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Christian Pulisic’s pelvic injury highlights athletes’ risks to groin – The Washington Post – The latest soccer highlights and football news


Call it the collision that shook American soccer fans, almost as much as it did the U.S. soccer star Christian Pulisic.

In the U.S. men’s team’s World Cup match against Iran, Pulisic scored and then barreled into the goalkeeper, Alireza Beiranvand, taking a knee to the groin area and collapsing to the ground, writhing.

During a news conference on Thursday he said his injury, since diagnosed as a pelvic contusion, which is a severe bruise, was “obviously very painful.”

It could have been worse, though, as many wincing spectators might agree.

“I didn’t get, like, hit in the balls,” Pulisic said, responding to speculation on social media and elsewhere. “I’m all right. It was very painful.” But, he concluded, “I’m getting better.”

Contact injuries to the male groin and pelvis in soccer and other sports can happen at all levels and ages of play, and cause excruciating pain and discomfort, even when they do not involve the genitals. Pulisic, 24, told reporters Thursday that he is “taking it day by day” and “doing everything in my power” to play against the Netherlands this Saturday in the World Cup’s round of 16. The U.S. Men’s National Team announced Friday that Pulisic has been cleared to play.

While his condition obviously affects the U.S. men’s team’s prospects, it also has focused unusual levels of public attention on the male scrotum, raising important, if impolite, questions about the immediate and longer-term consequences of being struck there during sports and whether and how athletes can protect this uniquely sensitive anatomical area.

Most men have hurt their testicles

Male genitalia hang outside the body, allowing the testicles to stay cool enough to produce sperm, but also leaving them without the protection of skin, muscles and bone afforded to internal organs and vulnerable to various accidental hits or other injuries. (Female athletes also get struck in the groin, but their consequences typically involve muscular injuries.)

“Most men have experienced some degree of testicular trauma in their lifetimes,” said Jeffrey Jones, an emergency medicine physician at Corewell Health in Grand Rapids, Mich., who has treated and written about injuries to the testes. “But male athletes are subject to genital injury far more often.”

The exact numbers of such injuries are unknown, though, since few athletes wind up hospitalized. “Scrotal trauma after a sports injury is usually not perceived as severe enough by the athlete to seek medical attention,” said Areg Grigorian, a professor of surgery at the University of California, Irvine, who has treated and studied severe genital injuries.

Plus, he said, “some male athletes may be embarrassed by a genital injury, which may prevent them from letting their coaches, parents or doctors know.”

Luckily, these injuries usually are minor. “It’s incredibly rare” for a soccer player or most other athletes who have been struck in the scrotum or groin to need medical attention, said Baker Cronin, an athletic trainer with the Charlotte Football Club in Major League Soccer.

But, since the testicles “contain a great number of densely packed nerve endings in a small area,” Jones said, these injuries can feel almost uniquely agonizing.

The pain from being hit in the testicles tends to be “completely debilitating,” said Reade Whitney, the head athletic trainer for the MLS team, D.C. United. Many players in this situation become nauseated. Some report stomach pain. Most curl into a fetal position.

But the worst effects normally pass off within “a matter of seconds to minutes,” Cronin said. Those minutes may feel interminable, but afterward, most athletes should be able to return to the game without treatment or lingering repercussions, he said.

Impacts to the groin during sports do sometimes cause serious injuries, though. If a testicle is struck with sudden, great force, for instance, it can rupture. These injuries usually occur during sports like baseball or hockey, when someone is hit below the belt with a fastball or puck. In other sports, including soccer, testicular ruptures are vanishingly rare. (The penis is almost never hurt during sports, since it is usually flaccid then. “We see penis fractures most commonly after sexual intercourse,” Grigorian said, “not sports injuries.”)

Other freakish injuries to the groin or scrotum also can occur, as Pulisic’s experience shows. In obvious pain, he was removed from the game at half time and taken to the hospital for tests, where doctors diagnosed him with a pelvic contusion.

A contusion, meaning a severe bruise, can be particularly painful near a pelvic bone because there isn’t a lot of protective muscle over the top of it, said Whitney.

Luckily, impacts to the groin rarely affect an athletes’ ability to reproduce. “Testicular rupture can affect fertility,” Grigorian said, but more-benign genital injuries will not.

Still, an athlete who has been struck in the pelvic area should seek medical care “if the pain doesn’t ease up after an hour or if they continue to feel nauseous or vomit,” Jones said. Blood in the urine or bruising and fluid in the scrotum are also warning signs.

Cronin suggests athletes self-monitor physical changes to the groin. “Every man knows what he looks like there,” he said. If you notice “some level of deformity,” such as swelling or other changes in your genitals in the hours or days after the injury, he said, see your doctor.

If, though, your sore genitals look normal, but still ache, “take a painkiller such as ibuprofen or acetaminophen,” Jones said. “Or use an ice pack on the area.” You could also place a rolled-up towel under the testicle when you lie down, he said, or “wear supportive underwear for several days to gently support the testicle.”

“Don’t skip the cup!”

Prevention is also possible, although few soccer players or male athletes in other sports wear protective cups over their genitals.

“I don’t know of any soccer players who wear a cup,” Cronin said.

Whitney agrees. “It would be very cumbersome and limit the dexterity of the types of movements they have to do with their legs to control the ball and all the different types of kicking techniques,” he said.

This reluctance permeates sports at all levels. “It’s been found that nearly half of young men do not wear a cup during contact sports,” Jones said.

As a physician, he wishes they would reconsider. “Don’t skip the cup!” he said.

But few, if any, male soccer players would consider it, Whitney said, relying, instead, on their own physical reflexes to steer them clear of balls or knees to the groin and on sportsmanship from the opposing team. “It’s mostly contingent upon your opponent’s playing clean,” he said.

As for Pulisic, fans are hopeful his injury will prove ephemeral.

“I’m at a conference” of medical professionals in Florida, Cronin said, many of whom treat and train soccer players. The conference has scheduled sessions on Saturday, but “I don’t think anyone will be attending,” Cronin said. They will all be watching the U.S. men’s team, he said, with, they hope, Pulisic leading the scoring.

Steven Goff contributed to this report.

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World Cup in Qatar

The latest: The knockout stage continued at the World Cup on Saturday with Argentina beating Australia, 2-1, in the round of 16. Argentina, featuring global star Lionel Messi in what is probably his final World Cup, is among the favorites to win the tournament and managed to finish first in Group C and move on to the quarterfinals despite a shocking loss to Saudi Arabia in its first game.

USMNT: The U.S. men’s national team fell to the Netherlands, 3-1, on Saturday in the opening match of the round of 16. The Netherlands, winners of Group A, had finished the group stage without a loss, conceding just a single goal. Its winning streak continues, while the U.S. run is over.

Knock out round schedule: A World Cup group stage filled with shocking upsets and dramatic turnarounds will now give way to a knockout round that promises more surprises.

Today’s WorldView: Ishaan Tharoor, The Post’s foreign desk columnist, chronicles his week at the World Cup in Qatar.

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