Muscle Pain - Groin Pain and Groin Pull Injury

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A Guide for the Treatment and Prevention of Groin Injuries.

Groin pain; Groin strain; Groin pull injury; or Adductor strain. Call it what you want, the fact is, it's a very common muscle strain injury that currently plagues sports like soccer, basketball, football, hockey, track & field and racquet sports.

If you suffer from groin strain or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, making stretching a part of your fitness regime will have a significant impact. To get you started on a safe and effective stretching routine learn more about The Stretching Handbook and how it can improve your fitness.

The groin, described as the junction between the lower limbs and torso, is vulnerable to a lot of different injuries. Hernias, stress fractures, and avulsion fractures are all common injuries that affect the groin, but for this issue we'll be focusing on one of the most common groin injuries; groin pull or groin strain.

In this issue I'm going to take a slightly different approach to the way I usually write these articles. Firstly, I'm going to talk briefly about what a groin pull is, what causes a groin pull and what to do to prevent a groin pull. Then I'm going to reproduce a detailed management plan for the correct treatment and complete rehabilitation of a groin strain.

This detailed management plan comes from one of my old university text books, called Arnheim's Principles of Athletic Training by Daniel D. Arnheim. It's one of those 900 page door-stoppers, but it's the book I refer to most for information on sports injury prevention and rehabilitation. It's extremely detailed and a valuable resource for anyone who works in the health and fitness industry. So...

What is a Groin Pull?
Depending on the severity, a groin pull can range from a slight stretching, to a complete rupture of the muscles that attach the pubic (pelvis) bone to the thigh (femur) bone.


A groin pull or strain specifically affects the "Adductor" muscles. (Adductor; meaning, moves part closer to the midline, or middle of the body) These muscles are located on the inside of the thigh, and help to bring the legs together.

The adductor muscles consist of "Adductor Brevis", "Adductor Magnus" and "Adductor Longus," all of which are displayed in the picture to the right. Adductor Longus has been cut to display the muscles underneath.

Of these three, it is Adductor Longus that is most susceptible to injury, and the most common place of injury on Adductor Longus is the point at which the muscle and tendon attach to the femur (thigh) bone.

What Causes a Groin Pull?
Competitors that participate in sports that require a lot of running or rapid change in direction are most susceptible to groin injuries. Other activities like kicking, jumping and rapid acceleration or deceleration also place a lot of strain on the groin muscles.

Another activity that puts a lot of strain on the groin is any movement that results in a sudden pressure being applied. Such as a fall, landing awkwardly, twisting, or bending while stress is applied to the groin muscles.

How to Prevent a Groin Pull?
The basis of prevention comes down to two simple factors. A thorough warm-up and physical conditioning, ie: flexibility & strength.

Firstly, a thorough and correct warm up will help to prepare the muscles and tendons for any activity to come.

Secondly, flexible muscles and tendons are extremely important in the prevention of most strain or sprain injuries. When muscles and tendons are tight and stiff, it is quite easy for those muscles and tendons to be pushed beyond their natural range of movement, which can cause strains, sprains, and pulled muscles. To keep your muscles and tendons flexible and supple, it is important to undertake a structured stretching routine.

Stretching is one of the most under-utilized techniques for improving athletic performance and getting rid of those annoying sports injuries. Don't make the mistake of thinking that something as simple as stretching won't be effective.

And to help you improve your flexibility quickly and safely, you can't go past The Stretching Handbook & DVD. Together they include over 130 clear photographs and 40 videos of every possible stretching exercise, for every major muscle group in your body.

The Stretching Handbook & DVD will show you, step-by-step, how to perform each stretch EXACTLY! Plus, you'll learn the benefits of flexibility; the 7 critical rules for safe stretching; and how to stretch properly.

And thirdly, strengthening and conditioning the muscles of the groin will also help to prevent groin strain. There are a number of specific strengthening exercises you can do for these muscles, like cable adductions and machine adductions.

A Complete Treatment and Management Plan for Groin Strain
The following is a very thorough and detailed management plan for the full recovery and rehabilitation of a groin strain. As mentioned earlier, it's taken directly from Arnheim's Principles of Athletic Training by Daniel D. Arnheim.

Considering this management plan was written over ten years ago, my only addition would be the reduction of ice therapy and the addition of massage and heat therapy during the 2nd, 3rd, and 4th phase. Regardless of my suggestions, the following will be extremely useful for anyone who is, or has suffered from a groin strain.

Injury Situation: A women varsity basketball player had a history of tightness in her groin. During a game she suddenly rotated her trunk while also stretching to the right side. There was a sudden sharp pain and a sense of "giving way" in the left side of the groin that caused the athlete to immediately stop play and limp to the sidelines.

Symptoms & Signs: As the athlete described it to the athletic trainer, there was severe pain when rotating her trunk to the right and flexing her left hip. Inspection revealed the following:

There was major point tenderness in the groin, especially in the region of the adductor magnus muscle.
There was no pain during passive movement of the hip, but severe pain did occur during both active and resistive motion.
When the groin and hip were tested for injury, the hip joint, illiopsoas, and rectus femoris muscles were ruled out as having been injured; however, when the athlete adducted the hip from a stretch position, it caused here extreme discomfort.
Management Plan: Based on the athletic trainer's inspection, with findings confirmed by the physician, it was determined that the athlete had sustained a second-degree strain of the groin, particularly to the adductor magnus muscle.

Phase 1

Management Phase

Goals: To control haemorrhage, pain and spasms.
Estimated Length of Time (ELT): 2 to 3 days.

Therapy

Immediate Care: ICE-R (20 min) intermittently, six to eight times daily. The athlete wears a 6-inch elastic hip spica.

Exercise Rehabilitation

No Exercise - as complete rest as possible.

Phase 2

Management Phase

Goals: To reduce pain, spasm and restore full ability to contract without stretching the muscle.
ELT: 4 to 6 days.

Therapy

Follow up care: Ice massage (1 min) three to four times daily. Bipolar muscle stimulation above and below pain site (7 min).

Exercise Rehabilitation

PNF for hip rehabilitation three to four times daily (beginning approx. 6 days after injury)
Optional: Jogging in chest level water (10 to 20 min) one or two times daily. Must be done within pain free limits.
General body maintenance exercises are conducted three times a week as long as they do not aggravate the injury.

Phase 3

Management Phase

Goals: To reduce inflammation and return strength and flexibility.

Therapy

Muscle stimulation using the surge current at 7 or 8, depending on athlete's tolerance, together with ultrasound once daily and cold therapy in the form of ice massage or ice packs (7 min) followed by light exercise, two to three times daily.

Exercise Rehabilitation

PNF hip patterns two to three times daily following cold applications, progressing to progressive-resistance exercise using pulley, isokinetic, or free weight (10 reps, 3 sets) once daily.
Optional: Flutter kick swimming once daily.
General body maintenance exercises are conducted three times a week as long as they do not aggravate the injury.

Phase 4

Management Phase

Goals: To restore full power, endurance, speed and extensibility.

Therapy

If symptom free, precede exercise with ice massage (7 min) or ice pack.

Exercise Rehabilitation

Added to phase 3 program, jogging on flat course slowly progressing to a 3-mile run once daily and then progressing to figure-8s, starting with obstacles 10 feet apart and gradually shortening distance to 5 feet, at full speed.

Phase 5

Management Phase

Goals: To return to sport competition.

Exercise Rehabilitation

Athlete gradually returns to pre-competition exercise and a gradual return to competition while wearing a figure-8 elastic hip spica bandage for protection.

Criteria for Returning to Competitive Basketball:

As measured by an isokinetic dynamometer, the athlete's injured hip and groin should have equal strength to that of the uninjured hip.
Hip and groin has full range of motion.
The athlete is able to run figure-8s around obstacles set 5 feet apart at full speed.

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Article by Brad Walker and The Stretching Institute
Copyright 2010. All rights reserved.
Brad is a leading stretching and sports injury consultant
with more than 20 years experience in the health and
fitness industry. For more articles on stretching, flexibility
and sports injury management, please visit:
The Stretching Institute
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