Fixing The Pulled Groin

Welcome back to Squat University! Last week we started our discussion on the complex topic of groin pain. Today we’re going to focus on treating one of the most common reasons for groin pain, the adductor strain. 

Treating the Adductor Strain

Like we mentioned in last weeks blog post, the adductor longus is the most commonly injured muscle in your classic “pulled groin.” The early stage of rehabbing from a strained adductor longus muscle will consist of three phases: ¹

• Rest (24-48 hours)
• Pain free muscle activation
• Soft tissue mobilization.

Notice that stretching was not included!

Rest

If you go to any doctor after sustaining an injury, what’s the first thing they tell you to do? Rest. It’s a pretty simple concept. If you sustained a groin injury while running, you should probably take some time off running. Rest is always the first step that allowing the body to heal and give you the best chance for returning to any sport safely and in a timely manner.

Strengthening with Submaximal Isometrics

While rest is important, it can’t be the only thing you do to really fix the injury. After a day or two of rest we need to do something to kick-start and facilitate the healing process.

Unlike flexibility, research shows that those who sustain a pulled groin often have a strength imbalance in the muscles that surround the hips.³ This is especially true of athletes who have weaker adductor muscles compared to the lateral hip or abductor muscles. This means that improving the strength of the adductor muscles must be a priority in the prevention and post-injury rehab program.

Initially following an adductor strain, it can be fairly painful to perform any aggressive strengthening to this muscle. So when it comes down to early strengthening, activating the muscle without any movement (called an isometric contraction) can be a great way to kick-start the healing process without placing too much stress on the injured tissues.

Lay on your back with your knees bent and a small ball in between your legs. Squeeze your knees together like you’re going to pop the ball. When you first start these exercises, think about contracting ~50-75% of maximum effort and don’t push through pain! Hold this contraction for five seconds before relaxing. As this becomes easier to perform, start squeezing with more intensity or increase the hold time to 10-15 seconds.

Recommended Sets/Reps: 2 sets of 20 reps for 5 second hold

Foam Rolling

Mobilizing the tissues of the inner thigh can also be a great help for relieving pain and promote proper healing of the injured groin. Lie on your stomach with your injured leg positioned as close to 90° from your torso as possible. Place the foam roller close to your groin, running perpendicular to your injured thigh.

Roll slowly on this section of your thigh for 2 minutes, pausing on areas of tenderness for a few seconds when you find them. If this is crazy painful move, to a lighter foam roller or hold off on this step for a few more days.

Ready to move to the next step?

See if you can pass this test. Lie on your side (injured hip on the ground). Have your top leg bent and positioned in front of you. Next, have a friend and apply some pressure to your injured leg through their hand pressed into your knee. If you can lift your leg off the table against light pressure from your friend (a concentric contraction) without any pain, you can progress to the next step.

If you suffered a light grade I strain of the adductors, this is something that you should be capable of around 7-10 days after the initial injury. If it was a higher grade tear, it may take 2-3 weeks before this is possible without pain.

Lateral Lunge Stretch

While we don’t want to stretch the injured tissues in the early phase of the healing process, eventually some light stretching can be helpful in regaining full hip mobility. Usually this is something we can start about a week or two after the initial injury as long at it is pain free.

Start by standing with a wide stance and your toes pointed straight forward. With your torso as straight up and down as possible, drive your right knee forward as you shift your weight towards the right side. This should bring out a nice light stretch to the groin region of your left leg.

Recommended sets/reps: 2 sets of 10 stretches for 10 seconds 

Balance and Reach

Here is another functional strength exercise I use in rehabilitating adductor strains. Start by standing with a towel (or something that will slide) under the foot of your injured leg. Perform a small squat on your opposite leg while pushing your injured leg out to the side. You should be applying pressure into the ground as the foot slides out to the side. Make sure to keep the knee of your stance leg in line with your foot the entire movement (don’t let the knee cave in!). This is a similar movement to the ‘balance & reach’ exercise we demonstrated for knee pain rehabilitation.

As you push the towel out to the side, you may feel the muscles of your inner groin stretching a little. As long as it’s not painful, this is a good thing. Once you have reached as far as you can without pain and with good technique, return to the starting position.

Recommended sets/reps: 2 sets of 15 reps

Lateral Lunges

 Lunges to the side can be another great exercise to incorporate in the treatment of an adductor strain. Stand with your feet spread apart with your toes pointed straight forward. Grab a medicine ball or a small weight and hold it by your chest. Next, push your butt back and bring your chest forward (large hip hinge) as you shift your weight to the side while simultaneously pushing the weighted ball in front of you. You should end up in a position where your feet, knees, hips and chest are all in alignment. Hold this position for a few seconds before returning to the start position.

Recommended sets/reps: 2 sets of 10 to each side

Skater Hops

The last exercise I want to show you is a more explosive movement. As we progress past the initial injury healing phase, we need to focus on strength and coordination as they are two of the most important factors in helping you return to your previous level.⁴ This exercise works both of those factors.

Imagine you’re an Olympic speed skater. Stand on one foot and step laterally to the side, landing in a mini single leg squat. Do the same back to the foot you started on.

As this movement gets easier and your technique is flawless you can start adding speed to this movement. You can also add a small hop after landing to increase the difficulty of the exercise. Eventually you should get to the point where you can bound explosively from side to side like a speed skater on dry land.

Recommended sets/reps: 2 sets of 20 (down and back is 1 rep)

Final Thoughts

Treating groin pain due to a strained adductor muscle takes a comprehensive approach of rest, early pain free strengthening and soft tissue mobilization. I hope this article was able to help you understand this injury some of the basic components of rehabilitation. If you are unable to find relief with your groin pain after performing these exercises, I recommend going to a medical professional (doctor or physical therapist) to assist in your recovery.

Until next time,

With

References

1. Tyler TF, Silvers HJ, Gerhardt MB, et al. Groin injuries in sports medicine. Sports Health. 2010;2(3):231-236
2. Tyler TF, Fukunaga T & Gellert J. Rehabilitation of soft tissue injuries of the hip and pelvis: invited clinical commentary. IJSPT. 2014 Nov; 9(6):785-797
3. Tyler TF, Nicholas SJ, Campbell RJ, et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med. 2001;29(2):124-128
4. Holmich P, Uhrskou P, Ulnits L, et al. Effeciveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomized trial. Lancet. 1999;353:439-43