Closing the gap on hip and groin pain

A photo of the course instructor Dr Andrea Mosler.

Closing the gap on hip and groin pain

A photo of the course instructor Dr Andrea Mosler.

Andrea Mosler explains the impact research can have in reducing the diagnostic challenges for clinicians when managing hip and groin pain in female athletes.

Dr Andrea Mosler FACP, FASMF, a Specialist Sports and Exercise Physiotherapist (as awarded by the Australian College of Physiotherapists in 2009), will share the latest research on hip and groin pain in the female athlete when delivering the keynote presentation at the 2024 Tasmanian Branch Symposium in May.

The research debunks a widely held narrative that only men experience groin pain. 

‘When you look at the actual epidemiology, women experience hip pain more than men and groin pain is only greater in men involved in specific sports. 

'It doesn’t mean it’s absent in women.’

The number of women participants in research studies is significantly lower than men, which could contribute to this narrative.

‘We don’t know as much about women in sport or women’s health issues generally. 

'So, this is an area where large gaps in knowledge and research need to be filled. 

'We do know that it is not just men who have groin pain.

‘The underlying theme of the keynote is how evidence-based practice can enhance outcomes for patients. 

'Participants can expect to hear an update of the current research, where the gaps are and how we have evolved our thinking and understanding on assessing, managing and preventing groin pain in athletes, with a particular emphasis on the female athlete.’

Andrea is a senior research fellow at La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, and an ACT-based clinician. 

Her work and clinical experience primarily focus on hip and groin pain, injury prevention, shoulder problems and women in sport research projects.

The clinician–researcher was drawn to the profession when, still in secondary school, she accompanied her mum to her physiotherapy appointment.

‘I was really enamoured with the role that the physio played in terms of changing her pain, making her feel confident to exercise and then assisting her to return to the things that she loved. 

'I thought what a great job to be able to work with people and help them in that way.’

Andrea’s career quickly evolved after she discovered that she could work as a physiotherapist with athletes and in sport. 

‘It pushed me along the lines of sports physiotherapy.’ 

While studying at the University of South Australia, she started working with Australian Rules football teams. 

‘I loved that ability to work within a team setting and help athletes achieve what they want to achieve and just being surrounded by sports.’ 

She graduated in 1988, then completed a Master of Applied Science in sports physiotherapy in 1994.

An 18-year stint at the Australian Institute of Sport (AIS) followed, with Andrea the first full-time female physiotherapist employed in a permanent role.

‘It was revolutionary at the time and I want to acknowledge the role that then-AIS head physiotherapist Craig Purdam (who retired from the AIS in 2017 after 35 years) played in trying to facilitate women working with elite sport. 

'The support and encouragement that he gave me throughout my clinical career is just outstanding.’

At the AIS, Andrea was sports medicine coordinator for the women’s national water polo team for seven years and a team physiotherapist with the water polo, gymnastics and rowing teams at many international sporting events, including the 2000, 2004 and 2008 Olympic Games and the 1998 Commonwealth Games. 

One highlight is the women’s water polo team winning Olympic gold in Sydney. 

‘I am still so proud of what they achieved.’

Andrea travelled with the national teams for 15 years and credits her time with the women’s water polo team with stimulating a desire to do more research after ‘dabbling with some projects at the AIS’.

‘I was starting to collect some injury epidemiology data and some injury burden data and wanted to understand correct research methodology. 

'The only way to do that was a PhD, so I contacted the clinician–researcher who I thought would best guide me—Professor Kay Crossley, Director of the La Trobe Sport and Exercise Medicine Research Centre. 

'Kay agreed to take me on as a PhD student in hip and groin pain.’

Andrea’s investigation into the relationship between the shape of the femur and the risk of developing hip and groin pain
was chosen on noticing an increasing awareness of femoral acetabular impingement syndrome. 

Her research was conducted on professional male football players after moving to Qatar in 2013 to become the senior physiotherapist at Aspetar Orthopaedic and Sports Medicine Hospital. 

She stayed for nearly five years.

‘While I have an interest in how groin pain is different between men and women, it was very difficult to conduct the research with women at that point in time as we didn’t have access to a large number of professional female football players. 

'More work will be done in this space.

‘In the five years that I was in Qatar, I followed the narrative in Australian sport. 

'When I came back, I could sense, see and experience a difference, which has just grown exponentially since. 

'It started with the professionalism of the Australian netball team—supporting players through pregnancy and post-pregnancy; followed by elite AFLW women athletes becoming professional; and culminated with Australia watching the Matildas.

‘The advent of and the growth in respect, love and admiration for women athletes is just so brilliant to see and it’s about bloody time.’

Straddling research and clinical work can be a ‘tricky balance’, Andrea says, and she would like to see the profession create a system that can better support clinician–researchers.

‘The current academic system is difficult in terms of the competitiveness for a part- time researcher, as is performing clinical work part-time… but to me, it’s the optimal balance for both because one’s research impacts one’s evidence-based practice and clinical practice helps drive impactful research questions.’

With more research to be done on and by women in sport, she encourages peers to consider sports physiotherapy. 

‘The world’s your oyster. Don’t limit yourself, get involved and be passionate, and be patient. 

'The opportunities will come to you if you’re open to them, but never force them, just do good work.’

Andrea’s key learning objectives for attendees:
•    understand the taxonomy and use current terminology and classification systems for hip and groin pain in women
•    discuss the aetiology of the musculoskeletal causes of hip and groin pain in women
•    identify the gaps in research with women as participants
•    apply the knowledge to improve outcomes for women athletes.

The Tasmanian Branch Symposium will be held on Saturday 18 May at the Royal Yacht Club of Tasmania in Hobart. Click here for more information and to register.


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