Milan, Marco Cesarini interview: “This is why groin pain is sneaky”

There are words that Milanello prefer not to use. One is the championship, another could undoubtedly be groin pain. Because crossing the threshold of that term is equivalent to a leap into the unknown. It’s a sneaky, disloyal, deceptive trouble. He takes his leave and introduces himself again. It unnerves you. Rafael Leao has been trying to figure out, for months now, how to solve it. So far without much success. Milan talks about “inflammation of the adductor”, but the gist doesn’t change. Groin pain, by its nature, always brings with it a long list of questions. We pass some of them on to Marco Cesarini, an osteopath with professional experience in Italy (Brescia, Bari, Milan, Sampdoria), England (West Ham, Watford, Fulham, Sheffield Utd), China (Henan), Turkey (Goztepe) and Arabia (Al-Shabab).

What are the triggers? Wear, posture, maybe a combination of patterns?

“Exactly: it is not a classic injury, it is a sum of factors. In fact, sometimes it is defined as a syndrome, that is, there is the presence of some conditions that cause pain in the same area. In that area there are muscles, tendons, joints, nerves. Often several elements are involved together. It is a juncture, difficult to approach. In the context of a normal injury you look for a precise point to work on. Depending on the degree of the injury you already know the prognosis, while with groin pain you don’t have a classic approach, you have to see the athlete at 360 degrees”.

What changes from the classic contracture-stretching?

“In these cases, as I was saying, you know where to intervene. Also because they are more frequent injuries and therefore easier to deal with. In pubalgia, some forms resolve in a couple of weeks, the player perhaps even plays with pain. Other times the pain is so debilitating that performances are drastically affected. Then a delicate psychological scenario also takes over: there are players who don’t want to make a bad impression, perhaps they are under pressure from a coach who is required to win. There are players who hide the problem so as not to fail in the game. And others who stop and get treatment as soon as the signs arrive. It’s a problem from this point of view too, not just from a strictly medical point of view. It’s a subtle problem because you find a player who arrives on the pitch and tells you that he’s fine.

And every time this happens, we need to stop.

“Be careful, however: sometimes it can be a mistake to stop the player completely. It is necessary to rehabilitate him progressively, under load, making him go on the pitch and always being careful not to exceed the critical threshold. To be clear: leaving him alone for a month at rest is not good. You have to manage the loads without stopping the activity. The difficulty is understanding the load that the player can bear at that moment. Also because at any moment he can fall back into the pathology.”

What are the treatment methods?

“I’ll give you three cases. I had a footballer with chronic groin pain, on whom we worked on the big toe joint because it was stiff and there wasn’t optimal mobility. A question of muscle chains that started from the foot and ended in the groin area. Another case was treated with a byte, to correct chewing: when you make an effort, you tend to grind, bite, and here too everything can reverberate in a chain up to the center of the body. Then there are classic therapies, i.e. rebalancing muscular decompensation, which is created due to the weakness of some muscle groups and overload”.

Previously you were talking about chronic pubalgia: what does it consist of?

“In reality it is a pathology considered chronic in itself. Let’s say that already beyond two weeks we are talking about chronicity.”

When is surgery worth it?

“It can be the solution in certain cases, even if sometimes it has happened that after the operation the footballer has not completely overcome the problem. The operation sometimes consists of strengthening the wall: two muscles are taken and joined together to provide greater resistance to loads. Other times a nerve is cut in the groin area to ‘switch it off’ completely, like a root canal tooth. I would like to underline that it is operated only when there is a precise and correct diagnosis, certainly not just to try. The real issue is that in football there is no there is time to wait, this becomes the problem, rather than the groin.”

How much progress has science made in approaching this pathology?

“Since there is a multifactorial cause it is not so easy to resort to technology, if anything it helps with load management. In general diagnostics have improved, but in terms of treatment there is no big news.”