Below are examples of exercises that may be used in the rehabilitation of a groin strain. We have split the following into stretching exercises, strengthening exercises and functional or sports specific exercises.
Always seek professional advice before starting a rehabilitation program. The exercises below should form part of a full groin strain rehab program.
Stage 1 - Acute stage
Stretching should not be done during the initial acute phase (usually 72 hours but may be longer).
Do not progress to stage 2 until at least 5 days post injury. Only move to stage 2 when walking is pain free and getting in and out of bed or a car is pain free.
Short adductor stretch - groin stretches performed with bent knees will target the short groin muscles. 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. 3 x hold for 10s, 1 x day and build to 2 x day.
Move to stage 3 when stretches are pain free with no reaction immediately afterwards or the next day, and you have done the stretches for 5 days. All stretches must be performed pain free and do not push too hard.
Continue bent knee groin stretches up to 3 sets per day and then introduce straight leg groin stretches in standing and seated positions.
Straight leg standing groin stretch - keeping the leg straight targets 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. Hold for 30 seconds and repeat 5 times a day. Changing the angle of the foot on the floor stretches different parts of the muscle.
Seated groin stretch - can be done in a more relaxed way taking the load off the muscle whilst stretching.
Hip flexors - although strictly not one of the groin stretches this exercise is still important. The adductor muscle assists in flexion of the hip (pulling the knee forwards and upwards). This will stretch the adductor muscles more specifically in the direction they are used for running. Assume the position as shown with one knee on the floor. Gently lean forward to increase the stretch. Hold for 30 seconds, repeat 5 times a day.
Move to stage 4 when able to jog pain free and stretches are pain free with no reaction later on or next day . All stretches must be performed pain free and do not push too hard.
Dynamic stretching - this should be done as the athlete returns to full activity. Dynamic stretching will stretch the muscle whilst it is moving and should be part of any warm up prior to training.
Gently swing the leg in a relaxed manner. It should not be forced. Forcing the muscle is ballistic stretching and can cause damage to the muscles. Aim for 10 swings on each leg, repeat 3 times a day. A good, relaxed swing is what is required, gradually increasing the height of swing.
Continue stretches until fully fit and before exercise when back fit. All stretches must be performed pain free and do not push too hard!
Groin strengthening exercises can be begin as soon as pain allows after the initial acute healing phase. Do not do any exercise if it is painful as you may be making the injury worse.
Stage 1 - Acute stage
No strengthening exercises at all during the acute stage. Be patient and rest. Focus on appling the treatment techniques for the first 2 to 5 days.
Only progress to stage 2 when pain free on walking and after at least 3 days of no strengthening.
Begin isometric or static exercises 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. They should be performed with legs bent and straight, and ideally they should also be done with varying amounts of stretch on the muscles.
Short adductor muscles are strengthened with the legs bent. Resistance can be applied by a therapist or partner with the hands or medicine balls and gym balls are also very convenient to help with these exercises. Start with 3 sets of 10 secs once a day and build up to 3 sets of 10 secs done twice a day. To work the short adductors in the outer range a much larger gym ball can be used.
Long adductors - place a ball between the ankles, with the legs straight and gently press inwards with the legs. Squeeze the legs together and hold, relax and repeat. Start with 3 sets of 10 secs once a day and build up to 3 sets of 10 secs done twice a day.
Start core exercises to improve abdominal strength because of the close relationship of the groin and abdominals
Move to stage 3 when walking normally and pain free on 3 sets of 5 reps of 30s holds for both bent and straight knee isometric exercises and with no reaction next day.
Start dynamic groin exercises with theraband or cables in a gym. Dynamic exercises involve movement against resistance.
Straight leg raise - this is a more advanced exercise. Sit upright with feet rotated outwards. Lift one leg slightly off the ground, move leg outwards whilst keeping off the ground. Return to the middle, then either rest for a couple of seconds, or if strong enough take the leg out again without resting. Aim for 3 sets of 10 repetitions daily.
This exercise can be progressed further by performing it on a couch or bed with one leg relaxed down the side of the couch. Raise the leg upwards and across the other leg, lower and repeat 10 times. Build up to 3 sets of 10 then increase the resistance by adding a weight to the ankle.
Eccentric adduction exercises are more advanced exercises which focus on strengthening the muscle whilst it lengthens rather than shortens as all the previous exercises have done. It is important to see how the muscle is the following day before over doing this exercise as eccentric exercise are more likely to produce muscle soreness.
With the patient sitting down, legs out straight, the therapist slowly moves the leg out to the side and the patient resists the movement but not so much that the leg doesn't move. This can be done very gently at first with the therapist increasing the resistance load and intensity over time.
Hip adduction against gravity - there are three different ways of performing hip adduction exercises using gravity for resistance. In the first one a chair is used and the lower leg raised towards the top one. Hold briefly then lower and repeat. Begin with 1 set of 10 reps building to 3 sets of 15 reps daily.
A slightly harder variation involves lying on your side with the top leg bent over to the front of the lower leg. The lower leg is raised as high as is comfortable, hold briefly then lower. This works the adductor muscles in the inner range of motion.
Finally, the most difficult version brings the core muscles into play as both legs are straight lying sideways again. Raise the top leg up then by contracting the adductor muscle and keeping the core muscle firm the lower leg is raised up to meet the top leg. Hold briefly then lower and repeat. Ankle weights can be used to increase the difficulty of any of these exercises.
Resistance band adduction works the adductor muscles through both the inner and outer range of motion. Tie one end of a section of resistance band around your ankle. Tie the other end around something sturdy, close to ground level. Stand away from the attachment point, standing on the uninvolved leg and hold on to something for balance if necessary.
Take the involved leg out to the side as far as possible and make sure the band is taught in this position. Keep the knee straight as you bring your leg in to the center and across the supporting leg, against the resistance of the band. Slowly return to the starting position and repeat 10 times initially. Gradually increase the number of reps you perform.
Hip abduction exercise will strengthen the muscles on the outside of the hip rather than the groin or adductor muscles. It is important to do all round hip strengthening exercises. Take the leg out to the side as far as possible. Slowly bring it back to the center. Make sure you have something to hold on to.
Use a resistance band or ankle weights for increased difficulty. Aim for 3 sets of 10 to 12 reps. This exercise can also be done lying on your side and using gravity for resistance. Do both sides to make sure there is no imbalance.
Hip extenson works the buttocks and hamstrings, the band is wrapped around the ankle and anchored to a table leg. The athlete faces the anchor point and starting with the band just taught, pulls the leg backwards against the band’s resistance. Slowly return to the starting position, maintaining control throughout.
Progress to stage 4 when able to perform 3 sets x 15 reps of cable theraband exercises pain free with no reaction the next day and after a minimum of 3 days exercises at this level and with no associated reaction next day.
Stage 4 includes more advanced functional exercises which are more relevant to the specific demands of sport.
Side lunges to strengthen the groin muscles in a more functional position. By using a medicine ball in the lateral lunge (side lunge) the athlete is able to add weight to the exercise as well as using it to aid balance. The athlete steps to the side keeping the toes forwards and the feet flat. Whilst keeping the involved leg straight, squat through the hip of the involved leg ensuring that the knee is in line with the foot. The athlete holds the ball out to help maintain balance. Squat as low as possible and hold for 2 seconds. Push back to the starting position.
Wide leg Squat - performing a squat in a wide leg position works the adductor muscles (groin) more than a conventional squat. The starting position for a wide leg squat is with the feet more than shoulder width apart and the toes pointing outwards. From here the athlete bends both knees, keeping back straight. Ideally the knee should reach a right angle (90 degrees), but if not this is something you can work on. Don't go past a right angle. Make sure the knees do not more in front of the toes, keep your weight over the mid foot and heel.
Progress to stage 5 when able to perform 3 sets x 6 reps side lunges and squats pain free and no reaction and after a minimum of 5 days of these exercises and with no reaction next day.
Download our step by step groin rehab chart here.