# Injuries and Pain Associated with Goalkeeping in Football--Review of the Literature
## 4 Discussion
### Goalkeepers' Injuries of Lower Limbs  
#### 4.6.1 Hips and Groins Regions  
The groin and hip area seems to be very often affected by pain and injuries in football GKs, which is the reason why GKs should use protective shorts. In the study of [PERSON] et al., analyzing pain in GK during a training camp GKs often suffered pain in the lower limbs, groin and hip caused by impact. The area of groin and hip was indicated the most frequently. In terms of muscle pain, GKs frequently reported the thigh, calf and gluteus area and thigh area was the most frequent (88%, 21 of 24 GKs). Joint pain was indicated in the area of groin and hip, knees, and ankles (29%, 27%, and 21%, respectively) [61]. Muscle injuries (rupture, tear, strain, cramps) are the main injury type in the groin and hip area in football players (all positions) and represent 60% of all injuries in the study of [PERSON], [PERSON], and [PERSON]. Unspecific overuse symptoms, tendon injury, contusion, haematoma, synovitis and other types of injury represent 24%, 6%, 4%, 1%, 1%, and 5%, respectively, of all injuries reported. GKs suffered 6% of the analyzed hip and groin injuries [71]. In contrast the study of [PERSON] et al., which focused on hip and groin injuries, showed that in football GKs of different age, gender and sports level, contusions and abrasions occur the most often. Abrasions were reported by 80-100% of players and contusions were indicated by 48-71% depending on a group. Other types of injuries were less frequently reported--synovitis of hip joint by 7-20%, arthrosis of hip joint only by 3% and fractures only by 2% of male amateurs. Bursitis was more often reported by professional than amateur players, but generally amateur players have a higher injury rate than professional ones. The injury risk was higher during training exercises than during a match. It is assumed that the reason is a higher number of interventions and goalkeeper-to-player interactions during training exercises than during the same time amount of match play. The authors state that in their study there was no influence of age, gender and exercise intensity on the injury rate. The injury rate was higher when playing and training on artificial grass compared to natural grass, but the difference was not statistically significant. The use of protective goalkeeper shorts did not influence the injury rate [72]. The further analysis of the issue of protective shorts conducted by [PERSON] et al. showed that the best models can reduce impact forces on the hip up to 53%, force acting on the neck of the femur bone by over 63% and vertical force also by 63%. The authors claim that padded shorts did not influence the observed injury rate but add that it was not measured whether the use of padded shorts changed the injuries severity level [73]. Despite the fact that goalkeeper padded shorts may not provide perfect protection, it may lower the severity of skin abrasions and bruises. Coaches and professionals should consider that repetitive micro trauma caused by overtraining or overuse can cause deformity of the femoral cam and neck in exceptional cases [74]. The anterior inferior iliac spine (AIIS), which is the attachment site of the straight head of the quadriceps muscle of the thigh, is a point with high injury risk. Injuries of proximal rectus femoris avulsion, avulsion fracture, tendon tear and ossification of tendon are presented in the scientific literature [36; 37]. [PERSON] and colleagues described a case study of injury of the anterior superior iliac spine (ASIS) which provides attachment for the inguinal ligament, and the sartorius muscle [22]. A typical injury mechanism occurs when kicking a ball hard during training or match play. Despite the fact the rectus femoris muscle is one of the biggest muscles in the whole human body, the GKs managed to continue play after suffering the injury in the described case study. A proper diagnosis is difficult because the symptoms are unclear and may be present only during kicking or sprinting.