When adductor related groin pain is present painful/weakness will be present upon resisted hip adduction. The range of passive hip abduction will be limited compared to the uninvolved side and will provoke the familiar pain. Palpation of the adductor longus tendon may reveal increased tone and tender trigger points. Depending on the stage the conditions (acute or chronic) pain may be constant, or occur only with activity that stresses the abnormal tendon. If improperly managed in the early stages of the disorder, it is easy for these conditions to become chronic. Once the condition has become chronic, it becomes more difficult to manage.
Unfortunately most athletes with adductor related groin pain continue to train and play until pain prevents them from doing so. When the condition has reached this stage, a lengthy period of rest from sports and rehabilitation is required.
If early warning signs of a groin problem are recognized, it is possible to take appropriate action to prevent a full blown syndrome from developing.
The early warning signs are:
· Tightness/stiffness during or after activity with no relief from stretching
· Loss of acceleration and speed when sprinting
· Vague discomfort with deceleration
· Loss of distance with a long kick
With the exception of the first few days after the onset of the injury rest, and electro/thermal agents offer little to no benefit from recovery of these disorders. Active rehabilitation that is closely monitored by a knowledgeable clinician provides 10 times the likelihood of pain free successful return to sport. However, in the acute phase of injury when pain is present at rest and activity is significantly limited RICE protocol (rest,ice,compression,elevation) is appropriate. Other appropriate treatments may include NSAIDS, TENS, gentle soft tissue mobilization, sub maximal painless isometric hip adduction and gentle passive hip ROM in pain free range.
In the sub-acute and chronic phase of the condition a closely monitored progressive exercise program of hip adductor strengthening and stretching is commenced. During this phase it is explained to the patient that recovery is likely to be slow and gradual and dependent on adherence to the structured rehab program. Furthermore it is explained to the patient that some production of the familiar pain during exercise is necessary to restore normal tensile strength and elasticity in the affected tendon, but the pain should not last after completion of the routine (typical delayed onset muscle soreness associated with exercise is allowed). If pain lingers beyond a few minutes after the exercises the routine is modified. As the condition improves the program incorporates dynamic exercises, and sports specific training exercises to gradually improve tolerance for sport activity such as running, changes in direction, and kicking.
Upon full recovery the athlete is taught a prevention routine to be done 1-2 times weekly for at least a year, or permanently as part of their pre-game warm up. The warm up often includes sport specific agility drills to warm up the legs especially lateral movements. Sumo squats, ball squeezes, and unilateral lunges with reciprocal arm movements to strengthening the hip adductor tendons. Various forms of lower extremity and trunk stretches are given with emphasis on passive hip abduction to increase the elasticity of the hip adductor tendons and other muscle groups around the previously injured area.
Below are a few of the key exercises I feel are most important in the recovery of adductor related groin strain.
Brukner, P., & Khan, K. (2005). Clinical sports Medicine (Third ed.). Australia: The McGraw- Hill Companies.
McKenzie, R., & May, S. (2000). The Human Extremities: Mechanical Diagnosis and Therapy. Wellington, New Zealand: Spinal Publications New Zealand Ltd.
Tyler, T. F., Silvers, H. J., & Gerhardt, M. B. (n.d.). Groin Injuries in Sports Medicine. Retrieved august 24, 2014, from SMSMF.org/press: http://smsmf.org/press/article/groin-injuries-in-sports-medicine