Groin strain is “an injury to the musculo-tendinous junction of the adductors in the muscle itself or at its insertion at the pubic junction/symphysis”. That definition is quite a mouthful, but this article will attempt to clarify what the condition means in more detail.

How frequent are groin strains?

Groin strains are generally uncommon in most sports, but there are exceptions when it comes to soccer, football, basketball and swimming. Groin strains occur in 6% of all athletes and increases to 13% with sport-specific activities related to pivoting, twisting, jumping and landing (Maffulli N, Via A & Oliva F 2015). Early diagnosis and treatment are important to prevent chronic pain from developing and limit the time off the field as much as possible.³

Anatomy of the groin area

In order to understand how the injury can happen, you need to understand the anatomy of your body and how all the muscles, bones, tendons, and ligaments in the groin area work together to produce movement. All of these, as well as the fascia, are connected to the pubic symphysis, which is a joint made of cartilage in the pubic/hip bone area. The adductor, iliopsoas (a muscle which is the main flexor of the hip joint) and abdominal muscles are the three muscle groups that make up the groin area.
Groin strains generally occur in sport with sharp movements

What are the causes of groin strain?

groin strain suffered by footballers is very commonAs mentioned before, groin strains are commonly found in athletes whereby the sport demands twisting, jumping, sprinting and turning. Males are affected more than females, and 13 % of soccer players suffer from groin injuries.

There are predisposing risk factors that should be addressed in order to prevent groin strains from occurring. These risk factors include hip muscle weakness, previous injuries, level of experience and preseason training.²

There are 3 main causes of injury to the groin:
  1. Direct trauma to the area resulting in bruising and haematoma.
  2. A forceful contraction of the adductor muscle group usually in the lengthened position of the muscle. This is usually the most common groin sprain.
  3. Overuse injuries of the adductor muscle resulting in a repetitive strain.

Groin strain can occur from an awkward kicking motion

What are the signs and symptoms?

The signs and symptoms of strain to the groin area depend on the severity of the injury.

  • Pain and tenderness in the groin area.
  • Pain increases when bringing your knees together.
  • Swelling and bruising depending on the severity.
  • Difficulty with taking a long stride.
  • Climbing stairs may be painful.

How is a groin strain diagnosed?

Diagnosing a groin strain with physiotherapyA physiotherapist, sports doctor or GP needs to do a thorough clinical examination and assessment. They will likely find the following symptoms:

  • Tenderness in the groin area when the specialist uses their hands to press the area.
  • Pain with resisted adduction.³
  • Pain when stretching the adductor muscles.
  • Using the squeeze test to differentiate between pain from the iliopsoas, adductor or abdominal muscles.

If there is confusion in the diagnosis, further investigation can be done via an ultrasound test or MRI but is often unnecessary.

What are the treatment options and prognosis for groin strain?

Practitioners generally prefer to treat this type of injury without invasive surgery, but rather focus on therapy:

  • Relative rest, ice and compression techniques
  • Gentle active range of motion exercises guided by your physiotherapist
  • Physiotherapy for scar tissue management
  • Possible use of crutches if needed
  • Anti-inflammatory medication
  • Rehabilitation exercises & sport-specific exercises within pain limits

An adductor strain injury prevention programme is usually made up of the following exercises:

  1. Warm-up
  2. Stretches
  3. Hip strengthening exercises
  4. Core/Abdominal strengthening exercises¹

Athletes can return to play depending on the severity of the injury, but as soon as they have full strength and the usual range of motion in movement, they can begin their normal activities. The severity of the injury can range from a minor Grade 1 strain, where time out of sport is minimal, whereas if they have a Grade 3 tear where they cannot function normally, it may take up to six months before they can return to play¹. Surgery is only an option if there has been no improvement within six months of rehabilitation and conservative treatment.

This article was submitted by Rikki Malherbe who practises at the Paulshof branch of Lamberti Physiotherapy. You can contact her to discuss any concerns with groin strain.

References
1. Tyler TF, Silvers HJ, Gerhardt MB & Nicolas SJ. 2010. Groin injuries in sports medicine. Sports Health, 2(3): 231-6
2. Nicolas SJ & Tyler TF. 2012. Adductor muscle strains in Sport. Sports Medicine, 32, 339-344 (2002)
3. Morelli V & Smith V. 2001. Groin Injuries in Athletes. Am Fam Physician, Oct 15;64(8); 1405-1415
4. The Health Engine 2020. Accessed 31 March 2020.
5. The Physio Company 2012. Accessed 1 April 2020.
6. Physiopedia 2020. Accessed 1 April 2020.