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Groin Strain Symptoms Causes Treatment Preventions & More All you need to know

December 28, 2021

Injury to the adductor muscles present on the inner side of the thigh is called a groin strain.

As a common sports injury, groin strain can be mild to severe and is caused by sudden movements of the leg, as in kicking.

Groin Strain Symptoms Causes Treatment Preventions

Anatomy of the inguinal ligament involved in groin strain

The inguinal ligament is a band of connective tissue in the lower limb. It extends from the anterior superior iliac spine of the ilium bone (part of hip bone) to the pubic tubercle on the pubic bone.

The ligament is formed by the free lower border of the external oblique muscle, which attaches to these two points between the iliac and pubic bone. The ligament forms the boundary of the femoral triangle and the inguinal canal present in the pelvis. It is closely related to several structures.

The ligament functions to attach external oblique muscle to the pelvis. It also protects all the structures passing between the pelvis and thigh (external genitalia).

The groin, also called the medial compartment of the thigh, is the junction between the abdomen and the thigh. It lies on either side of the pubic bone.

The groin strain may involve three large muscle groups;

  • the abdominal
  • iliopsoas
  • adductor group

The adductor group of muscles includes six muscles, and it is the adductor longus muscle involved in the groin strain.

Strains to the groin muscle are frequently encountered in ice hockey and soccer than in other sports because the movements require eccentric solid contraction of the adductor muscle.

The strain occurs at the insertion of the tendon of the adductor longus muscle to the bone.

Causes of a groin strain

Groin strain most often occurs in the dominant leg of an athlete when he kicks aggressively. In addition, sports like soccer, ice hockey, and ice skating often require turning quickly while playing and may strain the adductor muscle.

Lengthening action at the same time of contracting of adductor results in strain. As a result, the muscle may overstretch and experience tears also. Basketball, football, rugby, skating, tennis, and martial arts are some other sports that involve this injury.

Some other causes of groin strain include;

  • Falling
  • Lifting heavy objects
  • Resistance training
  • Overuse of a muscle

Symptoms of a groin strain

Symptoms of a groin strain depend upon the extent of the injury. It can range from mild to severe. These include;

  • Pain which is usually felt in the inner thigh
  • Pain may also occur anywhere from the hip to the knee joint
  • A snapping sound at the time of impact
  • Decreased strength in the upper leg
  • Apparent swelling
  • Bruising on the affected site
  • Difficulty walking or running

Groin strains are of three types;

  • Grade 1

A grade 1 groin strain damages about 5% of the muscle fibers: the muscle is usually overstretched or torn. Walking without pain is possible but running, jumping, kicking, or stretching is associated with pain. This grade requires two to three weeks to recover.

  • Grade 2

More fibers are damaged in the grade 2 groin strain. As a result, walking becomes difficult and is associated with pain. Bringing your thighs together is also a problematic move. Grade 2 requires two to three months to heal and recover.

  • Grade 3

A grade 3 groin strain involves most or all of the muscle or tendon. The injury is severe enough to cause sudden sharp pain. Any movement is painful. There may be associated bruising and swelling. On examination, a gap in the adductor muscle is palpable. Grade four take maximum time to recover, usually four months or more.

An x-ray and MRI scan confirms the diagnosis. The tests also help differentiate the condition from a stress fracture in the femur (thigh bone) or the pubic bone, hip bursitis, and hip sprain.

Treatment

The goal of treatment immediately after an injury is to reduce pain and swelling and facilitate movement. Grade 3 strain requires surgery followed by rehabilitation.

  1. Immediately after the injury to first few days
  1. RICER
    1. Medication
    1. TENS
  • After few weeks, when the injury has healed.
  • Massage

A thigh massage helps to recover in groin strain. The techniques are focused on the hamstring and quadriceps muscles, which are the front and back muscles of the thigh. The techniques help in reducing muscle tightness, relieve pain and increase blood circulation.

Standard techniques used during a thigh massage for groin strain include:

  • Effleurage

This technique improves circulation and enhances lymphatic drainage, thereby removing muscle waste accumulated during injury. In addition, the method is applied with flat hands and fingers and raises the local temperature, which helps relieve pain.

  • Kneading

Kneading involves squeezing and pulling the muscles gently. It improves circulation and speeds up recovery.

  • Frictions

Fingertips and thumb are used to apply friction massage to the thigh. This improves flexibility and preserves the range of motion in the thigh adductors. It helps to break the collagen fiber during healing.

  • Wringing

Wringing massage is done using flat hands and fingers. The tissues in the muscles are picked up from both sides of the thigh and then pulled inwards towards the center. The pressure during the massage varies. The technique helps loosen and stretch muscles.

  • Therapeutic ultrasound

Ultrasound therapy helps to relieve the pain after recovery of the strain.

  • Active rehabilitation

Some exercises for actively rehabilitating groin strain injury include;

Hip adductor stretch

  • Lie on your back. Bend your knees.
  • Press and plant your feet firmly into the floor.
  • Now keep the soles of your feet together and make your knees slightly drop open to the sides.
  • Drop as far as comfortable. The inner thighs receive the stretch.
  • Hold this position for half a minute.
  • Return to starting position and repeat at least three times.

Hamstring stretch on wall

  • Lie down on your back and position yourself near a doorway or a footstool
  • Extend out your healthy leg on the open space in the door opening or alongside the footstool.
  • Position the injured leg along the wall gently next to the doorframe.
  • Your affected leg should be extended straight out on the wall.
  • Hold this position for few seconds before releasing slowly.
  • Repeat three times.

Straight leg raise

  • Lie on your back on the floor. Extend your legs straight.
  • Bend the knee of your healthy leg.
  • Take support by pressing the healthy foot into the floor.
  • Begin by engaging the thigh muscles on the affected side.
  • Raise your affected leg a few inches from the floor or to a height you are comfortable without pain.
  • Bring back your leg to the floor. Make sure to move it slowly.
  • Do at least two sets of ten reps each.

Persistence of symptoms for more than six months after all the conservative treatment has been applied merits surgery. However, surgery is only indicated after an appropriate physical therapy regimen and a period of rest and protected weight-bearing with crutches has been observed.

Prevention of groin strain

  • Athletes who play high-risk sports for groin strain must practice in the off-season. This will help keep their muscles active and strong.
  • Any history of previous groin strain also weakens the muscle and poses a risk factor, so active rehabilitative exercises should be maintained.
  • Avoid activities that cause pain when moving your thigh till complete recovery.
  • Resume activities gradually but do not stay inactive.
  • Adopt proper training to learn sports techniques specific to your game.
  • Continue with regular training and practice throughout the year. Work up gradually if a break is needed to avoid groin strain.
Abdur Rashid
Medically Reviewed By Abdur Rashid
MSC Public Health, MCSP, MHCPC
BSC (Hon) Physiotherapy
Consultant Neuro-spinal & Musculoskeletal Physiotherapist

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