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How to fix the painful groin and get back to football


What is groin strain?


Groin strains are muscle strains to any of the adductor muscles on your inner thigh. Typically, strains come on rapidly when contracting the adductor muscles very quickly and forcefully. Groin strains are most common in football (or ‘soccer’) due to the requirement of strong contraction of the inner thigh muscles when shooting, passing or changing direction. However, there are many other causes such as direct trauma or loaded lengthening of the muscle. For example, when changing direction the groin strain typically occurs when the hip goes into extension, abduction and external rotation (lengthening of the adductor).


Groin strains are more common than one might think, accounting for 4-19% of all football injuries in men, and 2-14% in women. However, this may be understated as most athletes play through minor groin injuries without reporting it.


The most commonly injured muscle in the groin region is the adductor longus. When the adductor muscles are strained, they can be categorised into 3 grades:


Grade 1: Minor tear with no loss of function or strength

  • minor swelling

  • discomfort in groin

  • tightness.

Grade 2: Partial tear with severe loss of function and strength

  • significant swelling

  • sudden stabbing/sharp pain during exercise

  • bruising

  • painful when walking and/or running

  • weakness when squeezing legs together.

Grade 3: Complete tear with complete loss of function and strength

  • significant swelling

  • severe pain

  • bruising

  • able to feel lump/gap in inner thigh

  • unable to squeeze legs together.



Pain Reduction


Muscle strains are not pleasant at all. We will guide you through the initial recovery phase and what to do to manage your groin injury. To reduce pain, let’s follow the PEACE and LOVE principle.


Retrieved from: https://www.apemedical.com.au/initial-treatment-response/


You may also need to hire or purchase a pair of crutches from a physiotherapist or chemist.


Furthermore, follow the do no HARM principle:


Retrieved from: https://www.apemedical.com.au/initial-treatment-response/



There is strong evidence around the risk factors that may pre-determine a groin injury such as:

  • previous groin injuries

  • reduced hip adduction strength

  • higher level of play

  • lower levels of sports-specific training


Thus it is important to address some of these risk factors in your rehabilitation to facilitate injury prevention. Once your groin has recovered most of its strength and range of motion, it is important that training and conditioning your leg musculature does not stop.


Activation


Now that your groin has recovered and is almost pain-free , we can start to gradually regain your range of motion and strength! The first step into your rehabilitation journey is load management. Initially, you will need to gauge how much you’re able to tolerate and gradually increase the volume, intensity and frequency of your activity. Patience and motivation is crucial in this stage as your muscle is starting to learn how to do its duties again.


Following your few days’ rest, your muscles around your hip may have weakened. Thus the activation phase is about introducing your adductors to load as well as activating surrounding muscles to accelerate your rehab. An example of medium-difficulty exercises for each muscle group can be seen below:


  • Short Copenhagen Side Plank: Activating the adductors through isometric contraction (holding a position).


  • Hip Flexor ‘Ups and Overs’: Useful exercise to incorporate using your hip flexors and adductors/abductors to strengthen the hips.



  • McGill’s Ab Curl: Excellent for strengthening the core muscles such as abdominals, lower back, obliques, etc.



  • Monster Walks: Ensuring that the abductors are as strong as the adductors – this is important for future injury prevention.


Movement


This stage is about incorporating what we’ve been working on thus far into larger movements. Integrating the adductors into larger compound movements is the best way of continuing to develop strength and range of motion for the groin. Your leg musculature works in conjunction with one another in these movements, thus learning how to move correctly again may be difficult. The adductors play a large role in stabilising side-to-side knee stability so that your knees do not track outwards. Some great movement exercises to practice are:

  • Single Leg Squat: Ensure knee position is stable and abdominal muscles are tight during the descent of the exercise.

  • Lateral Lunge to Step Up: This exercise allows us to condition the adductors to both concentric and eccentric contraction types (shortening and lengthening). This is a great way to make your rehabilitation more sports-specific.

  • Banded Side Steps: Strength-based principles applied to movement. This exercise is done in a mini-squat position. It is a great exercise to establish effective control of your lower limb position when moving.


Strengthening/ Sports Performance


The final stage of rehabilitation is the most crucial stage for future injury prevention. For groin injuries, this stage is often going to include running, cutting, and kicking. However, sports-specific exercises should be accompanied by an ongoing strength program to keep your lower limb musculature strong and conditioned for play. Addressing the risk factors mentioned earlier is very important to prevent re-injury.


For more detail, it is recommended that you see a physiotherapist to provide you with a sports-specific training and strengthening program as well as a return to sport criteria, to provide you the best chance to get back on the field as soon as possible!



References

McSweeney, S. E., Naraghi, A., Salonen, D., Theodoropoulos, J., & White, L. M. (2012). Hip and Groin Pain in the Professional Athlete. Canadian Association of Radiologists Journal, 87-99.


Serner, A., Weir, A., Tol, J. L., Thorborg, K., Lanzinger, S., Otten, R., & Hölmich, P. (2020). Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine, 8(1).


Waldén, M., Hägglund, M., & Ekstrand, J. (2015). The epidemiology of groin injury in senior football: a systematic review of prospective studies. British Journal of Sports Medicine, 792-797.


Whittaker, J. L., Small, C., Maffey, L., & Emery, C. A. (2015). Risk factors for groin injury in sport: an updated systematic review. British Journal of Sports Medicine, 49(12), 803-809.







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