1. Education:
Gaining an understanding of what the problem is and how to stop provoking it, is the first important step. This is often called ‘load management’. Your Hip Pain Professional can identify specific aggravating factors and provide individualised advice. Things you do regularly may be making the situation worse. For example, stretching for adductor tendinopathy is usually not recommended.
2. Exercise:
A specific and individualised exercise program is the other main aspect of treatment. Improvements can occur quickly, particularly if you have caught the problem early. If you have had the condition for a long time, progress may be slower. In either case, it is a good idea to continue an exercise program for at least 3-6 months. This will allow time to see the full effect of treatment. A slowly progressive loading program can be undertaken for not only the adductor muscles, but to improve strength and control around the whole hip and pelvis and throughout the lower limbs. As the pain reduces and strength improves, more sport-specific or demanding drills are introduced.
An exercise program can have many benefits such as:
- improving health and coordination of the hip and thigh muscles
- changing certain movement patterns to avoid excessive loads on the groin region
- improving ability of your muscles to better share physical loads
- improving tendon health and ability to tolerate physical loads
- reducing pain
- improving ability to perform normal daily tasks
- increasing confidence in your ability to do things
- returning to activity and sport
- improving quality of life
3. Injections
Cortisone (corticosteroid) injections usually only provide short term relief. Cortisone, particularly repeated injections, may also reduce health of non-bony structures such as tendons. So, it is usually best to commit to an education and exercise approach first. Injections are rarely useful in isolation. Results are usually best when combined with load management and exercise.
4. Surgery
Surgery is a last resort and is usually only considered after 12 months of other treatments.
A recent review found there is only low-quality evidence that surgery is superior to non-surgical treatment (rehabilitation) and a high risk of bias (i.e., potential for the information to be misleading) amongst papers looking at surgery (King). When studies have looked at whether athletes get back to sport more quickly after surgery compared to rehabilitation without surgery, there is little difference in the timeframes. This means that non-surgical rehabilitation should always be the first option for treatment of adductor-related groin pain.
Visit our Pain Locator Map to learn more about soft tissue related pain in different regions around the hip and pelvis, or other causes of groin pain.