Groin Strain (Adductor Strain)
Groin strain is a common over use sports injury and occurs when the adductor muscles of the hip, become torn or ruptured, as a result of being overstretched.
The adductor muscles are situated on the inside of the groin. They consist of: adductor longus, adductor magnus, adductor brevis, pectineus and gracilis. The adductor longus, adductor brevis and pectineus are referred to as the short adductors and the pectineus and the adductor magnus are referred to as the long adductors. The adductor muscles originate from the pubis and ishium, and insert on the posterior and medial surface of the femur.
The adductor muscles help stabilise the hip, balance the body, and stop the legs overstretching, by bringing the leg back to the body’s midline.
Groin strain occurs when the adductor muscles are overstretched, and is usually a result of a side stepping action, twisting motion or a sudden change of direction. It is a common injury in sports which involve a quick change of direction, for example, football. Other sports susceptible to groin strain are horse riding, sprinting, hurdling, and gymnastics.
Groin strains are categorised in 3 categories, grade 1, 2 and 3.
A complete rupture, a grade 3 strain, usually occurs where the adductor inserts into the femur. Partial ruptures, grade 1 or 2 usually occurs at a muscle/tendon junction.
Grade 1 (a partial tear involving only a few muscles fibres)
In a grade 1 strain the pain is moderate, and tightness can be felt in the adductor muscles.
During exercise pain can disappear and might not resume until after exercise.
The area around the muscle tear might be tender to touch, warm and red.
Walking might be uncomfortable.
Grade 2 (a partial tear involving more extensive tissue damage)
Pain might be felt on stretching the muscle.
The onset of pain can be sudden and sharp.
There might be slight swelling and the area will be tender to touch.
Weakness and pain might be felt when the legs are squeezed together.
The adductor muscles might be tight. This tightness tends to occur the day after exercise.
Grade 3 (a complete rupture)
Pain is more severe and can be felt acutely during exercise, in particular, if a change of direction occurs, for instance in a game of football.
Squeezing the adductors together is difficult, due to the rupture of the muscles.
Inflammation and bruising is more severe.
A lump can be felt where thickening has occurred. This happens as a result of the build-up of scar tissue caused by the rupture of the adductor muscles, which then forms scar tissue as it heals (these are the nodules).
A gap might be felt where the muscle has ruptured.
It is important to seek treatment early to avoid developing a chronic groin strain.
Rest: to prevent further damage, and avoid any exercises that put a strain on the adductor muscles until the muscles have completely recovered.
In the sub acute (3 days to 3 weeks) and the chronic stage (3 weeks to 2 years) it is important that training should be adapted to avoid jumping or any exercises that put excessive strain on the adductor muscles. A physiotherapist or sports therapist can advise when exercise should be resumed and what exercise would be appropriate. It is important to always warm up and cool down properly when exercising.
Ice treatment: Ice, can be applied for 10-15 minutes, every 2-3 hours in the acute and sub- acute stage (frequency can be reduced according to recovery, and can be continued for as long as deemed necessary). In the sub-acute stage (3days – 3 weeks) heat therapy can be applied, usually in the form of a hot bath.
Compression: Compression shorts and thigh sleeves may be used to provide warmth and stability to the groin area. Core shorts by Underarmour are a good example where added elasticitity in the shorts in the groin and hamstring areas offer added compression over standard Neoprene Compression shorts
NSAIDS (anti-inflammatories) and paracetamol can be taken to aid pain relief. Medical advice should be sought, in case of possible side effects.
Steroid injections (under medical guidance) can alleviate pain, but it is recommended exercise should be avoided for 1-2 weeks after an injection.
Orthotics can prevent overprontation. It is therefore, worth consulting a podiatrist, who can perform gait analysis and advise on appropriate foot wear.
Kinesology taping techniques may be useful in this condition.
A doctor or physiotherapist might recommend an MRI scan to assess the extent of rupture. In severe cases surgery might be performed.
A physiotherapist might prescribe ultrasound treatment, sound waves; which speeds up the repair process, by breaking down tissues and stretching them. It can also help alleviate pain.
Massage can help aid recovery, and improve joint mobility and range of movement. It should not be administered during the acute stage. If there is any underlying medical condition, such as a heart condition, it is important to seek medical advice before receiving massage.
A physiotherapist, osteopath or sports massage therapist can recommend strengthening, flexibility and proprioceptive exercises in the sub-acute and the chronic stage of recovery. Exercises should focus on isometric training to strengthen the adductor muscles, for example, hip adduction.
The intensity of the exercises should be increased gradually and in a controlled way. Cycling or swimming (front/back crawl, not breaststroke) is a good way of maintaining fitness while the adductor muscles recover.