Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial.

HYPOTHESIS: A multi-modal treatment program (MMT) is more effective than exercise therapy (ET) for the treatment of long-standing adductor-related groin pain.

STUDY DESIGN: Single blinded, prospective, randomised controlled trial.

PATIENTS: Athletes with pain at the proximal insertion of the adductor muscles on palpation and resisted adduction for at least two months.

INTERVENTIONS: ET: a home-based ET and a structured return to running program with instruction on three occasions from a sports physical therapist. MMT: Heat, Van den Akker manual therapy followed by stretching and a return to running program.

PRIMARY OUTCOME: time to return to full sports participation.

SECONDARY OUTCOME MEASURES: objective outcome score and the visual analogue pain score during sports activities. Outcome was assessed at 0, 6, 16 and 24 weeks.

RESULTS: Athletes who received MMT returned to sports quicker (12.8 weeks, SD 6.0) than athletes in the ET group (17.3 weeks, SD 4.4. p = 0.043). Only 50-55% of athletes in both groups made a full return to sports. There was no difference between the groups in objective outcome (p = 0.72) or VAS during sports (p = 0.12).

CONCLUSIONS: The multi-modal program resulted in a significantly quicker return to sports than ET plus return to running but neither treatment was very effective.