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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.
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. 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.
How bad is my groin strain?
A Grade 1 groin strain is a minor tear where less than 25% of fibers are damaged. An athlete who has sustained a grade 1 injury feels discomfort in the groin or inner thigh but can often walk with minimal or no pain. He/she are often unable to recall when the injury actually occurred and the pain in the muscle may only be noticed after exercising has stopped. The groin muscles may feel "tight" and there may be an area which is tender to touch. Walking is often normal, discomfort may only develop during more strenuous activities such as running or sudden changes of direction during sport. Pain on stretching the groin muscle may be present, especially when compared to stretching the groin muscles on the opposite leg.
A Grade 2 injury is a moderate tear which involves damage to 25% to 90% of fibres. The athlete will often know when the injury occurred and will feel a sudden/sharp pain in the area of the groin (adductor) muscles during exercise. Bruising and swelling will usually develop over the next few days but this may not be visible to the naked eye. The injured muscle will be weak and painful when attempting to contract the muscle - this is easily tested by squeezing your legs together with a ball between your knees. Pain will also be felt on stretching the groin muscles.
Grade 3 groin strains are the most serious and involve either a complete (100%) or almost complete rupture (90%+) of the muscle. The main symptom of a Grade 3 groin strain is severe pain during exercise (the athlete will definitely be able to recall when the injury happened) and in particular on sudden changes of direction during running and on kicking (such as a ball). The athlete will be unable to contract the groin muscles when squeezing the legs together and this is due to a combination of weakness and pain. Substantial swelling and bruising will usually develop around the inner thigh area and this may become visible within 24 to 48 hours. Finally, pain will also be felt on attempting to stretch the groin muscles and there may be a "gap" or "lump" in the muscle where the muscle has completely torn.
See more on assessment and diagnosis.
Treatment for a groin strain is based around administering immediate first aid to minimise bleeding and swelling and then restoring the muscle back to full function. The early stages of treatment include cold therapy and compression which are part of the P.R.I.C.E principles (see below). A groin support or strapping is also useful in the early stages in order to minimise pain and support the muscle while it heals.
In addition to the supports, 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 can also be useful in the rehabilitation stages in order to help restore muscle function and flexibility but should not be used in the early stages of healing because it may lead to an increase in bleeding/swelling.
P.R.I.C.E stands for Protection, Rest, Ice, Compression and Elevation. The treatment principles of PRICE should be used in the first 72 hours of an injury. Protection of the injured groin (adductor) muscle can be achieved by wearing an elasticated support and this will make the injured area feel more comfortable especially in more severe injuries. The muscle should be rested from all sporting activities in the early stages of healing and cold therapy applied to the area for no more than 15 minutes at a time - this is best achieved by using a cold pack and compression bandage as this applies both cold and compression in one application. Elevation of the injured limb should also be done in the early stages and this is best achieved by lying on a sofa with the leg rested up on 2 pillows.
Groin supports & strapping
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. Thinner lycra type compression shorts can then be used when rehabilitating the injured muscle and when returning to full fitness.
See more on groin strapping
After the initial acute stage of the injury has passed, a gradual rehabilitation program consisting of stretching and strengthening exercises should begin. 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).
Short adductor stretch
Groin stretches performed with bent knees will target the short groin muscles. Assume the position as shown. Gently press down with the elbows onto the knees to increase the stretch. If it is painful then stop. You should feel a gentle stretching in the inner thigh.
Long adductor stretch
This groin stretching exercise will stretch the long adductor muscles that attach below the knee. Stand with your feet wide apart as shown, and lean away from the side you are stretching.
See more on stretching exercises
The aim of strengthening exercises is to gradually increase the load that is put through a muscle. Strengthening exercises 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 then progress to dynamic exercises with resistance band and finishing with sports specific running and sprint drills.
Isometric or static exercises are where the muscle contracts but there is no actual movement. They are usually the safest strengthening exercise to start with in the early stages of rehabilitation. Gym balls can be used to target the adductor muscles.
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.
See more on strengthening exercises
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 and therefore it is important to wait until the initial healing is complete. Very gentle massage can be applied in the early stages and as the injury heals and muscle gets stronger, massage can be applied more deeply. Massage should always be performed by a professional therapist to avoid causing additional damage to the injury.
See more on sports massage for groin strains
Groin strain injury in detail
Pain in the groin can be due to a number of causes and can come on gradually or very suddenly. If an acute (sudden onset) groin injury is not treated efficiently and correctly it may become prone to recurring and chronic/long term in nature. It should be stressed that chronic injuries are much harder to treat than acute injuries and take considerably longer to heal.
There are five groin (adductor) muscles - three of them are called the "short adductors" and include pectineus, adductor brevis and adductor longus and the other two are called the "long adductors" and include gracilis and adductor magnus.
The main function of the adductor muscle group is to pull the leg back towards the midline, a movement called adduction. They also stabilize and control the pelvis during movement of the legs during most activities including walking, running, sprinting, playing football, horse riding, hurdling and any sport which requires rapid changes in direction. This is achieved by the adductor muscles on one side keeping the pelvis level and still while the adductor muscles on the opposite side are used to move the leg.
A rupture or tear in the muscle usually occurs during activities such as sprinting, changing direction or during rapid movements of the leg against resistance such as kicking a ball. The likelihood od sustaining an injury is increased if a thorough warm-up has not been completed first! Finally, repetitive overuse of the groin muscles may result in adductor tendinopathy or chronic inflammation of the groin which are often long term injuries and are much harder to treat.