Groin strain is common in sport, especially hockey, basketball, soccer, tennis, horse riding and karate. They can be very debilitating for a short period or repeatedly troublesome over a long period.
What Is A Groin Strain?
The groin is a complex area involving the abdomen, the hip muscles, and the genitals, all of which can be injured.
- Impact injuries involve a direct blow during contact sports or anywhere where the body can come into contact with an object. Medical advice should be sought if there is any doubt about the severity of the injury.
- Groin strains (adductor strains) involve a muscle tear at the junction of the muscle to its tendon and can involve the gracilis, iliopsoas and adductor muscles. The adductor longus muscle is the most commonly injured at an estimated 62% of groin injuries. The muscle-tendon junction has a poor blood supply but a rich nerve supply and this relates to the severe pain people report and the poor healing capacity of these injuries.
- The hip pointer injury involves a sudden extension of the hip that sprains or pulls off the attachment of the sartorius muscle from the iliac crest at the front of the pelvis.
- Other groin problems include hernias, Gilmore’s groin, stress fractures, osteitis pubis, bursitis, and hip impingement.
Who Gets Groin Strain?
Groin strains and injuries are most common in sports such as hockey or soccer. Sudden movements and changes of direction, especially side to side, can stress the adductor muscles, as can forced abduction (movement outwards away from the centre body line) of the hips such as partial splits.
The muscles may contract hard as they are lengthening, which produces too much force and a tear develops near the tendon junction to the muscle. Athletes who are older and who have weaker adductor muscles may be at greater risk of a pulled groin.
Groin Strain Symptoms
- Sudden onset of groin pain
- Pain often severe and very sharp on movement or weight bearing
- The person is unwilling to move the affected leg out to the side
- Continuing the sporting activity is impossible
Groin Strain Treatment
Physiotherapy is the main treatment for a groin strain and the physio will manage an acute injury using the PRICE protocol. Crutches may be necessary for a few days if pain is severe, resting from the aggravating activity is vital, and ice and compression bandages may be useful. Control of pain and inflammation are the key factors here to allow healing to occur most quickly.
Physiotherapy treatment is aimed at reducing the pain and inflammation and progressing the patient towards full function as soon as possible. However, it is very important not to overdo the injury by excessive exercise or stretching as this can progress to the problem becoming a chronic groin strain. Chronic strains can be problems for years and severely limit functional activities such as sport.
Treatment is typically dictated by the pain’s response to movement. Rest is followed by gentle active movements and isometric contractions of the adductor muscles. If that is painless, work can progress to resisted movements and gentle stretching, moving on to sliding board movements, plyometrics, and sports-specific movements.
Strengthening of the abdominal muscles, hip stabilisers and adductor muscles is important, as lack of endurance is a factor in groin strain. Tired adductor muscles are more likely to suffer a strain, so physiotherapy will involve increasing the endurance of these muscles by performing high repetitions of an activity such as 30-40 reps.
Acute strains may take from a few weeks to three months to rehabilitate, while chronic strains could take up to six months even if they go well.
Grade 1 Strain
Provided they are pain-free, hip movements and gentle stretches may be appropriate. Strengthening exercises, progressing steadily and without pain, can be instituted. Here, plyometrics, lateral lunges, and sport-specific work can be added, with recovery being rapid with good management.
Grade 2 Strain
Range of motion exercises of the hip can be encouraged if they are pain-free, and static (isometric) contractions can also be started once they can be performed without pain.
It may take a week before sliding board exercises and plyometrics might be appropriate, with pain guiding the progression to sport-specific work. The person is likely to be unable to perfrom their usual activities for several weeks.
Grade 3 Strain – (not suitable for surgery).
The PRICE protocol as mentioned above, and using crutches for severe strains to take all the stress off the area for one to three days. Compression bandages can also be useful. The progression is then the same as the other grades, gradual range of motion, isometrics, leading on more active work and sports specific activities as the pain allows. This process can typically start from day three to day five after the injury and progress from there.
Once the person can walk without pain, they can discard the walking aids.
Chronic strain
Rest, ice, massage, and therapeutic ultrasonography have been recommended to treat long-standing groin pain. Nonsteroidal anti-inflammatory drugs (NSAIDs) and steroid injections have been suggested but have not been supported by controlled trials. Forceful adductor stretch under general anesthetic has been recommended. A careful monitored program with a total cessation of the sports activity is necessary for the chronic adductor injury to heal and become pain-free.
The physical therapy program should consist of isometric exercises, strengthening of the hip- and pelvis-stabilizing muscles, and proprioceptive training. No increase in pain should be experienced during or after the exercises. The load of the exercises is gradually increased. Specific strengthening of the adductor muscles is then implemented.
Cycling can be used to maintain general conditioning, but running can begin only after the patient can perform the exercises at high intensity without pain. Sprinting and cutting activities may then follow. Sport-specific training is the final step before full return to sport. This part of the rehabilitation program may take 3-6 months.
References:
- Groin Pain. Information and Exercise Leaflet for Patients and Carers. East Lancashire Hospitals. http://www.elht.nhs.uk/Downloads-docs/PLIMS/Leaflets/Lower%20Limb/Groin%20Pain%20-%20Patient%20Information%20and%20Exercises%20-%20PHYSIO%20001.pdf
- Tyler, Timothy F. et al. “Groin Injuries in Sports Medicine.” Sports Health 2.3 (2010): 231–236. PMC. Web. 25 Nov. 2015. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445110/
Last Review Date: 08-01-2020
Next Review Date: 07-01-2022
