Injury of the Week- Groin Strain

A groin pull; strain; adductor strain involves a tear, strain and/or bruising of the adductor/groin muscles.  These muscles help connect your hips and thighs and work to bring the legs together towards midline.  Generally, a groin strain occurs while playing sports that require quick pivots, changes in direction and explosive acceleration.   The sports most commonly affected are soccer, basketball, ice hockey, figure skating, cross country skiing and swimming (especially breaststroke).

Groin strains are also commonly seen as overuse injuries.  A study conducted by Emery & Meeuwisse, reviewed 1292 National Hockey League players.  Those with a previous groin injury had twice the risk of repeat injuries as that of athletes without a previous injury.  Furthermore, veteran hockey players had an injury rate 5 times greater than that of rookie players.

If you experience pain sliding sideways or increased pain or weakness during active and resisted hip adduction (bringing legs toward midline) or passive hip abduction (legs away from midline) then read on for more information.  These may be signs of a groin strain (Anderson, Hall, Martin). 

Dr. Bernard Bach, member of the Orthopedic team for the Chicago Bulls describes symptoms of a groin pull as such: 

Symptoms:

Groin pulls can cause pain in the groin that radiates down the inside of the thigh.

Grade I—A minor stretch of the muscle which results in some discomfort, but normal everyday activity is not significantly impaired.

Grade II—A more severe stretch and possible partial tear to the groin muscle. A Grade II groin injury is considerably more painful. Also, activity may be limited due to the pain, bruising, and swelling.

Grade III—A severe tear of the muscle, pain from which can limit even the smallest movements. A Grade III injury often produces marked bruising, muscle spasms, and severe swelling.

Additionally, because a strain or tear at the adductor causes stress and compensation patterns in the surrounding muscles and bones, a groin pull may lead to hip misalignment.  This in turn can lead to low back pain, hip flexor discomfort, pain at the inside of the knee and gait abnormalities. 

Treating a Groin pull:

• Immediately ice to reduce swelling.  Continue for 3-4/days several times a day
• Compression and non-steroidal anti-inflammatory medication
• See orthopedic doctor for X-ray and urinalysis to rule out any other acute complication or injury
• Rest for a minimum of 5 days with Grade I sprain.  If Grade II the resting period should be at least 7 days.  If Grade III rest for at least two weeks.  Crutches and immobilization may be necessary. 
• Light stretching and strengthening as tolerated without pain
• Evaluation of gait imbalance (if any) and appropriate hip joint mobilization and release of hip flexor muscles to correct as tolerated
• Sports massage therapy to hip flexors, gluteal muscles, IT band and groin as able
• Gradual return to full activity under the supervision of a PT or trainer

Preventing a Groin Strain:

Studies performed on pro hockey athletes showed those athletes who did very little sport specific training in the off season were at a higher risk for groin sprain during the new training season especially if they’d previously had this injury. 

Taking this data into consideration, if you are an athlete playing a sport with a higher risk of groin strain it may be in your best interest to continue at least a moderate level of sport specific training during your off season as opposed to drastically cutting down on your physical activity. 

Additionally, keeping your hips as flexible as possible through stretching, heat and massage may decrease your risk.  The following video provided by SportsMD shows hip flexor stretches to perform.

Strengthening your groin and adductor muscles can also go a long way to helping prevent a groin strain.  See the following link for specific adductor stretches and strengthening courtesy of The Sports Medicine Specialists

References:

• http://www.rushortho.com/answer_md.cfm?quid=30
• http://www.nabsports.com/CSIC/hockeygroin.pdf
• http://www.sportsinjuryclinic.net/cybertherapist/front/frontthigh/groin_strain/rehabilitation.php
• http://emedicine.medscape.com/article/87895-overview
• http://www.sportsmd.com/Articles/tabid/1010/id/23/Default.aspx?n=groin_strain_%28hip_flexor/adductor_strain%29
• Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc. Sep 2001;33(9):1423-3
• Anderson, Hall, Martin, Sports Injury Management; 1^st Ed 1995; 408-9