Initial Management of Groin Injury in Hypermobile Patients

Comprehensive Biopsychosocial Assessment

Conduct a biopsychosocial assessment that screens for generalized joint hypermobility using the Beighton score (≥5/9 in adults < 50 years), evaluates lower‑limb alignment, proprioception, pain patterns, activities of daily living, and motivation for self‑management. 1

Use the Beighton scoring system (five maneuvers, each side scored 0–1, maximum 9) to quantify generalized joint hypermobility; a score ≥ 5 confirms hypermobility and signals the need for tailored management. 1

Examine hip joint range of motion, strength, alignment, proprioception, and posture as part of the lower‑limb assessment. 1
Document skin findings such as hyperextensibility, easy bruising, or tissue fragility that may suggest an underlying connective‑tissue disorder. 2

Screen for systemic features of hypermobile Ehlers‑Danlos syndrome, including cardiovascular involvement (aortic root dilation in roughly 25‑33 % of cases), gastrointestinal involvement (present in up to 98 % of patients), and autonomic dysfunction such as POTS. Refer to genetics when systemic signs are identified. [2][3]

Low‑resistance exercise aimed at increasing muscle tone and joint stability is the cornerstone of treatment for hypermobile patients with groin injury. 3
Initiate neuromuscular re‑training that develops protective reflexes and strengthens surrounding musculature, progressing with “small amounts often” pacing over several months. 4
Emphasize sustained isometric strengthening of both lower limbs, focusing on quadriceps and proximal hip‑girdle muscles. 4
Incorporate myofascial release techniques to address muscular tension and imbalance. 3

Provide individualized education on the nature, causes, consequences, and prognosis of joint hypermobility in the context of groin injury. [1][4]
Link prescribed exercises to daily functional activities so they become integrated into the patient’s lifestyle rather than isolated tasks. 4

When not contraindicated, prescribe oral NSAIDs for symptomatic groin pain. [5][6]
Offer oral acetaminophen as an alternative when NSAIDs are unsuitable. [5][6]
Avoid opioid use for chronic pain, particularly in patients with gastrointestinal manifestations of connective‑tissue disorders. [2][3]

Develop an individualized management plan with defined short‑ and long‑term goals, intervention strategies, and scheduled reassessments to allow program adjustments. [1][4]
If pain and functional limitation persist after 6–8 weeks of appropriate physical therapy and activity modification, refer to sports‑medicine or orthopaedic specialists for further evaluation. 5
Continuously monitor for emergence of systemic symptoms that would warrant genetics referral or multidisciplinary team involvement. [2][3]

Do not dismiss groin pain as a simple muscle strain without first assessing for generalized joint hypermobility, as this can lead to repetitive injury and altered biomechanics elsewhere. [2][3]
Reserve invasive procedures or surgery for cases with secondary complications after exhaustive conservative management has been attempted. [2][3]
Remain vigilant for systemic manifestations that may indicate underlying Ehlers‑Danlos syndrome, especially vascular forms with high mortality risk. [2][3]
Recognize that asymptomatic hypermobility can become symptomatic over time; therefore, preventive strengthening is essential even when current symptoms are mild. [2][3]