Field hockey is a popular sport worldwide and played in more than 139 countries (International Hockey Federation). Injuries in field hockey ranked it the 3rd highest injury risk sport at the 2008 Olympics. The recent evidence shows that male field hockey players have a high prevalence and incidence of hip/groin pain. The in-season prevalence of hip/groin pain is 17% (non-time-loss: 11%, time loss: 6%). Hockey demands explosive movement, rapid directional changes, and intense lower-body engagement.  These movements place enormous stress on the adductor muscles, hip flexors, and core stabilizers making them prone to injury. Adductor strain, hip flexor strain, sports hernia and osteitis pubis constitute main burden of groin pain in hockey players.

Because of the complex anatomy, coexistence of multiple pathologies that can cause similar symptoms and multi factorial nature of injury, the evaluation and treatment of groin pain in hockey players is challenging. Moreover links between groin pain and lower extremity biomechanics are poorly represented in scientific literature. Despite the lack of an evidence base, the link between foot-ankle biomechanics, leg length inequality and pelvic instability is well documented. Within the clinical spectrum of groin injury, biomechanical optimization principles in footwear are frequently utilized to prevent, rehabilitate and manage groin pain. Footwear is the only form of player apparel that acts as a filter between the ground surface and the body. Shoe-surface interaction directly influences movement patterns of an athlete on a variety of surfaces (soft, hard, wet, dry and undulating).

For players with long-standing groin pain, the evidence for specific treatment options is unfortunately limited by poor research methodology. For adductor-related groin pain, it is pretty clear that passive treatments are often insufficient and a progressive increase in load is essential. Additionally, it seems that recent treatment programs have been able to reduce expected timelines from around 4-5 months to around 2-3 months. The return to play (RTP) decision is dependent on the level of risk the player accepts to tolerate. Knowing that the player and clinicians may have completely different re-injury risk assessments, it is key to have open discussions. While there are few high-quality studies on surgical treatment, current evidence does suggest that these approaches are generally successful specially when used in long standing non responsive cases. The clinician needs to have an understanding of the entity, focus on the biomechanical risks associated with groin pain from a lower extremity perspective and implement the role of podiatry as an effective adjunct to the multi-disciplinary groin management team.