What is a groin strain?
The inner thigh muscles (adductors) are known as the groin. A groin strain occurs when the adductors are overstretched or forced to contract.1 This generally occurs immediately (acute), causing immediate pain and potentially leading to further complications if left untreated. A groin strain tears muscle fibres due to the muscles being unable to cope with the demands placed on them from the body structures.2,3
WHAT CAUSES A GROIN STRAIN?
Groin strains commonly occur due to rapid acceleration or deceleration, sudden changes in direction and kicking. They are one of the most common injuries in soccer athletes accounting for 8–18% of all injuries but also occur in other sports such as rugby, AFL, ice hockey and cricket.4
Pushing off in the opposite direction while running5
Kicking a ball on the inside of their foot with a resistive force of another player5
Overstretching of the muscle while kicking
Repetitively doing any of the above even it begins pain-free
WHAT STRUCTURES ARE INVOLVED?
The groin is a complex region where the upper body connects to the lower limbs via the pelvis. It contains many different structures involving organs, muscles, tendons, ligaments, nerves and joint structures. As a result of the complexity of this area many possible regions may contribute or cause groin pain.3
The groin is a region of the body where the upper body meets the lower body. The hip adductors involve three main muscles including, the adductor magnus, adductor longus and adductor brevis. The adductor longus is the muscle most commonly injured and accounts for 62% to 90% of cases (pictured).5
All three of these muscles attach the pelvis to the femur (thigh bone). They are all primarily used in bringing the leg towards the other leg (adduction) and assist in stabilising the pelvis.
WHAT ARE THE RISK FACTORS? COMMON POPULATIONS?
Numerous factors increase the risk of sustaining a groin strain including: 3,6,7
A previous groin injury
Decreased hip adductor strength as it reduces the muscle capacity, imbalances between the synergistic functions of hip adductor and abductor muscles, and increased risk of muscle injury during movements
Higher level of play
Lower levels of sport-specific training
WHAT ARE THE SIGNS AND SYMPTOMS?
Pain in the groin region 3,8
Tightness in the morning / before ‘warming it up’
Throbbing
Bruising and/or swelling
Difficulty walking up stairs, running, sitting cross legged, rolling over in bed, sitting on the toilet
HOW LONG WILL I BE OUT FOR?
Groin strains can vary in their recovery time depending on the severity and location of the strain on the muscle. The appropriateness of the rehabilitation program also impacts on the return to sport of groin strain patients.8,9
Acute injuries may return as quickly as 4 to 8 weeks with conservative treatment (exercise therapy), whereas chronic strains may take many months to achieve desired results.3,4,5
SO, WHAT SHOULD I DO?
Initially after hurting your groin, you should go and see a health professional to get their advice. This may include seeing a physiotherapist or a GP which will work together to provide you with the best rehabilitation plan.
A physiotherapist will conduct a clinical examination where they will test strength, pain, range of motion and rule out any other injuries potentially present. They might also ask you to fill out a HAGOS questionnaire which evidence has shown to be very useful in soccer players.9,10 After conducting an assessment and diagnosis your physiotherapist will provide you with advice, education and a program that will enable you to return to sport safely and reduce the risk of it becoming a long-term injury.3
If you see a physiotherapist quickly, they will initially advise you to about the prognosis and treatment for the injury. Initial management of adductor strains generally involves conservative management. Conservative management includes relative rest from sports, ice, compression, analgesia, and physical therapy. Studies have shown non-steroidal anti-inflammatory medications to be effective for short-term pain relief. The rehabilitation program should incorporate strengthening exercises for the affected leg and core accompanied by a gradual return to sport.2,4,6
Initially, the exercises will consist of isometric adductor exercises to work on maintaining strength. After an initial period of isometrics, the progressing is working through the full range of motion and building strength through range. As this strength is built and improved, plyometric exercises will be included. Running will then also be introduced and a return to sport plan.
EXERCISES
There is a large amount of research of exercises involving the adductors which target them most effectively.
5. Slide adduction exercise
Incorporates balance, strength and range of motion. Perfect for all stages of rehab.
4. Adductor with band
The banded adduction is a perfect exercise for returning to kicking.
3. Skater
Excellent for returning to the vigorous demands of changing direction in soccer.
2. Ball isometric squeeze – can add in glute squeeze
A great exercise for using your glutes (bum muscles) and adductors together. On par with the best adductor exercise known in the research world.
1. Copenhagen Plank (adduction)
3 progressions provided, from easiest, to hardest. Can be used in all stages of rehab.
REFERENCES:
1. LeBlanc K, LeBlanc K. Groin pain in athletes. Hernia. 2003 February 8; volume 7(2):68-71. DOI: https://doi.org/10.1007/s10029-002-0105-x
2. Hölmich P, Uhrskou P, Ulnits L, Kanstrup I, Nielsen M, Bjerg A et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet.1999 February 6; volume 353(9151):439-443. DOI: 10.1016/S0140-6736(98)03340-6
3. Brukner P, Clarsen B, Cook J, et al. Brukner & Khan’s clinical sports medicine. 5th ed. North Ryde: McGraw-Hill Education; 2017:629-657.
4. Serner A, Jakobsen M, Andersen L, Hölmich P, Sundstrup E, Thorborg K. EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. Br J Sports Med. 2013 March 19; volume 48(14): 1108-1114. DOI: http://dx.doi.org/10.1136/bjsports-2012-091746
5. Kiel J, Kaiser K. Adductor Strain. NCBI. 2021 July 25. Available at: https://www.ncbi.nlm.nih.gov/books/NBK493166/
6. Whittaker J, Small C, Maffey L, Emery C. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med. 2015 June; volume 49(12):803-809. DOI: 10.1136/bjsports-2014-094287
7. Waldén M, Hägglund M, Ekstrand J. The epidemiology of groin injury in senior football: a systematic review of prospective studies. Br J Sports Med 2015. 2015 June; volume 49(12):792. DOI: http://dx.doi.org/10.1136/bjsports-2015-094705
8. Rolph R, Morgan C, Chapman G, Marsh S. Groin pain in athletes. BMJ. 2020 Mar 4; volume 368. DOI: http://dx.doi.org/10.1136/bmj.m559
9. Harøy J, Clarsen B, Wiger EG, Øyen MG, Serner A, Thorborg K, Hölmich P, Andersen TE, Bahr. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 2018 June 10; volume 53(3):150-157. DOI: http://dx.doi.org/10.1136/bjsports-2017-098937
10. Charlton P, Drew M, Mentiplay B, Grimaldi A, Clark R. Exercise Interventions for the Prevention and Treatment of Groin Pain and Injury in Athletes: A Critical and Systematic Review. Sports Medicine. 2017 May 12; volume 47(10):2011-2026. DOI: https://doi.org/10.1007/s40279-017-0742-y
11. Schilders E, Dimitrakopoulou A, Cooke M, Bismil Q, Cooke C. Effectiveness of a Selective Partial Adductor Release for Chronic Adductor-Related Groin Pain in Professional Athletes. Am J Sports Med. 2013 February 13; volume 41(3):603-607. DOI: https://doi-org.ezproxy.canberra.edu.au/10.1177/0363546513475790
