Groin Strains: Management and Prevention
The Missoula seasons have turned, temperatures are increasing, spring sports are in full swing, and we are amidst professional playoffs (Go Seattle Kraken!)
Whether it’s the weekend warriors on my adult rec league soccer team or Chris Paul for the Phoenix Suns, groin strains are a common injury that can keep an athlete from sports performance for weeks to months at a time.
What Makes a Groin Strain?
When we experience symptoms in our groin, there are a few different tissues that could contribute (see below and left) (1). Groin strains refer to the strain of the inner thigh muscle group, the adductors (see below and right).
Groin or adductor strains are very common in cutting sports (soccer, hockey, lacrosse, American football, basketball). Risk for an adductor strain increases when an athlete has had a previous groin injury, reduced strength/flexibility of the adductor muscle group, higher level of play, and less sport-specific training (2).
Strains can occur while an athlete is kicking, changing directions, jumping, reacting to a play, or overuse (3). Symptoms may include tenderness to the touch, discomfort with stretching, and pain when using the muscle. A quick functional test to assess for adductor-related pain is a side lunge. If you experience significant or prolonged discomfort, swelling, bruising, or pain with walking, it would be best to seek expert advise on management.
Beginner Adductor Exercises
Adductor strains respond best to progressive strengthening. When you first experience a groin strain, gentle isometrics are a great exercise to start with (see below). Complete 10 repetitions for 10 seconds each, squeezing the object hard enough to keep your symptoms below a 3/10 pain. Here are two examples with a shorter lever arm and a longer lever arm:
Intermediate Adductor Exercises
Once isometrics are easier, a more challenging exercise is the Copenhagen adductor exercise. You can hold these for time or complete repetitions, tapping your hip to the floor. Below are the first few progressions of this awesome adductor activity:
Short lever with bottom leg support and Short lever:
Long lever with bottom leg support and Long lever:
Advanced Adductor Exercises
Leg muscles that cross two joints are more likely to strain and include the adductors, calves, hamstrings, and quadriceps. When these muscles are weak or short, they have the greatest risk of strains. Eccentric strengthening (such as lateral lunges on a slider) can help to address both length and weakness (5, 6).
Below is the final progression of the Copenhagen exercise, which includes an eccentric component. It is easy to implement with a partner and helps to reduce the risk of strains by up to 41%! (4) If you are a coach, have your players complete this exercise twice a week for one set of ten repetitions per side:
(Photo from Haroy et al, 2018 demonstrating a partner Copenhagen adductor exercise with both a long lever 3A/3B and short lever 2A/2B)
Other Considerations
The adductors also assist with hip flexion and extension and it is important to strengthen these motions as well. Finally, Otten et al 2019 found that compression shorts may help to reduce groin pain and improve comfort during competition (7) so it may be worth the investment.
If your adductor strain is stubborn, feel free to give us a call and set up an appointment so we can get you back to your sport!
Written by Benjamin Blakely PT, DPT, CSCS
References
1. Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med 2015;49:768–74. doi:10.1136/bjsports‐2015‐094869
2. Whittaker JL, Small C, Maffey L, Emery CA. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med. 2015;49(12):803-809. doi:10.1136/bjsports-2014-094287
3. Serner A, Mosler AB, Tol JL, Bahr R, Weir A. Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis. Br J Sports Med. 2019;53(3):158-164. doi:10.1136/bjsports-2018-099246
4. Harøy, J., Clarsen, B., Wiger, E. G., Øyen, M. G., Serner, A., Thorborg, K., … Bahr, R. (2018). The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British Journal of Sports Medicine, bjsports–2017–098937.doi:10.1136/bjsports-2017-098937
5. Van Dyk N, Behan FP, Whiteley R. Including the Nordic hamstring exercise in injury prevention programmes halves the rate of hamstring injuries: a systematic review and meta-analysis of 8459 athletes. Br J Sports Med. 2019;53(21):1362-1370. doi:10.1136/bjsports-2018-100045
6. Ishøi L, Sørensen CN, Kaae NM, Jørgensen LB, Hölmich P, Serner A. Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial. Scand J Med Sci Sports. 2016;26(11):1334-1342. doi:10.1111/sms.12585
7. Otten, R., Stam, S., Langhout, R., Weir, A., & Tak, I. (2019). The effect of compression shorts on pain and performance in male football players with groin pain – A double blinded randomized controlled trial. Physical Therapy in Sport.doi:10.1016/j.ptsp.2019.04.013