Summary

Olympic weightlifting and playing a skilled position are strongly associated with the development of athletic pubalgia in collegiate football players.

Abstract

Background

Athletic pubalgia is a common injury among student-athletes. The cause of this injury is multifactorial and poorly understood and has been associated with repetitive explosive movements that cumulatively injure the groin and surrounding tissues. Therefore, the aim of this study was to evaluate the effect of Olympic weightlifting, body mass index and position type (skilled vs non-skilled) in collegiate football players with respect to development of athletic pubalgia.

Hypothesis

The introduction of Olympic weightlifting and playing a skilled position will significantly increase a student-athlete’s risk of developing athletic pubalgia.

Methods

Football student-athletes at a single collegiate institution from January 2010 to December 2019 were included in the study. The primary outcome measure was athletic pubalgia surgery confirmed with magnetic resonance imaging. Odds of athletic pubalgia was determined using logistic regression with the dependent variable being whether or not the student-athlete received athletic pubalgia surgery. Independent variables included Olympic weightlifting exposure, skilled vs. non-skilled position and body mass index. Skilled positions were defined as quarterbacks, wide receivers, running backs, tight ends, linebackers, cornerbacks, and safeties, with these positions being subject to a high volume of running, cutting, and rapid change of direction. Non-skilled positions were defined as offensive linemen, defensive linemen, and specialists (punters, kickers, and long snappers), with these positions being subject to a low volume of running, cutting, and rapid change of direction. Olympic weightlifting exposure occurred suddenly in January of 2015 when Olympic weightlifting was implemented in the weight training regimen where it was not previously present, therefore all student-athletes on the 2015 roster and later were deemed positive exposures. Previous core muscle injury or athletic pubalgia surgery excluded student-athletes from the study.

Results

A total of 1,154 student-athlete exposures met inclusion criteria, defined as any male football student-athlete who was listed on the active program roster and participated in football team activities from the 2010 through 2019 seasons. Of the 576 student-athlete exposures to Olympic weightlifting, 20 developed athletic pubalgia, whereas 7 student-athletes not exposed to Olympic weightlifting developed athletic pubalgia. Student-athletes exposed to Olympic weightlifting had a 2.86 (95% CI, 1.25-7.35; p=.018) times higher odds of developing athletic pubalgia as compared to those not exposed. Skilled position players had a 9.32 (95% CI, 1.71-63.96; p=.014) times higher odds of being diagnosed with athletic pubalgia compared to non-skilled position players. Body mass index was not associated with a significant risk for developing athletic pubalgia.

Conclusion

Olympic weightlifting and playing a skilled position are strongly associated with the development of athletic pubalgia in collegiate football players. Skilled position players may benefit from modified training regimens to decrease this risk.