Australian Award - Can the Adductor Longus Transmit Force Across the Pubic Symphysis? Implications for the Pathophysiology of Athletic Groin Pain

Abstract

INTRODUCTION: Athletic groin pain (AGP) is a common injury in sports that involve repetitive sprinting, kicking and rapid twisting movements, and can often be of long-standing duration. Unfortunately, its pathogenesis is poorly understood at present. A more complete understanding of the biomechanical inter-relations among the anatomical structures commonly implicated in AGP is therefore required. METHODS: Force transfer across the pubic symphysis in eight cadaveric specimens was examined by simulating an adductor longus (AL) contraction and assessing elongation in the contra-lateral abdominal rectus sheath (RS). This was performed by applying a variety of controlled loads to the AL and measuring tissue strain in the contra-lateral distal RS using calibrated strain gauges. RESULTS: A Wilcoxon Signed Rank test was performed on the data, and it was observed that the RS underwent statistically significant elongation when load was applied to the contra-lateral AL. In addition, observations made during the anatomical dissection revealed that fibres of the AL tendon extended above its insertion into the pubic tubercle in multiple directions, including direct connections with the RS. DISCUSSION: The results of this study indicate that AL has the capacity to transmit force across the pubic symphysis. These findings have implications for the pathogenesis of the AGP. The presence of strong connections between the AL and RS would suggest that these tissues are likely to be subjected to high loads during athletic activities. Targeted strengthening exercises for these particular muscles might therefore be of importance in the rehabilitation of AGP.