An interventional study of A pain-guided rehabilitation program in Groin Pain, sponsored by University of West Attica. Enrolling by invitation at 1 site in Greece. Open to male participants aged 18 Years and older. Per ClinicalTrials.gov, last updated 2026-11-03.
Sponsored by University of West Attica · Not applicable, Interventional, and Treatment
Groin injuries are among the most common injuries in sports that require changes of directions, shooting, passing etc, and are presented both as acute and long-standing. Although there are many exercise-based rehabilitation programs for long-standing groin pain in athletes, there is still the need for a more flexible pain-guided program based on specific progression and return to sport criteria. In addition, there is no much focus on less demanding sports such as track and field. The current study introduces a pain-guided rehabilitation program for a long-distance runner with long-standing groin pain.
A 38-year-old male recreational runner reported pain in his right groin (adductor and lower abdomen area). The mean pain level reported was 2 in a numeric pain rating scale (NPRS) of 0-10, which occasionally increased to 3. Aggravating exercises included straight abdominal sit-ups, sliding hip exercise, and hip adductor squeeze at 45 degrees. In addition, symptoms were provoked by laughing and sexual intercourse. The initial onset of pain was nine years before the athlete contacted the research team seeking assistance (2017). Pain was resolved after two years (2019) of systematic resistance training, but reappeared five years later. The athlete did not report any specific mechanism of the initial injury, but described an insidious pain presented during an intense running period. Although the athlete had a number of physiotherapy sessions within the last year, including electrotherapeutic modalities (TENS, radiofrequency therapy) and massage, there was no improvement of the pain in the groin area. His weekly training schedule during the month before the clinical examination included one running session (10 km), one upper limb resistance training session, and one groin-specific resistance training session. The athlete reported no previous musculoskeletal injuries, while no radiological examination had been performed.
The program will comprise two distinct phases. Phase A will consist of a baseline monitoring period, during which the athlete will exclusively perform adductor strength testing without any exercise intervention. This phase will serve to establish a stable baseline strength level before the athlete starts the rehabilitation program. Transition to Phase B will be determined by the strength variance between sessions; if there is a difference of ≤ 10% across the first three sessions for each leg, the athlete will move to Phase B at the fourth week. Otherwise, further testing sessions will be needed before the athlete starts the program, provided that a difference of ≤ 10% is achieved across three consecutive testing sessions.
In phase B, the athlete will perform a pain-guided progressive rehabilitation program which comprises three distinct components: anterior chain, posterior chain, and functional training. Anterior chain includes exercises relevant to the groin (adductor muscles, hip flexor muscles, and trunk muscles), posterior chain exercises targeting muscle groups not related to the injured area (hip extensor and abductor muscles, knee extensor and flexor muscles, and ankle plantar flexor muscles), and functional exercises related to the sport (hopping and jumping and linear running). The athlete will be allowed to choose between a number of exercises for each muscle group included in anterior and posterior chain components. Weekly training frequency will vary between 3 to 6 sessions, including 3 anterior chain sessions, 2-3 posterior chain sessions, and 2-3 functional training sessions, depending on the athlete's availability. Once specific return to sport criteria are fulfilled (Appendix II), Phase B will be completed.
During the rehabilitation period, the athlete will not be allowed to participate in any other form of training outside the predefined protocol. Additional upper limb exercises and any therapeutic options will be allowed after discussion with the research team, provided they do not interfere with the rehabilitation protocol implementation.
Exercise progression
Anterior chain exercise progression will be determined by the pain level, while no pain will be allowed during posterior chain exercises. In exercises where pain is present, a "pain-controlled repetition maximum" (PRM) approach will be followed. The athlete will perform each set until failure keeping pain at 2/10. If pain is more than 2, the athlete will have to reduce the load. If pain is less than 2, the athlete will have to increase the load. If the athlete experiences pain > 2/10 longer than 24 hours after training, he will be advised to return to the previous training level until pain returns to normal. In exercises where pain is absent, a repetition maximum (RM) approach will be followed, during which the athlete will perform 8-10 repetitions keeping 3 repetitions in reserve (RIR) in each set.
The rehabilitation protocol will be performed as an unsupervised intervention, reflecting pragmatic clinical scenarios where recreational athletes lack access to clinical supervision due to financial or other constraints. However, adherence, exercise execution, or any difficulties during rehabilitation will be addressed during weekly meetings with the physiotherapist performing strength testing. During these meetings, the physiotherapist will ensure that exercises are executed with proper form and any queries by the athlete are answered. In addition, prior to initiation of the rehabilitation the athlete will be provided with documents including detailed exercise descriptions, ensuring understanding and proper execution.
10,054 studies on the registry are indexed under Pain; 1,649 are open to participants now.
This study's planned enrollment of 1 is below the median of 66 across 8,493 interventional studies indexed under Pain.
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Exclusion Criteria:
- Neurological or musculoskeletal condition which do not allow the athlete to perform the strength testing and the program intervention.
Other: A pain-guided rehabilitation program
A pain-guided unsupervised rehabilitation program
Return to sport time
The time to return to sport is defined as the total number of weeks recorded from the date of the first rehabilitation session to the day the athlete fulfils the return to sport criteria.
Time frame: Return to sport time is determined as the time (number of days) from the first rehabilitation session to the day the athlete fulfils the return to sport criteria. The estimated time of the rehabilitation completion is up to 12 weeks.
Adductor muscle strength
Maximum eccentric and isometric adductor muscle strength will be assessed with a mid-range unilateral supine isometric adduction test and an outer-range unilateral supine eccentric adduction test, following standardized procedures which have demonstrated good intra-tester reliability \[EHAD ICC 0.91 (0.70-0.98), SEM: 6.3%, IHAD ICC 0.78 (0.30-0.95), SEM: 7.3%\]. Strength values will be normalized to the athlete's body weight and recorded as Nm/kg.
Time frame: Eccentric and isometric adductor muscle strength will be tested on weekly basis from baseline to the completion of the treatment. The estimated number of testing sessions throughout the intervention is 12.
Tissue tolerance
Tissue tolerance is defined as the maximum adductor strength generated when the athlete reaches a pain level of 2/10 of the NPRS, and will be assessed with the use of a bilateral squeeze test at 0° of hip and knee flexion. Strength values will be normalized to the athlete's body weight and recorded as Nm/kg.
Time frame: Tissue tolerance will be evaluated on weekly basis from baseline to the completion of the treatment. The estimated number of testing sessions throughout the intervention is 12.
Hip-related quality of life
Hip-related quality of life will be evaluated with the use of the Greek version of the 12-item International Hip Outcome Tool (iHOT-12). The iHOT-12 is a validated tool which assesses domains including symptoms and functional limitations, sport and recreational activities, job-related concerns, and social, emotional, and lifestyle concerns. Hip-related quality of life will be evaluated baseline and at the completion of the rehabilitation with the use of the 12-item International Hip Outcome Tool (iHOT-12). Score range: 0-100, with higher scores indicating a better outcome.
Time frame: Hip-related quality of life will be evaluated baseline and at the end of the rehabilitation. The estimated time for the intervention completion is 12 weeks.
Athlete's recovery perception
Subjective overall recovery perception will be evaluated via the validated Greek version of the Global Perceived Effect (GPE) scale. Athlete's recovery perception will be evaluated on weekly basis until the completion of the rehabilitation with the use of the Global Perceived Effect (GPE) scale. Score range: -3 to 3, with higher scores indicating a better outcome.
Time frame: Subjective overall recovery perception will be evaluated on a weekly basis. Although the overall duration of the intervention cannot be defined due to the criteria-based nature of the progression, the estimated time for completion is 12 weeks.
PDFs hosted by the registry, ClinicalTrials.gov.
Plan to share: Yes — Strength raw data
Supporting information: Study protocol, Statistical analysis plan
Time frame: Beginning after study publication
Access criteria: IPD and supporting information (raw data) will be available after request from the lead author
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University of West Attica