Of course, I can help. This was a question from a patient in his 20s who regularly played soccer in an adult league. He ran and played soccer frequently but was not very diligent about stretching. This left him tight in both of his hips. When kicking a long pass to a teammate, he felt a sharp pain in his upper inner thigh and groin. It sounded like an adductor strain to me which means that recovery could take a while. It was, in fact, an adductor strain. He did successfully return to soccer, but it took about 4 months.
What are the adductors?
The adductors are a group of 5 muscles. There are 3 short adductors and 2 long adductors. The short adductors are the pectineus, adductor brevis, and adductor longus. These muscles attach to the pelvis and extend to the inner thigh bone. The 2 long adductors the gracilis and adductor magnus. These muscles attach to the pelvis and extend to the knee. Together these muscles help to stabilize the pelvis and perform hip adduction (moving the leg towards the midline of the body). The adductor longus is the muscle that is most likely to be injured with an adductor strain.
What is an adductor strain?
A strain is an acute injury to the muscle and/or tendon. The musculotendinous junction is the most common area of injury in a muscle strain. This is the area where the muscle transitions into tendon in order to attach to a bone. In adductor strains the injury typically occurs at the musculotendinous junction of the adductor longus where it attaches to the pubic bone. This makes it a very common cause of groin pain.
How does the muscle get injured?
There are 3 different ways that the muscle can be torn.
- Direct blunt-force trauma – This is a strain that is a result of a direct force to the adductors. For example, a direct hit in the inner thigh from a baseball or a football tackle. This will cause injury and bleeding in the muscle.
- Forceful contraction – This is the most common cause of injury to the adductor area. This typically occurs when the muscle is activated while in a stretched position. For example, when the athlete pushes off in the opposite direction or when forcefully kicking the ball. Many, if not most, of these injuries are non-contact.
- Repetitive injury – This occurs with the accumulation of microtrauma. These are small, but repeated injuries that lead to chronic groin pain.
How bad is my injury?
Not all strains are the same. Some are more severe than others. There are grades that describe the severity of a strain.
- Grade 1: This is the mildest strain. There is only a small area of injury. Walking will, most likely, not be affected. The muscle is tender and painful but there is no loss of strength.
- Grade 2: This is a moderate strain with about half of the muscle fibers torn. Walking will be affected. There is more tenderness and pain with a significant loss in strength. There can be intense, sudden stabbing pains in the groin area when activating the muscle. Bruising and swelling could appear a few days after the initial injury.
- Grade 3: This is a severe strain in which more than half to all (complete rupture) of the muscle fibers are torn. A “popping” sound may have been heard during the injury. There is a complete functional loss of the muscle. Putting weight on the leg will be extremely difficult and painful. A person will need crutches to aid in walking.
What are the symptoms of an adductor strain?
There are several symptoms associated with an adductor strain. These include:
- Sudden onset of pain
- Intense groin or inner thigh pain
- Tenderness at or near the pubic bone where the tendon attaches
- Pain is worse with activity
- Swelling and bruising are present for higher grade strains
- Stiffness when moving the leg.
- Weakness in the leg with activity
- Difficulty walking
What sports are associated with adductor strain?
There are some sports where adductor strains are more common. These include:
- Ice hockey
- Soccer
- Football
- Tennis
- Dance
- Figure skating
- Basketball
- Horseback riding
- Baseball
Are there risk factors for adductor strains?
There are some risk factors associated with adductor strains. These include:
- Previous hip and groin injury – This is the greatest risk factor.
- Increased age
- Weak adductors
- Muscle fatigue
- Tight adductors
Is an adductor strain the same as adductor tendinopathy?
This answer is no. Strains are acute injuries which means that they have a sudden onset. Whereas tendinopathy results from continual microtrauma to the tendon. Pain from tendinopathy increases gradually over time. Also, a strain affects the musculotendinous junction, but tendinopathy is an injury to the tendon.
Who should I see?
- Physical therapy – This would be my first stop. Physical therapy can help decrease pain and swelling in the groin and inner thigh. Also, your physical therapist will slowly introduce strengthening and stretching exercises as the musculotendinous junction heals. Your PT will aid you in a gradual return to sport. Acute, less severe, strains might return to sport in 4 to 8 weeks. However chronic strains can take many months to recover and return to activity.
- Orthopedic physician – An orthopedist might be necessary if the condition is not responding to physical therapy. Your physician can prescribe medication, give a steroid injection, or order imaging if needed. Since this injury can take a prolonged time to heal, conservative care is continued for several months before surgery is considered. Surgery is an option if your condition does not respond to any conservative treatment.
What can I do?
- Relative rest – Resting the area to decrease further pain and damage is required for healing. Depending on the severity of the strain, this might mean no activity, or it could mean activity that does not cause further pain. For milder strains walking, biking, and swimming could be alternate forms of activity. Returning to some form of cardiovascular exercise that does cause any further damage to the muscle is important in maintaining aerobic capacity and strength for eventual return to sport.
- Ice – Ice can help decrease pain and swelling in the muscle. Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or is preventing you from participating in an activity. Ice immediately after activity.
- Stretching – Gentle stretching is appropriate during the initial stages of healing. However, once the pain and swelling has decreased, you can gradually become more aggressive with your stretching. Stretch the short and long adductors separately. See the video below.
- Strengthening the muscles around the adductors – It is important to strengthen the muscles around the hip. This includes your gluteal muscles, quadriceps, and the hamstrings. It is also important to strengthen your core muscles. All these muscles will help take some of the stress off of the adductors. Using ankle weights and loop resistance bands can increase strength and difficulty.
- Strengthening the adductors – You will need to strengthen the adductors as well. This is to be progressed slowly as not to place too much stress on the injured muscle too quickly. This is why having a physical therapist to guide you through the rehab process is essential. The first video is isometrics and can be done at the beginning of your healing process. The next video is more mid-stage rehabilitation strengthening and should only be performed once the pain has subsided significantly. There should be minimal soreness when performing the exercises and no pain afterwards. Using resistance bands and ankle weights can increase strength and difficulty of the exercises. See the videos below.
In review
- The adductors are a group of 5 muscles. These muscles work together to adduct the hip (bring it toward midline)
- There are 3 short adductors and 2 long adductors.
- The short adductors are pectineus, adductor brevis, and adductor longus.
- The 2 long adductors are gracilis and adductor magnus.
- A strain is an acute injury to the muscle and/or tendon.
- The musculotendinous junction is the most common area of injury in a muscle strain.
- Most common cause of injury is a forceful contraction of the muscles during sports or activity.
- Adductor strain is a very common cause of groin pain.
- There are grades of muscle strain from grade 1, which is very mild, to grade 3, which is severe.
- Adductor strains are more common in certain sports including ice hockey, soccer, and football.
- Severe strains can take months to heal and return to sports.
- Conservative care including anti-inflammatories and physical therapy should be tried for several months prior to considering surgery.
- There are things that you can do including:
- Relative rest
- Ice
- Stretching
- Strengthening
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.