Groin Pain in Athletes

Groin pain is extremely common amongst athletes, especially in sports that require kicking, quick accelerations/decelerations and sudden direction changes, such as soccer and Football. Groin pain can be classed as a range of conditions but the three main causes are muscle strains, inguinal hernias and hip related problems. Of these conditions, adductor (groin) strains are increasingly becoming more common, more often due to hip related problems.

How do I know if I have an adductor strain?

The athlete can generally tell you the exact moment it happen, for example in a tackle, stretching for the ball or a sudden change of

direction. The athlete will report a pulling feeling in the muscle with the onset of sudden pain in the muscle. The athlete would be unable to continue playing or training and will continue to have pain with activities involving movements of the hip to the side of the body as well as pain when walking up stairs.

On examination by your Physiotherapist, the athlete will experience pain when palpating the adductor muscles. The pain is generally localised to the area of the torn muscles and may have little referred pain due to swelling and possibly bruising. The athlete will also have pain on resisted movements across the body and movements out to the side of the body.

How should I treat this injury?

The first thing you should do is apply ice to the injured body part keeping it on for 10-15 minutes every 30 minutes following the injury. You should then seek further assistance from a treating Physiotherapist closest to you. Your Physiotherapist will perform a detailed examination of your condition and develop an appropriate treatment/management plan to ensure you return back to sport at your optimal performance.

The first stage of treatment is to limit the swelling and prevent further injury. This involves the athlete to rest and avoid all painful movements/activities, ice the injured area as directed, take anti-inflammatories to help control swelling and apply compression.

The next stage is to limit muscle wastage and regain range of motion in your hip and knee joints. Your Physiotherapist will prescribe you with some gentle exercises to help regain your range within your pain limits.

You’re Physiotherapist may also use modalities such as ultrasound, TENS or Interferential to assist in healing muscle tissue and removing swelling.

The last stage begins when the athlete has full, pain free movements.

This is where the athlete will aim to regain strength (adductor, core and pelvic strength), flexibility (adductors and hip muscles), proprioception (activities on uneven surfaces) and endurance (cardiovascular and strength). The athlete will first start with low weight and high repetitions progressing to heavier weight with fewer repetitions as their pain and strength improves. After the athlete has regained 70-80% of their strength, your physiotherapist will assist you in a program to improve your running, agility and return to sport drills. Once your Physiotherapist is happy with your progress, they will return you back to sport first with limitations and then full play.

Note: It is important that you do not return to sport too early as this can lead to chronic groin pain which is even more difficult to treat.

Why am I not progressing quickly?

There are a number of factors which affect healing times; main one being patient compliance. Other factors which delay healing times include;

1.     Anatomical Features

The adductor muscles attach directly on to the pubic bone (as shown in the picture above) which has poor blood supply. This has a direct impact on the healing rate of adductor strains as tissue healing requires a good blood supply. Especially if you have a muscle tendon strain which requires further blood supply.

2.       Pain

Following muscle injury, scar tissue forms along the deep fascia (layer around muscle). Fascia and scar tissue have a high blood supply, so when a muscle pulls on the scar tissue the pain refers to the nearest part of overlying skin. This can cause the athlete to experience ‘deep pain’ and become reluctant to move into range and start strengthening exercises. If these muscles become shortened and tight, they contribute highly to pelvic instability (muscle imbalances).

3.     Muscle imbalances

Muscle imbalances can cause a disturbance of the combined action of the hip joint muscles. Muscle imbalances around the pelvis have been suggested as a pre-cursor in adductor related pain and if not corrected during rehabilitation, these imbalances may not only be the cause of adductor strains but also prevent full recovery. Similarly, a loss of core stability has been demonstrated to overload the adductor muscles. Following an acute strain of the adductor muscles this increased overload may prevent a minor strain from healing and become more of a long term injury.

4.     Neural Components

It is important for your physiotherapist to test how well your nerves slide/glide. Factors that can affect normal neural structures are;

  • Local swelling which increases neural sensitivity. If you suffer from increased swelling then you are more likely to increase your sensitivity of the nerve/s around the area.
  • Scar tissue formation amongst the muscles may prevent movement of the nerves as they pass through the muscles
  • If you have had previous surgeries such as removal of your appendix, hernia repair or a caesarean then you are more likely to have altered fascia around the pelvis which can prevent nerve mobility.
  • Tight hip flexors (muscles that bend your hip) can cause stiffness in your lower back, especially in athletes who play sports involving kicking a ball. The nerves from your spine exit from your lower back so you are more prone to develop nerve stiffness.

How do I prevent groin pain?

Your Physiotherapist should design you a strengthening program to address which muscles are weak and which muscles are tight. This generally includes strengthening the muscles around your pelvis and your core strength. This should be incorporated with stretches to be completed following all training/gym sessions. This will prevent any joint stiffness and allow your muscles and nerves to move at their optimal length.