Groin strains usually occur through trauma/injury and/or overuse. Muscles involved include: the adductor muscles (inner thigh), most commonly adductor longus; rectus femoris; iliopsoas, and occasionally the lower abdominals. Most common injury of the groin muscles occurs with forced adduction (movement of the leg toward midline of the body), extension, twisting, running, or jumping with hips externally rotated.
Pain is usually located at the pubic ramus (proximal inner thigh), lesser trochanter or further distal at the inner knee. Pain is illicited with passive abduction (movement of the involved leg away from midline of the body) and with resisted adduction. Definitive diagonosis can be made via MRI (magnetic resonance imaging), which will show abnomalities in soft tissue. Evaluation by a physician is important for differential diagnosis, as the symptoms present with a groin strain can also be associated with spinal radicular (referred) pain, inguinal hernia and genitourinary infection.
During the acute stage, groin strains are treated with ice, compression, elevation and rest from activities that aggravate. Anti-inflammatory medication can be helpful to reduce pain and swelling. Hip spika bracing or taping with 6" elastic wrap can be helpful to support injured area and prevent re-injury. Early restoration of range of motion via gentle stretching and light massage and isometric exercises can be initiated.
Adductor stretch: Sitting with knees bent and feet together, slowly allow knee to drop to the floor until a pull is felt in the inner thigh. Hold static stretch for 10-20 seconds and repeat 3 times. Avoid onset of pain, especially in the early stages of a groin strain. May also be done with the involved knee straight, leaning forward to bias other adductor muscles that cross the knee joint.
Adductor isometrics: Lying with knees bent place folded pillow between knees and gently squeeze knees together. Hold 3-5 seconds and repeat 10 times. Submaximal contraction of about 75% in the early stages of a groin strain. Can also be performed with the knees straight to bias other adductor muscles.
Hip flexor stretch: Lying at the base of your bed or toward the involved leg side, hug opposite knee toward your chest while slowly lowering the involved leg off the edge. Hold static stretch for 10-20 seconds and repeat 3 times. The involved knee can also bend slightly to further stretch the quadriceps (front of thigh) muscle.
As the pain intensity decreases with time and becomes more intermittent, heat modality and more aggressive stretching and soft tissue mobilization can be incorporated into treatment. Leg strengthening via inner thigh lifts and straight leg raises can be initiated as well as stationary biking. Prior to return to full activity, individual should have full painfree passive motion as well as full adductor strength without pain. Often times it is helpful to add concentric, eccentric, plyometric and sport specific training to treatment pending patient's prior level of function and treatment goals.
