What is a Groin Strain?
A groin strain is a tear of the adductor or groin muscles at the top of the inner thigh. Damage to the insertion of the abdominal muscles or inguinal ligament may also play a role in groin pain. It is a common condition in athletes involved in multidirectional sports such as soccer and gaelic. Groin strain can be a rehab challenge as it can be tough to manage symptoms while continuing to play sport and athletes don’t want to take time out mid-season to recover fully.
What causes Groin Strain?
Groin pain normally occurs in two scenarios:
- At a time in the season when there is an increase in overall training volume or intensity
- Early in the season, when the training volume is being ramped up suddenly. This often coincides with multidirectional movements such as mini-game.
If the groin becomes painful, it can be challenging to eradicate, especially if training continues. The pain often re-occurs every time the athlete plays sport at a certain intensity. Frequently, the pain is minimal when running in a straight line but can increase sharply when change of direction forces are applied to the groin or there is a sprinting and deceleration element to the training.
Clinically it is observed that kicking a ball exacerbates symptoms in football players with groin pain. 40% of acute groin injuries are related to kicking (Serner et al. 2015).
Often, exercise technique and biomechanical factors can play a significant role in the development of the condition. For example, abnormal tilting of the pelvis while running can increase the forces applied to the groin and increase pain. As long as these factors continue unaddressed then groin pain can prove very difficult to resolve and is something that can lead to ongoing issues for months & even years if not managed appropriately from the outset.
Is it a Pelvic Fracture?
Pelvic fractures are an infrequent cause of groin pain. This can occur in individuals with low bone density who have taken up exercise. It can also occur in marathon runners or people without an exercise history who recently took up high load classes such as “Cross Fit” or “Body Attack”. Diagnosis of a pelvic fracture requires an MRI as x-rays can often miss fractures of the pelvis
On rarer occasions, other internal organs can cause a referral to the groin region. For example, gynaecological conditions, such as endometriosis can refer to the region.
What are the Symptoms of Groin Strain?
Groin pain normally manifests as a localised pain; however, patients will often report a pain in the thigh or buttock. This can can come in addition to or instead of their groin pain. Femoroacetabular impingement (FAI) is one of the most common reported causes of hip pain which can refer to the groin. FAI occurs when the head of the leg bone contacts the pelvis side of the joint abnormally. This can damage the joint cartilage & give rise to pain.
Often, placing the outside of the involved side ankle across the opposite leg and pushing down on the involved knee (FADIR position) will bring on pain in this case.
Is it an Inguinal Hernia?
Despite what most people think, inguinal hernias do NOT commonly give rise to groin pain. Medics can often be guilty of lumping groin pain and hernias, especially inguinal hernias together and this can create confusion in the minds of the public.
How do I manage groin strain?
An individually tailored and comprehensive rehabilitation programme is required in order to address groin strain. This should take place under the expert supervision of a physiotherapist. Hip range of motion is proposed as relevant measure when it comes to groin pain. Some believe that a decrease in hip range of motion can predispose to pain.
The evidence suggests that manual treatment of the adductors, alongside exercise rehabilitation, results in favourable outcomes regarding pain and return to play (Weir et al. 2009).
The athlete may be able to continue their activity for a short period of time if there is a major event pending; however, a period of rest is often necessary if full recovery is to occur. Rushing back to sport too early is a recipe for disaster for those who have prolonged groin pain.
A tapered exercise protocol with a gradual return to sporting activity is vital with this condition.
References:
Serner A, Tol JL, Jomaah N, Weir A, Whiteley R, Thorborg K, Robinson M, Hölmich P. Diagnosis of Acute Groin Injuries: A Prospective Study of 110 Athletes. Am J Sports Med. 2015 Aug;43(8):1857-64. doi: 10.1177/0363546515585123. Epub 2015 May 14. PMID: 25977522. https://pubmed.ncbi.nlm.nih.gov/25977522/
Weir A, Veger SA, Van de Sande HB, Bakker EW, de Jonge S, Tol JL. A manual therapy technique for chronic adductor-related groin pain in athletes: a case series. Scand J Med Sci Sports. 2009 Oct;19(5):616-20. doi: 10.1111/j.1600-0838.2008.00841.x. Epub 2008 Aug 5. PMID: 18694435. https://pubmed.ncbi.nlm.nih.gov/18694435/
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