Adductor-Related Groin Pain

Groin strains are synonymous with injury to the Adductor muscles which are located around the inner thigh, for this reason Physiotherapists will often refer to this injury as Adductor-related groin pain. However, as the accompanying picture demonstrates, this is a region where numerous other parts of our anatomy (not just muscles) have the potential to generate pain.

• Sudden onset pain from a sudden, forceful movement such as a lunge, change of direction or over-stretch.

• Pain localised to the groin and inner thigh that may radiate to the inside surface of the knee and in to the anterior thigh.

• You may notice swelling and/or bruising in the damaged area.

• Walking with a normal stride length may aggravate your symptoms causing you to walk with a shorter stride or with a limp.

• The pain is usually provoked by having the knees apart or actively squeezing the knees together.

There are a number of ways in which Adductor-related groin pain can occur. Injury can occur after a forceful contraction of the Adductor muscle group, alternatively injury might be caused by repetitive smaller injury (often referred to as microtrauma), less typically injury might result from a direct blunt trauma.

Forceful contraction and microtrauma are both examples of what would be referred to in the literature as a ‘load tolerance’ issue. Load tolerance simply refers to a muscles ability to cope with a specific demand, if the demand exceeds the muscles capability then injury may be the outcome.

Seeking advice from a musculoskeletal specialist is recommended. At Pure Physiotherapy, our clinicians complete a thorough assessment which facilitates in making an accurate working diagnosis and the subsequent development of an individualised, condition specific rehabilitation protocol.

Following assessment, if an Adductor muscle has been found to be the source of pain your clinician will inform you of the suspected grade of your injury. Grading refers to the level of injury to the muscle, this grading system further enhances the clinician’s ability in developing appropriate treatment strategies.

Your Physio will provide you with advice and education on your injury so that you can understand how to help relieve symptoms and facilitate optimal recovery. Depending on when you sustained the injury, you may be advised to use heat or ice on the area and to try over-the-counter medication to reduce your pain levels. By being provided with an understanding of the structures involved, you will be able to avoid positions/activities that may worsen your symptoms. As you recover from your injury, your Physiotherapist will provide you with ongoing advice and support so you can manage independently and prevent re-occurrence.

Adductor-related groin pain requires active rehabilitation to improve load tolerance, strength and address any potential impairments. Your Physiotherapist will create a rehabilitation plan based on your personal goals. If someone is wanting to return to running for example, it is recommended they start with slow straight line running and progress time and speed. Then the introduction of slow side steps, forward-backward and zig-zag runs prior to increased acceleration/deceleration might be implemented. Regardless of your level of physical ability, your Physio will help you return to your normal level of function by carrying out regular re-assessment and ensure your exercise are helping towards achieving your goals.

To finish with, the good news is that once you have recovered from your initial Adductor-related injury, randomised controlled studies have demonstrated that simple exercise completed once a week significantly reduce the on-going incidence of this injury (Harøy et al., 2019; Hölmich et al., 1999).

Harøy, J., Clarsen, B., Wiger, E.G., Øyen, M.G., Serner, A., Thorborg, K., Hölmich, P., Andersen, T.E. and Bahr, R. (2019). The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British journal of sports medicine, 53(3), 150-157.

Hölmich, P., Uhrskou, P., Ulnits, L., Kanstrup, I. L., Nielsen, M. B., Bjerg, A. M., & Krogsgaard, K. (1999). Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. The Lancet, 353(9151), 439-443.