Integrating Focused Shockwave Therapy into Rehabilitation for Groin Pain Syndrome: A Prospective Study in Soccer Players

Background/Objectives: Groin pain syndrome (GPS) is a frequent and heterogeneous condition in athletes, often associated with persistent pain and functional limitation. Both focused extracorporeal shockwave therapy (f-ESWT) and exercise-based rehabilitation have been proposed as conservative treatment options, but evidence for their combined use in GPS remains limited. This prospective single-arm pilot study aimed to describe temporal changes in pain and function following a multimodal conservative program combining f-ESWT and structured rehabilitation in athletes with GPS, using validated groin-specific outcome measures. Methods: Thirty-one consecutive adult soccer players (mean age 28.4 ± 5.8 years; 77.4% male) with clinically and MRI-confirmed GPS underwent three weekly f-ESWT sessions (Duolith; 2400 pulses/session; 4 Hz; energy flux density 0.20 mJ/mm2) integrated within a supervised 16-week rehabilitation program (progressive adductor strengthening, core stabilization, and stretching). Outcomes were assessed at baseline (T0), 1 month (T1), and 4 months (T2): HAGOS (primary), VAS pain, and Roles and Maudsley (RM). Within-subject changes were analyzed using repeated-measures ANOVA with Bonferroni correction. Results: Statistically significant temporal changes were observed across all outcomes (all p < 0.001). HAGOSs changed from 47.23 ± 7.79 at T0 to 77.94 ± 16.18 at T1 and 90.00 ± 14.26 at T2 (partial η2 = 0.89). VAS decreased from 6.81 ± 1.25 to 3.68 ± 1.11 and 1.90 ± 1.45 (partial η2 = 0.91). RM decreased from 2.39 ± 0.50 to 1.52 ± 0.57 and 1.26 ± 0.63 (partial η2 = 0.72). No adverse events were reported. Conclusions: In this single-arm pilot study, the multimodal program combining f-ESWT and structured rehabilitation was associated with temporal changes in groin-specific function and pain that exceeded established MCID thresholds. However, in the absence of a control group, these findings are purely descriptive and hypothesis-generating. The observed changes cannot be attributed to f-ESWT specifically, as the 16-week rehabilitation program likely contributed substantially to the outcomes. These preliminary observations require confirmation through adequately powered randomized controlled trials comparing the combined intervention to rehabilitation alone.