Friday 23 December 2011

Gibbs and the curious case of footballer's groin

So Kieran Gibbs has had repeated surgery on this troublesome groin and will be out of action for at least another month, realistically a couple of months is likely.  He had initial 'hernia' surgery in October and was hoped to be back in action this Christmas, unfortunately he suffered a further setback in training recently, had a repeat scan and then the decision was made to go under the knife again.

Obviously it is tricky to speculate too much without knowing the details, but one can certainly say that the original surgery wasn't a success and in this context it is worth having a brief think about the interesting problem that is groin pain in high level athletes.

The painful groin in athletes is sometimes referred to as 'Gillmore's groin', Gillmore is the surgeon who originally described the so called 'sports hernia' and it has been a subject of intense debate ever since.  Arsenal players have been operated on by Gillmore on a number of occasions according to the surgeon's presentations:

                                                 OPERATION    P.A. (per annum)
1986 – 1996 (GRAHAM) 33           3
1997 – 2007 (WENGER)  10           1

The big problem with all of this is that the diagnosis of Gillmore's groin is highly contentious to say the least.  There are many diagnoses that may mimic the inguinal hernia which Gillmore treats, hip problems, muscle tendon tears, bony problems, referred pain from elsewhere and on and on.

The problem I have with Gillmore's groin is that the results seem too good to be true, and in medicine if something is too good to be true, then it probably isn't quite what some would have you believe it to be.  The results of surgery and amazing, success rates are in the high 90s percentage wise, failure is rare, as is recurrence.  The problem is I can see very little published on the long term outcomes of these patients, most are just followed up for a short period.  The other confounding factors are that surgery has a strong placebo effect and is always combined with rest afterwards, rest being an effective treatment in some cases of groin pain related to over use.

The sports hernia certainly exists and can certainly be treated fairly effectively with surgery, I won't argue with this, but I doubt the results are quite as good as they say on the tin, as it were.  The lack of long term data backs this viewpoint up.  I would also be very careful before assuming that groin pain is down to a sports hernia, it is a very subjective and tricky thing to diagnose, there is a certain 'eye of faith' at work here.  Modern imaging such as MRI scanning is also very subjective in its results and is so sensitive it will find lots of major abnormalities in asymptomatic sportsmen.

The bottom line in all this is that groin pain in the footballer or athlete is a tricky thing to manage, it is not easy to come to a precise diagnosis, the treatments are not as reliable as some would have you believe and the outcomes from surgery are not as well known as one would imagine.  Medicine is an art, despite the picture that some may paint in the media or on their own glossy websites, and I am just trying to get the inexact nature of this across with this article.  Good luck to Kieran Gibbs with his surgery and his recovery, I hope he makes it back to top form soon enough.

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