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Pain down there? Common causes and treatment of groin pain

2 April 2024

Close-up of a triathlete in a red race suit with hands at the waist

Photo by Victoire Joncheray on Unsplash

In the vast majority of cases, groin pain results from a muscle strain or tear and usually resolves on its own. Athletes disproportionately experience groin pain due to their activity levels, with statistics suggesting prevalence rates between 0.5% and 28% amongst football players. But what actually causes groin pain in the first place?

There are several unique causes of groin pain; however, the most common cause is a muscle strain, also known as a pull groin muscle. This occurs when the hip joint is involved in an acquired movement that causes a stretch or tears to the inner thigh muscles. The pain experienced is usually sharp and sudden, with the source of it often apparent. Inner thigh muscle spasms and leg weakness may also occur.

Beyond muscle strain, the following are also common causes of groin pain:

Inguinal hernia. A condition where the fatty tissue of the intestine protrudes through the abdominal wall.
Kidney stone. A small clump of minerals will form inside the kidney, causing waves of pain as it passes down through the urinary tract.
Hip osteoarthritis arises when the smooth hip joint is worn down, causing leg movements to become painful and stiff.

Treating groin pain depends on what started it in the first place. In most instances, you may not need medical intervention; however, if the pain persists and impacts your daily activities, then get in touch.

When determining the best route of treatment, you will be asked when the pain started, what activities exacerbate the pain, and if you have experienced any accompanying symptoms. A full physical examination will then be performed, with imaging often being used as well.

There are five treatment approaches that may be taken, depending on the severity of the pain and your lifestyle:

Rest and recuperation. Although it seems repetitive with sports injuries, rest and ice are your best friends. Limiting your activities as much as possible for a short period of time can significantly speed up the healing process.
This approach solely offers short-term pain relief and has no significant impact on the healing process.
Physical therapy. Depending on the cause of the groin pain, you may be referred for physical therapy. For example, if your groin pain results from hip-related causes, such as hip osteoarthritis, then long-term physical therapy may be beneficial in managing flare ups. Moreover, certain exercises can help improve your range of motion and flexibility, further preventing further injuries.
This intervention is not always necessary and is only applicable in some serious conditions, including hip joint infections.
Regenerative medicine. Platelet rich plasma (PRP) is a novel treatment that has had great success in treating arthritic conditions, including hip osteoarthritis. We go into more detail on the process of PRP here. The benefits of PRP on hip function and pain have been shown to be superior to other options given the long-term duration of its effects.

At Opus, we pride ourselves on offering a range of treatments to our patients to ensure that the most appropriate route of recovery is selected. If you are experiencing persistent groin pain, we can provide you with the traditional routes of treatment but also the regenerative options, including PRP. Get in touch today to discuss the best option to get you back on your feet.

Debunking myths about PRP

20 March 2024

Woman holding her lower back with both hands

Photo by Kindel Media on Pexels

PRP is a minimally invasive outpatient procedure and can reduce pain, improve function and help you return to your normal activities or sporting pursuits. This novel approach, despite its success in clinical studies, is still surrounded by several myths. So, let’s debunk them.

1. PRP therapy requires surgery.

The plasma, the liquid where the platelets reside, is drawn from your body before being placed in a machine that separates the PRP from the rest of the blood. This PRP is then injected into the area of your body being treated. Once the platelets are in the target area, they will break down, releasing growth factors, important proteins that stimulate cell growth, differentiation, survival, inflammation, and tissue repair; collectively triggering your body’s healing process.

As you can see, PRP therapy does not require surgery, solely injections. In most instances, real-time imaging will also be used to guide us and ensure that the PRP is injected directly at the site of your injured tissues.

2. PRP is only good for pain relief.

Although PRP is generally used in patients with chronic pain conditions, there are so many additional benefits that this treatment will present beyond pain relief. This includes reduced inflammation, the recruitment of stem cells to the area triggering new tissue production, stimulation of blood vessel growth, and the degeneration prevention of healthy tissues. These benefits combine to speed up tissue regeneration and healing, relieving your pain. This is especially beneficial for athletes who are looking to get back on their feet as soon as possible.

3. PRP is a highly risky procedure.

Given that PRP therapy relies solely on injections, the procedure itself is deemed exceptionally safe. For starters, the plasma injected is autologous, meaning that it is made for your own blood, and you do not need to worry about potential negative reactions or side effects. What’s more, PRP therapy has been used for several years now, with no major complications being reported.

One study, in particular, investigated the clinical application and safety of PRP therapy for patients with patellar tendinopathy, a condition that causes chronic back pain. One of the key points the researchers noted, besides the remarkable improvement in back pain, was the safety of PRP and that no complications or side effects were seen across all 15 clinical studies included.

Considering PRP therapy but don’t know where to start? Or have more questions that you need answering? Get in touch with our team to discuss your options and how we can help relieve your pain.

Can regenerative medicine help with back pain?

4 March 2024

Golfer in a red top holding their lower back with gloved hands

Photo by Gordon Cowie on Unsplash

Back pain is a silent problem amongst the general population, with figures suggesting that approximately 1 in 6 people are experiencing back pain at any given time in England. What’s more, back pain is deemed the largest single cause of disability across the UK. But why is this? And why are the numerous treatments available not bringing these numbers down?

Most cases of back pain are caused by muscle and ligament strains and, in the vast majority of cases, cannot be avoided. However, there are several other causes of back pain, including sciatica, a slipped disc, and ankylosing spondylitis, that can often occur spontaneously and without trauma. Then, we move to treatments. For the most part, treatments of back pain focus on rehabilitation and pain management, which, although great in getting you back on your feet, does not always treat the underlying cause and prevent further injury. Sports medicine is a great option to educate you on preventative measures; however, regenerative medicine offers more long-term symptom relief.

The role of regenerative medicine

Let’s first consider platelet rich plasma (PRP) injections. For those experiencing repetitive and debilitating back pain, surgery is usually the last option you want to take; however, PRP offers an effective alternative that could treat the pain of your injury as well as prevent further strains. Depending on the root of your back pain, PRP can be injected into the discs, facet joints, and paraspinal muscle, with previous patients seeing an improvement in their symptoms within six weeks of their first treatment. In clinical studies, PRP injections have been used to treat patients with degenerative disc disease, join-related pain, and pain or functional decline caused by facet joint arthropathy.

Mesenchymal stem cell therapy, on the other hand, has shown great success in patients with chronic discogenic low back pain. This type of pain is caused by chemically or mechanically damaged discs in the back and is often caused by trauma. However, this pain also arises due to deterioration as a result of ageing. Stem cell therapy is deemed a valid alternative treatment for back pain caused by disc disease, with one study demonstrating treatment success in over 90% of patients. This success is down to the regenerative impact of stem cells and their ability to differentiate into cartilage at the site of injury.

The key distinction between Opus and other private clinics in the UK is that we are the only institution that offers a regulated and licenced mesenchymal stem cell treatment. Get in touch with our team to discuss how we can support you in your treatment journey using either our world renowned sports medicine specialists or regenerative medicine.

Platelet rich plasma: The scientific evidence

17 February 2024

Physiotherapist stretching a patient's leg on a treatment couch

We have already had a look at how platelet rich plasma (PRP) works (if you haven’t had a chance to read this yet, you can find it here), but now we are going to dive more deeply into the scientific evidence behind this treatment.

Randomised controlled trials (RCTs) are the gold standard study for determining if one treatment offers superior benefits over another. In these trials, patients are randomly assigned to either receive the treatment of interest or an alternative treatment, usually the standard of care or a placebo. Moreover, the patients are ‘blind’ to what treatment they are receiving. Here, we are going to look at two RCTs that investigated the use of PRP to treat knee osteoarthritis and chronic tennis elbow.

Knee osteoarthritis

A study by Bansal et al. (2021) investigated the optimal dose and concentration of therapeutic PRP required to achieve the desired physiologic efficacy. One hundred and fifty patients were enrolled in this trial, with then being randomised to either receive PRP or hyaluronic acid for their knee osteoarthritis.

The results revealed a significant improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), International Knee Documentation Committee (IKDC) score*, and six-minute pain free walking distance. Besides external improvements, this trial also noted a significant decline in IL-6 and TNF-a levels in the PRP group when compared to the hyaluronic acid group at six months, both of which assist in mediating an inflammatory state (Bansal et al., 2021). If you would like to read more about the role of these cytokines in osteoarthritis, we have an additional blog post discussing just that.

Collectively, this trial, along with several others, demonstrate the efficacy of PRP, specifically with an absolute count of ten billion platelets, in achieving a long sustained chondroprotective effective in arthritis.

*The WOMAC represents an osteoarthritis index and measures a patients’ physical function, pain, and stiffness over a 48 hour period. The IKDC, on the other hand, gives an indication of a patients’ condition, containing questions on knee symptoms, overall function, and sports activities. The scoring system ranges from zero to one hundred, with zero representing the lowest level of function and the highest level of symptoms.

Chronic tennis elbow

A study by Mishra et al. (2014) evaluated the clinical value of tendon needling with PRP in 230 patients with chronic tennis elbow compared with an active control group. Patient outcomes were followed for up to 24 weeks, with the findings revealing several beneficial results at this mark. In those treated with PRP, a significant improvement of 71.5% was observed in their pain scores. Moreover, the percentage of patients reporting significant elbow tenderness notably decreased over this time. This demonstrates the clinical efficacy of PRP in the treatment of chronic tennis elbow on a larger scale (Mishra et al., 2014).

References

Bansal, H., Leon, J., Pont, J. L., Wilson, D. A., Bansal, A., Agarwal, D. & Preoteasa, I. 2021. Platelet-rich plasma (PRP) in osteoarthritis (OA) knee: Correct dose critical for long term clinical efficacy. Scientific Reports, 11, 3971. Mishra, A. K., Skrepnik, N. V., Edwards, S. G., Jones, G. L., Sampson, S., Vermillion, D. A., Ramsey, M. L., Karli, D. C. & Rettig, A. C. 2014. Efficacy of platelet-rich plasma for chronic tennis elbow: a double-blind, prospective, multicenter, randomized controlled trial of 230 patients. Am J Sports Med, 42, 463-71.

Platelet rich plasma injections for tendonitis

17 February 2024

Clinician in gloves giving an injection into a patient's upper arm

Platelet rich plasma treatment(PRP)
represents a promising approach to therapy for a range of conditions, including torn tendons, arthritis, muscle injuries, and tendonitis. We have already looked at the process of PRP and the underlying scientific evidence in our previous posts. Now, we are going to look specifically at the use of PRP in the treatment of tendonitis. But first, what is tendonitis, and how does it affect a person?

Tendonitis is a term used to define inflammation and pain following a tendon injury. This usually causes significant pain, stiffness and alters how the tendon can move. The most common areas that are affected by tendonitis are the rotator cuff, the elbow, and the Achilles tendon, with an overall prevalence of an estimated 11.6% in the general population. Although most cases of tendonitis resolve themselves within two to three weeks with relative rest of the area, icing, and strengthening exercises, a number of cases require medical intervention if they persist.

PRP therapy for tendonitis generally involves three injections, given at two to three week intervals; however, in certain cases, further injections may be needed to complete your journey. But do not worry; our doctors at Opus will discuss this and the treatment protocol with you throughout the process. The procedure itself follows three stages:

The plasma, the liquid where the platelets reside, is drawn from your body through the blood.
This is then placed in a machine to separate the PRP from the rest of your blood.
The PRP is then injected into the area where you are experiencing tendonitis.

Once the platelets are in the target area, they will break down, releasing growth factors. These growth factors are the pivotal component of PRP and are the reason that this treatment has shown great promise in conditions such as tendonitis. Growth factors are important proteins that stimulate cell growth, differentiation, survival, inflammation, and tissue repair; collectively, triggering your body’s healing process. Specifically, in the treatment of tendonitis, growth factors play an important role in the tendon healing process. Not only are they directly involved in tendon tissue engineering, but they have also been shown to stimulate the action of mesenchymal stem cells. To understand the role of these stem cells in regenerative medicine, we discuss them in more detail here.

If you or someone you know are suffering from tendonitis, book an appointment today to speak to one of our team at Opus on the next steps to reduce your pain and improve your everyday function.

Antibodies and the Immune System

20 December 2023

Vial labelled COVID-19 vaccine on a pink and blue background

Photo by Artem Podrez from Pexels

We have already looked at the role of antibody testing in the fight against COVID-19; however, there was just too much information to discuss in one post. Therefore, this post is aimed at diving into a bit more detail on antibody testing for SARS-CoV-2 and looking at misconceptions surrounding this.

When taking an antibody test, we are looking for anti-SARS-CoV-2 antibodies, which can be found in your blood as early as ten days after experiencing COVID-19 symptoms. Therefore, not only is antibody testing useful on its own, when combined with PCR testing, these detection methods minimise the likelihood of receiving a false-negative test. Moreover, antibody tests for SARS-CoV-2 are based primarily on the detection of antibodies against specific proteins. But, what does this mean? The novel coronavirus has four main structural proteins, the nucleocapsid (N), the spike (S), the membrane (M), and the envelope (E), as seen in the image below. However, antibody testing solely focuses on the detection of the S protein, consisting of S1 and S2 subunits, and the N protein, as these are the main immunogens of this virus.

The S protein of SARS-CoV-2 is located on the surface of the virus and is highly immunogenic. Each subunit of this protein plays a different role, with the S1 protein containing the receptor binding domain, a key target of neutralising antibodies. The N protein, on the other hand, plays a crucial role in the replication of viral RNA, enabling the virus to survive in our system. Its role in transcription enables the virus’s genome to be packaged into virions and also inhibits the cell cycle process of our cells. During infections, the N protein is vastly expressed and possesses high immunogenic activity.

Labelled diagram of the SARS-CoV-2 virus showing the spike, matrix, nucleocapsid and envelope proteins binding to a host cell

Image taken from: https://www.invivogen.com/covid-19-related-genes

Although antibody testing is focused on detecting antibodies against either the S or N protein of SARS-CoV-2, it has been recommended that a testing method that detects antibodies against both proteins be used to gain the most accurate results. This method has been adopted across the UK, and the antibody testing at Opus is no exception to this.

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Pain down there? Common causes and treatment of groin pain

Photo by Victoire Joncheray on Unsplash