How Do You Treat Groin Pain in the Adult Patient in Your Practice?

INVESTIGATION OF POSSIBLE CAUSES

As always, I take a relevant history. In this case, I want to know about any new bulge in the groin and whether it is reducible with gentle pressure. I ask about restricted, painful movement at the hip, with a limp or difficulty walking, and I enquire about exercise and sporting activities. This gives me a clue concerning aspects of my clinical examination to concentrate on.

It is essential to exclude a hernia by careful palpation and a cough test, as this will influence the depth of needling. I treat hernia pain by “Surrounding the Dragon.” First reducing the hernia then, while keeping a finger over the hernial orifice, I insert short (15 mm) needles horizontally and superficially around my finger, thus ensuring that there is no chance of puncturing the bowel. I aim that these insertions should include one or more of the hernia points ST 29, ST 30, and SP 12. Occasionally, I will use electrostimulation at Han frequencies (alternating 2/100 Hz) to the needles across the orifice, stimulating release of opioid neurotransmitters and tightening up the local musculature. ¹

It may come as a surprise, but the change in normal walking movements resulting from an arthritic hip often activates trigger points in the adductor muscles of the leg, with consequent referred groin pain. A full examination of the hip is not really necessary, but I do simplified “range of movement” tests to act as a baseline.

TRIGGER POINTS IN MUSCLES

I search for the activated trigger points in the adductor longus and brevis by palpating for acutely tender spots superficially in the upper, inner thigh. They are usually to be found close to the acupuncture points LR 10 and LR 11. The adductor magnus is a deep muscle, so requires deep palpation to elicit the acute tenderness of its trigger points. The main one referring pain to the groin I generally find halfway down the medial aspect of the thigh, roughly at SP 11. ² It seems sensible also to treat the origin of the problem: the osteoarthritic hip. ³ So I use the longer, 40 mm needles around the hip itself, doing gentle periosteal tapping. ⁴

The pectineus muscle also has some adductor function, but its trigger points are less likely to be activated by an arthritic hip. Instead, they react to falls with the legs splayed, hip or gynecological surgery, and excessive adductor tension, as in horse riding or over-enthusiastic sexual activity. ⁵ The predominant active trigger point giving referred pain to the groin is easily found in the groin itself, and I’ve noticed often exhibits a strong twitch response on rolling the muscle fibers under my finger.

A less common cause of groin pain, sometimes found in fitness enthusiasts, is referral from activated trigger points in the lower abdominal muscles, notably the lower fibers of the external oblique. ⁶ These points are easily identified with the patient lying supine with a relaxed abdomen.

ACUPUNCTURE TREATMENT

My approach to deactivating trigger points is to needle directly into the acutely tender spot and manipulate the acupuncture needle by rotation to and fro for a few seconds at a time, leaving it in situ for a relatively short time (10 min) after which the tenderness is usually reduced or eliminated. ⁷ However, it may be necessary to repeat the process several times over a week or so. I also like to teach my patients how to find the trigger point and perform acupressure on it, so the deactivation process can continue between my acupuncture sessions and can be used immediately should there be a recurrence later.

Finally, I will have been aware from my initial examination of the groin and pelvic area if there is any testicular swelling or suspiciously enlarged lymph nodes that need further investigation and urgent referral to an appropriate expert.