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ADDUCTOR TENDON STRAIN/GROIN STRAIN
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What is it?

The adductor muscles are a group of muscles in the groin area made up of six main muscles: adductor brevis, adductor longus, adductor magnus, pectineus, gracilis and obturator externus. They start at the pelvic bone and attach at the thigh (femur) and leg (tibia) bones. Their main function is to bring the hip and thigh towards the body (adduction). An adductor strain or groin strain is a stretch, pull or tear in any of these muscles or their tendons. This occurs in 10-30% of soccer and hockey players.

 

Symptoms

Symptoms of adductor tendon strain/groin strain may include:

• Immediate pain in the groin region

• A popping sensation in the groin region with an injury

• Persistent pain in the groin region

 

Sports Medicine Evaluation & Treatment

A sports medicine physician will take a complete history on how the injury occurred and perform a physical exam. In the physical exam, the physician will inspect the groin area looking for obvious deformities, swelling, bruises or collection of blood. The physician will push on the groin area towards the pelvic bone to look for deformity and pain. The physician should test adductor strength by having the patient bring his or her thigh closer to the body while applying resistance at the same time. If there is an adductor strain, there may have weakness or pain during this test.

The physician may order an x-ray because sometimes the bone where the muscles and tendons attach may break off (avulsion) causing pain. An MRI may be ordered which may show swelling and a collection will blood around the site of injury.

Typical treatment includes the following:

• Apply ice for 20 minutes 3 times a day to help with pain and swelling.

• Take anti-inflammatory medications such as Ibuprofen to help with pain.

• Crutches may be needed to reduce the weight on the injured side.

A referral to physical therapy to help strengthen the core muscles should be considered by the physician. This exercise program would usually begin with stretching before the strengthening phase. Surgery is generally not needed for adductor or groin strains. However, there is a different category of adductors injury called core muscle injury or athletic pubalgia which may need surgery.

 

Injury Prevention

Some studies have shown that a good adductor and core muscle strengthening program may reduce the extent of adductor strain injuries, but not necessarily prevent them.

 

Return to Play

Return to play will depend on the extent of injury. Adductor strains can be classified into 3 degrees. The following are the grades and expected return to play times:

• Grade 1 (Pain with minimal loss of strength and motion) – 1 to 4 weeks

• Grade 2 (Decreased strength) - 3 to 8 weeks.

• Grade 3 (Complete loss of muscle function) - 8 to 12 weeks or longer.

AMSSM Member Authors
Adae Amoako, MD and Skye Heston, MD

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.
Byrne C, Alkhayat A, O’Neill P, Eustace S, Kavanagh E. Obturator internus muscle strains. Radiol Case Rep. 2016 Dec 16;12(1):130-132.
Cejudo A, Ayala F, De Baranda PS, Santonja F. Reliability of two methods of clinical examination of the flexibility of the hip adductor muscles. Int J Sports Phys Ther. 2015 Dec;10(7):976-83

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