SYNOPSIS: Pubic-related groin pain is one of the least common clinical entities of groin pain in athletes. However, it can cause persistent and long-standing pain. In this Viewpoint, we summarize the current state of knowledge regarding terminology, underlying pathology and diagnosis, and imaging findings for pubic-related groin pain. We share new perspectives on the clinical presentation, sex-related differences, examination, the role of diagnostic imaging, and how examination findings may direct management. J Orthop Sports Phys Ther 2026;56(7):376-381. Epub 12 February 2026. doi:10.2519/jospt.2026.13827.

OBJECTIVES: The primary aim was to assess the radiographic features of the pubic symphysis in elite female football players. The secondary aim was to explore associations between radiographic findings and groin complaints. DESIGN: Cross-sectional study. METHODS: This was a multicenter study of 100 elite female football players from three Dutch professional clubs. Players completed questionnaires (including Hip and Groin Outcome Score) and had clinical assessments (including palpation and squeeze tests) and radiographic imaging. Skeletal maturity was graded using the Maturing Adolescent Pubic Symphysis (MAPS) classification. Five radiographic pubic symphysis findings were evaluated using the Aspetar protocol. Players were classified as having groin complaints if player-reported complaints and positive clinical findings from the symphyseal and/or adductor region were present. RESULTS: MAPS stages increased with age. In 23% (7 of 30) of otherwise skeletally mature players, the pubic symphysis was immature, including players up to age 27 years. Sixty-nine (69%) players had 1 or more radiographic findings. The most prevalent findings were bony proliferations (49%) and sclerosis (47%). Fifteen of the 100 players had groin complaints. No differences were found in number or type of radiographic findings in those with and without groin complaints. Fifty-eight players (68% of 85) without complaints (vs. 11 [73% of 15] with complaints) had at least one Aspetar protocol finding. CONCLUSION: Radiographic findings of the pubic symphysis were common in female football players and appeared irrespective of groin complaints. Nearly one quarter of otherwise skeletally mature young adult players were not fully mature at the pubic symphysis. J Orthop Sports Phys Ther 2026;56(7):448-455. Epub 4 May 2026. doi:10.2519/jospt.2026.13580.

OBJECTIVE: To evaluate the reporting quality and exercise characteristics of exercise-based rehabilitation programs for athletes with long-standing groin pain. DESIGN: Scoping review. LITERATURE SEARCH: We searched the Scopus, Cochrane Library, PubMed, and Google Scholar databases in March 2025. STUDY SELECTION CRITERIA: We included original research studies on exercise-based rehabilitation programs for athletes (≥18 years) with long-standing groin pain. DATA SYNTHESIS: Reporting quality was evaluated according to Consensus on Exercise Reporting Template (CERT) (score range of 0-19) and Fundamental Resistance Exercise Descriptors (FRED) (score range of 0-13) recommendations. Intervention content was extracted. RESULTS: Twenty-two reports were included. Four reports used the same rehabilitation protocol and were considered as 1 study. According to the CERT, 3 studies had moderate and 16 studies had low reporting quality. The mean CERT score was 7.7 (SD, ±4.3; range, 1-14), and the mean FRED score was 3.7 (SD, ±1.8; range, 0-7). The CERT items reported by most studies were whether exercises were generic or tailored (89%), the setting (68%), and whether there were nonexercise components (68%). The FRED items reported by most studies were the repetition and set number (73%), the session number per day/week (73%), and the program duration (63%). CONCLUSION: The quality of reporting in the rehabilitation of long-standing groin pain was generally poor and should be improved to help with replication in future research and clinical practice. Most protocols included exercises targeting the injured and uninjured structures, tending toward a more general exercise prescription for rehabilitation of long-standing groin pain in athletes. J Orthop Sports Phys Ther 2026;56(7):427-447. Epub 19 May 2026. doi:10.2519/jospt.2026.13708.

This infographic is based on the JOSPT article Understanding Adult Hip Dysplasia: Clinical Presentation, Assessment Techniques and Exercise-Driven Management Strategies. It provides a visual summary of three key clinical questions related to adult hip dysplasia: What is it? How should it be assessed? What should clinicians look out for and treat? The infographic highlights key features of acetabular undercoverage, important findings from clinical examination and imaging, and considerations for rehabilitation and surgical referral. Its purpose is to support clinicians in recognizing hip dysplasia as a potential source of hip pain and instability and to facilitate informed clinical decision-making. J Orthop Sports Phys Ther 2026;56(7):472. doi:10.2519/jospt.2026.9003.

BACKGROUND: Hip dysplasia is a common cause of hip-related pain in young adults. Hip dysplasia is frequently overlooked by clinicians, leading to delayed diagnosis and subsequent adverse outcomes, including debilitating pain, functional impairments, and poor quality of life. Diagnosing hip dysplasia is often challenging due to its variable clinical presentation, its overlap with other conditions, and the absence of standard diagnostic criteria. Despite these challenges, an emerging body of research provides valuable insight into the management of hip dysplasia. CLINICAL QUESTION: How can new and existing evidence on hip dysplasia be synthesized to support clinicians in understanding its etiopathogenesis and diagnostic approaches-including both imaging and clinical evaluation-and in improving management strategies to enable timely diagnosis and treatment of this common condition? KEY FINDINGS: Hip dysplasia presents with variable symptoms and commonly coexists with other musculoskeletal conditions. Clinical examinations should include assessment of generalized joint hypermobility, hip range of motion, symptom-reproducing tests, and extra-articular structures. Imaging remains essential but must be interpreted in the clinical context. Evidence for non-surgical management, including exercise and education, is emerging but remains limited. CLINICAL APPLICATION: Clinicians should adopt a comprehensive and structured assessment approach that integrates patient history, physical examination, and imaging findings. Awareness of coexisting conditions and alternative pain sources is critical. Early recognition may facilitate timely referral and appropriate management. In the absence of strong condition-specific evidence, clinicians should combine available research with clinical reasoning and consider outcomes beyond pain, including quality of life, physical function, and participation. J Orthop Sports Phys Ther 2026;56(7):382-398. Epub 9 April 2026. doi:10.2519/jospt.2026.13860.

OBJECTIVE: To explore associations between hip muscle strength and symptom severity in individuals with femoroacetabular impingement (FAI) syndrome. DESIGN: Cross-sectional study. METHODS: Baseline data from 150 participants with FAI syndrome who participated in a clinical trial were analyzed. Hip abduction, adduction, flexion, extension, internal rotation, and external rotation muscle strength assessments were performed using a handheld dynamometer. Symptom severity was assessed using the International Hip Outcome Tool-33 Symptoms subscale (iHOT-Symptoms). Linear and nonlinear associations were explored using generalized linear models. RESULTS: Nonlinear associations (spline) between hip muscle strength values and iHOT-Symptoms scores were observed. Lower hip flexion (average marginal effect [AME] = 0.25, 95% confidence interval [CI] [0.12, 0.39]), abduction (AME = 0.25, 95% CI [0.11, 0.40]), and adduction (AME = 0.29, 95% CI [0.11, 0.47]) muscle strength values were associated with worse iHOT-Symptoms scores. Greater hip muscle strength was not associated with better iHOT-Symptoms scores. Hip external rotation (AME = 0.10, 95% CI [-0.01, 0.20]), internal rotation (AME = 0.10, 95% CI [0.01, 0.19]), and extension (AME = 0.02, 95% CI [-0.02, 0.07]) muscle strength values were not meaningfully associated with iHOT-Symptoms scores. CONCLUSION: Reduced hip flexion, abduction, and adduction muscle strength were associated with worse symptoms in patients with FAI syndrome, but only in individuals with hip muscle weakness. Hip external rotation, internal rotation, and extension muscle strength were not associated with symptom severity. J Orthop Sports Phys Ther 2026;56(7):465-471. Epub 2 March 2026. doi:10.2519/jospt.2026.13674.

OBJECTIVE: To evaluate a 3-month post-hip arthroscopy rehabilitation program within a randomized controlled trial comparing hip arthroscopy to sham surgery for femoroacetabular impingement syndrome (HIP ARThroscopy International [HIPARTI] trial) by describing exercise adherence, type, and pain; 6-month changes in International Hip Outcome Tool-33 (iHOT-33); and physical impairments and functional performance. DESIGN: Exploratory cohort study nested in a pilot randomized controlled trial. METHODS: Participants aged 18 to 50 years with femoroacetabular impingement syndrome completed a 3-month, physical therapist-led, postsurgical rehabilitation program, self-reporting rehabilitation adherence and pain levels on the visual analog scale using weekly training diaries. Baseline to 6-month changes in quality of life (iHOT-33), physical impairment (hip strength, range of motion [ROM]), and functional performance (single-leg hop, side bridge endurance) were reported as mean (standard deviation). RESULTS: Twenty-nine people (37% female, 29.9 ± 7.9 years) participated. Hip extension, abduction, and functional exercises were performed most often. Exercise adherence analysis was limited by underreporting. Training diary data adequate to assess adherence were available for 20 participants (69%). Among those with available data, 16 (80%) met the predefined adherence target of ≥2 sessions per week, and average pain remained acceptable (<2 visual analog scale); iHOT-33 (+18.6 ± 22.5; 95% confidence interval: 10.2, 27.0) and hip flexion ROM (+6°; 95% confidence interval: 2.14, 9.60) improved significantly. Hip extension, adduction, external and internal rotation strength improvements exceeded the minimal detectable change, although they were not significant. CONCLUSION: Adherence was generally high among participants with available data, though limited by underreporting. Hip-related quality of life (iHOT-33) improved despite limited changes in physical impairments, and no improvement in functional performance. J Orthop Sports Phys Ther 2026;56(7):456-464. Epub 23 April 2026. doi:10.2519/jospt.2026.13775.

BACKGROUND: While hip osteoarthritis (OA) typically affects older adults, its prevalence in young adults is growing. Hip OA exists on a continuum; the early stages may be when treatments (surgical or nonsurgical) have the greatest chance of slowing or changing its trajectory. Most research and clinical interest have centered on early-stage symptomatic knee OA, with several global initiatives in place to improve diagnosis, classification, and treatment. Early-stage symptomatic hip OA has not had adequate attention. Clinicians and patients often do not recognize the condition or understand when and how to provide effective treatment. CLINICAL QUESTIONS: Why is it important to identify early-stage symptomatic hip OA? What are the benefits and challenges of developing classification criteria? Which candidate features should inform future consensus-based classification? What evidence exists regarding its development, trajectory, clinical and imaging characteristics, and management? KEY RESULTS: We propose candidate symptom, clinical, and imaging (radiographic and magnetic resonance imaging) criteria to stimulate clinical and research interest and to support future initiatives. Mechanical factors are implicated in the development and progression of early-stage symptomatic hip OA. A major clinical challenge is differentiating imaging findings indicative of symptomatic disease from normal age-related variation or incidental changes. Surgical and nonsurgical treatments may be appropriate for early-stage symptomatic hip OA. CLINICAL APPLICATION: Clinicians should consider early-stage symptomatic hip OA in patients with hip pain. While evidence specific to this stage of OA is still evolving, familiarity with its trajectory, key clinical and imaging findings, and factors associated with its development may improve early recognition and guide management decisions. J Orthop Sports Phys Ther 2026;56(7):399-412. Epub 26 May 2026. doi:10.2519/jospt.2026.14223.

OBJECTIVE: To describe the lived experiences and health care perspectives of people with femoroacetabular impingement (FAI) syndrome to help guide patient-centered care. DESIGN: Preregistered (CRD42024581726) systematic review of qualitative studies followed the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statements. LITERATURE SEARCH: Embase, CINAHL, MEDLINE, PsycINFO, and Cochrane Library were searched from inception to June 24, 2024, using key subject and free-text terms, updated on November 8, 2024. STUDY SELECTION CRITERIA: We included English-language qualitative and mixed-methods studies that explored the experiences, beliefs, attitudes, perspectives, and/or needs of individuals aged ≥12 years with FAI syndrome. Studies with ≥5 participants were included; there were no publication date restrictions. We used the Critical Appraisal Skills Program (CASP) qualitative and mixed-methods checklist to assess methodological quality. DATA SYNTHESIS: We conducted a hybrid framework and thematic synthesis using the Common-Sense Model of Self-Regulation. Certainty of findings was assessed using the Grading of Recommendations Assessment, Development and Evaluation - Confidence in the Evidence from Reviews of Qualitative Research (GRADE-CERQual) framework. RESULTS: Eight studies (4 qualitative, 4 mixed-methods) with 409 participants were included. Four key themes were identified: (1) physical and psychosocial effects of FAI syndrome and its care, (2) preference for surgery based on pathoanatomical and biomechanical beliefs, (3) unmet needs and expectations, and (4) varied perceptions of physical therapy. CONCLUSION: This review highlighted the physical and psychosocial impacts of FAI syndrome. Patient education and support may be valuable to set realistic treatment expectations and improve surgical and nonsurgical treatment outcomes. J Orthop Sports Phys Ther 2026;56(7):413-426. Epub 7 October 2025. doi:10.2519/jospt.2025.13404.

SYNOPSIS: This focused issue of JOSPT highlights emerging research in hip and groin pain, with particular emphasis on amplifying the contributions of early career researchers who often face significant barriers to recognition and funding in a competitive academic landscape. The issue encompasses a range of conditions including pubic-related groin pain, hip dysplasia, and femoroacetabular impingement syndrome (FAIS), addressed through diverse methodologies spanning viewpoints, reviews, and rehabilitation trials. Notable contributions examine rehabilitation strategies for long-standing groin pain, diagnostic and treatment pathways for hip dysplasia, muscle function impairments in patients with FAIS, postsurgical recovery outcomes, and early-stage hip osteoarthritis. While large-scale randomized controlled trials remain forthcoming, the work collected in this focused issue reflects an active and evolving field. The issue also prioritizes inclusive authorship, with a focus on broad representation across sex, professional discipline, and international geography. J Orthop Sports Phys Ther 2026;56(7):374-375. Epub 3 Jun 2026. doi:10.2519/jospt.2026.14485.

Correction to an article that was published in the October 2025 issue of JOSPT: Giovannico G, Cioeta M, Giannotta G, Bargeri S, Brindisino F, Pellicciari L. Efficacy of Spine High-Velocity Low-Amplitude Thrust Manipulations in Patients With Radiculopathy: A Systematic Review With Meta-Analysis. J Orthop Sports Phys Ther 2026;56(6):373. doi:10.2519/jospt.2026.56.6.373.

OBJECTIVE: To (1) describe the course of disabling musculoskeletal pain in children and adolescents in an 18-month follow-up, and (2) develop a prediction model to identify those most likely to recover. DESIGN: Prospective cohort study. METHODS: We recruited children and adolescents with disabling musculoskeletal pain from schools in Brazil. We collected information about sociodemographic characteristics and biopsychosocial variables. Recovery and recurrence were reported as frequencies and percentages over time. Prediction models were developed through logistic mixed models with candidate variables selected using a theoretical model. We measured the performance of the model and the internal validity. RESULTS: We included 694 children and adolescents with a mean age of 12.2 years (standard deviation, 2.7). Of those, 85.9% (95% confidence interval [CI]: 82.8, 88.6) recovered from disabling pain. From those who recovered, 31.7% (95% CI: 27.6, 36) suffered a recurrence. The prediction model identified cases of recovery from disabling musculoskeletal pain, with an area under the curve of 84.1% (95% CI: 79.8, 87.8), an accuracy of 0.55 (95% CI: 0.51, 0.58), and a sensitivity of 0.72 (95% CI: 0.67, 0.78). The model was assertive in 6 out of every 10 positive cases based on the positive predictive value. CONCLUSION: Up to 9 in every 10 children recovered from pain, and pain recurrence was common. The prediction model tested was adequate to identify children and adolescents who were more likely to recover from disabling musculoskeletal pain. J Orthop Sports Phys Ther 2026;56(6):359-369. Epub 27 March 2026. doi:10.2519/jospt.2026.13817.

This infographic summarises the key messages of Serighelli's et al. article on hip crepitus in sub-elite football (soccer) players. J Orthop Sports Phys Ther 2026;56(6):370. doi:10.2519/jospt.2026.9002.

SYNOPSIS: Decades of research have not identified a consistently superior treatment for musculoskeletal (MSK) pain conditions. Across trials, interventions such as exercise therapy and manual techniques demonstrate modest, broadly equivalent average treatment effects, likely mediated by overlapping, nonspecific, and contextual mechanisms. Treatment pluralism provides a practical way to interpret this evidence. It acknowledges that while treatments may appear comparable at the group level, substantial heterogeneity in treatment effects means that individual patients can respond quite differently. Frameworks such as the person-centered hypothesis aim to integrate pain phenotype, context, and pattern recognition to refine treatment selection. For now, predictive precision remains aspirational. Pluralism encourages a bounded range of safe, plausible, evidence-informed treatment options; it allows clinicians to practice with different orientations provided these are communicated transparently and aligned with patient values, goals, and preferences. Rather than enforcing uniformity, embracing pluralism offers an honest and patient-centered way to navigate uncertainty in MSK care. J Orthop Sports Phys Ther 2026;56(6):331-333. Epub 25 March 2026. doi:10.2519/jospt.2026.13992.

OBJECTIVE: To synthesize qualitative research exploring patient experiences of lower limb tendinopathies and identify themes to support patient-centered care. DESIGN: Systematic review with thematic synthesis. LITERATURE SEARCH: MEDLINE, EMBASE, CINAHL (Cumulative Index to Nursing and Allied Health Literature), and SPORTDiscus were searched from inception to September 2024, using MeSH (Medical Subject Headings) terms and key words. Forward and backward citation tracking of included studies was performed in Web of Science. STUDY SELECTION CRITERIA: Peer-reviewed qualitative studies published at any date and using interviews or focus groups exploring perspectives on common lower limb tendinopathies (plantar heel pain, Achilles tendinopathy, tibialis posterior tendinopathy, patellar tendinopathy, gluteal tendinopathy, or proximal hamstring tendinopathy) were included. Participants of any age were eligible if diagnosed by a health care professional and symptomatic for at least 3 months. DATA SYNTHESIS: Thematic synthesis was conducted using an inductive approach. Two reviewers independently coded data. Descriptive themes were developed, refined through discussion, and structured into final analytical themes. RESULTS: Thirteen studies were included (n = 153; 84 females), with Achilles tendinopathy being the most common focus (n = 70; 7 studies). Ten themes were identified and organized hierarchically. These included psychosocial impacts; activity limitations; knowledge gaps regarding diagnoses, causes, and management; the importance of therapeutic alliance; and mixed treatment experiences. Six of 29 items in the Critical Appraisal Skills Programme Checklist for Qualitative Studies were unmet in over half of the studies. Confidence in findings ranged from low to moderate (GRADE-CERQual [Grading of Recommendations Assessment, Development and Evaluation Confidence in the Evidence from Reviews of Qualitative Research]). CONCLUSION: Lower limb tendinopathies impact patients beyond physical pain, affecting work, daily function, and sports and social participation. These challenges often lead to psychosocial consequences, including frustration, anxiety, and isolation. Strong therapeutic alliances can improve patient experiences and satisfaction with care. J Orthop Sports Phys Ther 2026;56(6):334-345. Epub 23 April 2026. doi:10.2519/jospt.2026.13666.