Rehab Versus Surgery Evidence and Clinical Exam and MRI Findings

Few randomized trials exist. Hölmich's 1999 Lancet trial found active adductor strengthening beat passive therapy, with 79% returning to sport at the same level without pain, and Weir's trial reported return to play at 12.8 weeks. Reviews show both rehab and surgery can work, though entry criteria and terms differ so much that studies may not compare the same condition. The examination covers hip internal and external rotation, flexion to end range, FADDIR and FABER tests, a sacroiliac shear test, squeeze tests at 90, 45 and 0 degrees, resisted hip flexion for the rectus abdominis and anterior pubic ligament, palpation of adductor longus, the pubic aponeurosis and the inguinal rings, and the Thomas test. In Andy's cohort of 382 mostly Gaelic football players, 60% had pain above the pubic tubercle, which the Doha categories do not cover well, and many had overlapping findings. MRI showed hip morphology changes in almost half and bone marrow edema in over 60%. The same MRI finding may be reported as a pubic aponeurosis defect or adductor enthesopathy.