A groin strain is a tear or rupture to any one of the adductor muscles resulting pain in the inner thigh. Groin injuries can range from very mild to very severe injuries that are completely debilitating.
Groin pulls are common in people who play sports that require a lot of running and jumping. In particular, suddenly jumping or changing direction is a likely cause. Although muscle strains can occur randomly there are factors which can increase the likelyhood of sustaining injury. These include not warming up properly, having weak adductor muscles, tight adductor muscles, previous injury, lower back problems and biomechanical factors.
Symptoms and Diagnosis
Here are some symptoms of a groin pull:
- Pain and tenderness in the groin and the inside of the thigh
- Pain when you bring your legs together
- Pain when you raise your knee
- A popping or snapping feeling during the injury, followed by severe pain
Groin pulls are often divided into three degrees of severity:
- 1st degree: Mild pain, but little loss of strength or movement
- 2nd degree: Moderate pain, mild to moderate strength loss and some tissue damage
- 3rd degree: Severe pain, severe loss of strength and function due to a complete tear of the muscle
To diagnose a groin pull, your doctor will give you a thorough physical exam. Tests like X-rays and MRIs (magnetic resonance imaging) may be needed to rule out other problems.
RICE. Groin injuries involving the strain of muscles and tendons often respond well to the RICE protocol, which stands for Rest, Ice, Compression, and Elevation:
Rest. This is most commonly prescribed activity reduction, but some injuries will require crutches or otherwise reduced weight bearing.
Ice. In addition to rest, athletes are advised to ice the affected area using a cloth-wrapped ice pack. Ice can be applied for 20 to 30 minute intervals every 3 to 4 hours over a 2 to 3 day period, or until the pain and swelling subsides.
Compression. To provide compression, athletes can wrap their thighs and/or groin area with elastic bandages, wear compression garments, or use athletic tape to help reduce swelling and stabilize the injury. In some cases, a medical professional may need to apply the compression rather than the athlete.
Elevation. Elevating the groin area above the level of the heart by reclining over a pillow or bolster for a few hours each day can help reduce swelling and boost the healing process.
Non-steroidal anti-inflammatory medications (NSAIDs) and other pain relievers. Athletes with one or more groin injuries often respond well to over-the-counter medications such as ibuprofen (for example, Advil or Motrin) which both relieve pain and reduce inflammation at the injury site.
Sports massage – This may help once the acute stage has passed (after 72 hours) by releasing tension in the muscle and encouraging blood flow and nutrients. Caution is advised as massaging an injury too soon may increase the bleeding and may make the injury worse. Electrotherapy modalities such as ultrasound may be used by a professional practitioner to aid the healing process.
After the initial acute stage of the injury has passed, a gradual rehabilitation program consisting of stretching and strengthening exercises should begin.
Stretching exercises should always be pain free starting with gentle static stretches and progress through to more sports specific stretches performed dynamically (with movement). Do not start stretching too early as the healing of the muscle may be compromised (not before day 5 post injury). Exercises to stretch both the short adductor muscles and the long adductor muscles should be done.
Standing Groin Stretch
- Stand with your legs wide apart.
- Shift your weight to the left.
- Allow your left knee to bend until it is over your left foot. You will feel the stretch in your right groin.
- Keep your feet on the ground facing forward.
- Hold for 20 to 30 seconds.
- Repeat the stretch on the opposite side, then repeat the stretch three times on each side.
Seated Groin Stretch
- Get into a seated position.
- Bend your knees and bring the soles of the feet together.
- Hold your feet with your hands and rest your elbows on your knees.
- While keeping your back straight (no slouching), allow your knees to fall towards the ground.
- You can apply gentle pressure on the inner thigh by pressing gently on the knees with the elbows.
- You should feel gentle pulling and tension in the groin. Do not bounce (learn the rules of stretching).
- Do not press down with great force.
- Hold the stretch for 20 to 30 seconds.
- Release and repeat three times.
- To increase the stretch, bring the feet closer in towards your groin.
Strengthening exercises aim to gradually increase the load that is put through a muscle and can start as early as day 5 as long as they are low-level and pain free. Isometric or static exercises are advised first and do not involve any movement of the muscle. Eccentric exercises are more advanced exercises which focus on strengthening the muscle whilst it lengthens rather than shortens as all the previous exercises have done. A therapist or partner is needed to assist with this one. Dynamic exercises with resistance band are performed as the muscle gains in strength.
- Lie down on your back over a mat on the floor, placing your hands on the sides of your body.
- Keep your knees pointing upwards and in a 90-degree angle, place a soft ball in between them.
- Slightly squeeze the ball to tighten your adductor muscles.
- Pause for a few seconds and repeat it again for 8-10 times.
- Eccentric Groin Strength
- Start the exercise by lying down on your left side.
- Support your head with your left hand while keeping both the legs straight.
- Slowly lift your right leg in the air as much you can do comfortably.
- Lower the leg down as slowly as possible.
- Repeat this exercise 8-10 times, then repeat it with the other leg by changing your side.
- Stand straight with your hands positioned on your sides and place your right foot in front of you.
- Slowly bend your forward knee while keeping your back straight.
- Keep bending it until your right leg is at an angle of 90 degrees. Also bend your back leg during this process.
- Hold on this position for a few seconds until you feel the stretch in your groin muscles and return back to your normal position.
- Repeat with the other leg. This exercise may seem hard at the beginning and should be done according to your comfort level.
Functional exercises are more sports specific exercises and involve running, changing of direction drills, hopping and plyometric exercises. These bridge the gap between rehabilitation exercises and returning to full training and competition.