Risk Factors for Athletic Pubalgia in Collegiate Football Student-Athletes: A Retrospective Cohort Study

Abstract

Background: Athletic pubalgia (AP) is an increasingly recognized injury among young athletes. This study aimed to evaluate the characteristics associated with AP in college football players.

Hypothesis: Repetitive explosive movements that require aggressive core muscle activation results in AP in collegiate football players.

Study design: Retrospective cohort design.

Level of evidence: Level 3.

Methods: Football student-athletes at a single Division I collegiate institution from January 2010 to December 2019 were included in the study. The primary outcome measure was surgery for AP. The odds of AP were determined using logistic regression, with the dependent variable being whether or not the student-athlete received AP surgery. Independent variables included Olympic weightlifting (OWL) exposure, primary playing position (skill position vs nonskill position), and body mass index (BMI).

Results: A total of 1154 total student-athlete exposures met the inclusion criteria. Of the 576 student-athletes exposed to OWL (OWL occurred throughout entire calendar year), 20 developed AP, whereas 7 student-athletes not exposed to OWL (OWL was not performed at any point during calendar year) developed AP. Student-athletes exposed to OWL had a 2.86 (95% CI, 1.25-7.35; P = 0.02) times higher odds of AP than players not exposed after controlling for primary playing position and BMI. Skill position players had a 9.32 (95% CI, 1.71-63.96; P = 0.01) times higher odds of AP than nonskill position players when controlling for BMI and OWL training.

Conclusion: Modifiable factors that increase exposure to repetitive explosive activities, such as OWL and playing a skill position, may be important considerations in developing AP.

Clinical relevance: The cause of AP is multifactorial and poorly understood. Identifying factors associated with AP informs athletes, athletic trainers, physicians, and coaches.

Keywords: Olympic weightlifting; athletic pubalgia; collegiate football; injury and prevention.

Figure 1.

Number of AP cases by year. Bar graph illustrating an increase in the number of AP cases in recent years. OWL was instituted in January 2015. AP, athletic pubalgia; OWL, Olympic weightlifting.

Figure 2.

Number of AP cases by position. Bar graph demonstrating the breakdown of AP cases by primary player position. Skill positions included quarterbacks, wide receivers, running backs, tight ends, linebackers, cornerbacks, and safeties. Nonskill position included offensive linemen, defensive linemen, and specialists (punters, kickers, and long snappers). AP, athletic pubalgia.