Groin Strain

A groin strain is a tear or rupture to any one of the adductor muscles resulting pain in the inner thigh. Groin injuries can range from very mild to very severe injuries that are completely debilitating.

Initial treatment involves protection, rest, ice and compression during the early acute stage followed by a thorough rehabilitation and strengthening program.

Symptoms

The main symptoms of an acute groin strain is a sudden sharp pain in the groin area, either in the belly of the muscle or higher up where the tendon attaches to the pelvic bone. It might be felt when sprinting or changing direction quickly. The athlete may or may not be able to play on depending on how severe the injury is. Although there is often swelling (oedema) as a result of a groin strain this is often not visible to the naked eye. Groin strains are graded 1, 2 or 3 depending on the extent of the injury. Grade 1 is a minor tear where the athlete feels discomfort but can walk without much pain. Grade 2 is likely to result in more severe pain, bruising and swelling. Grade 3 is a complete or almost complete rupture.

Read more on symptoms and diagnosis.

Causes

Groin strains are usually occur when sprinting or changing direction quickly or during rapid movements of the leg against resistance such as kicking a ball. Over stretching the muscle such as in martial arts high kicks can also cause a torn adductor muscle.

There are five groin (adductor) muscles; three of them are called the 'short adductors' (pectineus, adductor brevis and adductor longus) and the other two are called the 'long adductors' and consist of gracilis and adductor magnus. Although muscle strains can occur randomly there are factors which can increase the likelyhood of sustaining injury. These include not warming up properly, having weak adductor muscles, tight adductor muscles, previous injury, lower back problems and biomechanical factors.

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Treatment

Treatment for a groin strain is based around administering immediate first aid of cold therapy and compression to minimise bleeding and swelling and then following a full rehabilitation program which includes stretching, strengthening and functional / sports specific exercises to restore the muscle back to full function

The P.R.I.C.E principles (protection, rest, ice, compression and elevation) should be applied as soon as possible after injury and for the first 72 hours. A cold therapy and compression wrap will help stop internal bleeding, reduce pain and swelling speeding up the healing process. Wearing a groin support or strapping is also useful in the early stages in order to minimise pain and support the muscle while it heals. The use of groin supports / shorts is useful to protect and support the muscle while it is healing. They can also be used during the various stages of rehabilitation and when finally returning to playing sport to warm up and support the muscle during exercise.

After the initial acute stage a progressive stretching and strengthening exercise program is advised to ensure the muscle regains pre-injury levels of strength and flexibility and is therefore less prone to re-injury.

Sports massage may help once the acute stage has passed (after 72 hours) by releasing tension in the muscle and encouraging blood flow and nutrients. Caution is advised as massaging an injury too soon may increase the bleeding and may make the injury worse. Electrotherapy modalities such as ultrasound may be used by a professional practitioner to aid the healing process.

Read more on groin strain treatment.

See more on groin strapping

Exercises

After the initial acute stage of the injury has passed, a gradual rehabilitation program consisting of stretching and strengthening exercises should begin.

Short adductor stretch

Stretching exercises should always be pain free starting with gentle static stretches and progress through to more sports specific stretches performed dynamically (with movement). Do not start stretching too early as the healing of the muscle may be compromised (not before day 5 post injury). Exercises to stretch both the short adductor muscles and the long adductor muscles should be done.

Strengthening exercises aim to gradually increase the load that is put through a muscle and can start as early as day 5 as long as they are low-level and pain free. Isometric or static exercises are advised first and do not involve any movement of the muscle. Eccentric exercises are more advanced exercises which focus on strengthening the muscle whilst it lengthens rather than shortens as all the previous exercises have done. A therapist or partner is needed to assist with this one. Dynamic exercises with resistance band are performed as the muscle gains in strength.

Functional exercises are more sports specific exercises and involve running, chang of direction drills, hopping and plyometric exercises. These bridge the gap between rehabilitation exercises and returning to full training and competition.

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