saturday mornings from 22/04/2023. 

Bookings can be made on-line at

Book Appointment

Or call

5332 2969

Ballarat Sports Medicine’s New Registrar

Ballarat Sports Medicine has a new Sport and Exercise Medicine registrar, Dr Jai Sharma.  Jai manages to combine many passions in life – medicine, sport and exercise.  He has a passion for local cricket, running, cycling and enjoys a good coffee.

A Ballarat boy himself, Jai moved to the UK to acquire his medical degree (University of Liverpool 2015) and gain valuable experience working in the NHS before returning home to Victoria.


He has extensive experience in many hospital settings in particular orthopaedic surgery, emergency medicine, general practice and general medicine. Regarding sports, he has worked as team doctor for North Melbourne and Frankston VFL teams,  with AFLW  as the concussion doctor and coverage of cycling events. Jai has also completed a Master’s degree in Sports Medicine (University of Queensland 2021).


Growing up and going to school in Ballarat gives Jai a unique perspective of the local area and he is keen to engage with the local community and other health care professionals involved in your care to provide the best possible management for you.

Jai will be available for appointments in mid-February.

Ballarat Sports Medicine has a new physiotherapist

Simon Lewis has recently joined both Luke Blunden and Peta Johnston as a physiotherapist Ballarat Sports Medicine, increasing physiotherapy availability. Simon’s journey towards physiotherapy began back in high school with an intense interest in athletics and sport. He has since completed a Certificate IV in Fitness, Bachelor of Health and Physical Education (Deakin University)
and a Bachelor of Physiotherapy Honours (Australian Catholic University Ballarat). He has worked as a personal trainer, teacher, and physiotherapist across multiple sites in Ballarat, Melbourne, and the Grampians region.

Treating the whole person is a core value of Simon’s and this is reflected in the coaching approach that he uses. Simon has a particular interest in treating children and teens as well as older adults. His passion lies in helping people not only recover from injury but to thrive and improve all aspects of their lives. Simon has completed further study in the areas of paediatric physical activity, psychological informed practice, behaviour change, and pain education. When not working Simon enjoys spending time with his wife and two daughters, going for a hike, or hitting the gym.

Appointments are now available for Simon at: 

Book Appointment

Obesity and hip replacement

A new study published demonstrates hip replacement surgery fixes pain and improves walking both in obese and non obese patients, but the obese group are more likely to need walking aids at ten years.

Continue reading

Australian National Joint Replacement Registry Report 2022

Australia has been leading the world with its National Joint Replacement Registry since 2000, with every joint replacement and its long term outcome being followed.

Key issues identified this year include:

  1. The registry is now tracking the outcome of 1.8 million joint replacements.
  2. 2021 saw 52,787 hip replacements, 68,466 knee replacements, and 8,733 shoulder replacements.
  3. As a result of COVID, some 19,500 people have not had a joint replacement that in normal times should have occurred. This was predominantly in the public sector, with a 14.9% reduction compared with 2019.

Implants that were implanted 10 years ago, still being used, have a 4.4% ten-year failure for hips, and 4.7% for knees.  Young patients under 55 having knee replacement are the biggest risk.

Various designs and surgical approaches have been advocated to improve results. Highly cross-linked polyethylene (XLPE) is a proven winner, but dual mobility, and constrained liners, have not improved outcomes for primary hip replacement.

Anterior surgical approach in the Australian Registry has a lower dislocation rate, but the overall revision rate not changed.  It seems currently any dislocation improvement is offset by an increased risk in fracture & loosening.  

Total hip replacement for fracture (instead of bipolar) has become more common, with a 10-year revision rate of 6.9% vs 5.3% for the bipolars.  That difference is obvious for the older patients over 70, but not very different for the younger ones.

Hip resurfacing in men, with a femoral head size of 50mm or greater still has a place.

Partial knee replacement has diminished to 5.6% of knee replacements, the robotic Restoris (Mako) doesn’t seem better than the ZUK, or Persona.

Some designs have been identified as having a higher-than-expected revision rate, fortunately we have not routinely used these.