Adductor related groin pain is pain in the groin region (upper-inner thigh) related to the adductor muscles and their connections. Tears or strains may occur within the adductor muscles themselves; where the muscles and tendons join (musculotendinous junctions); or within the tendons (attaches the muscle to the bone).
As there is so much interconnection between the fibrous structures around the pubic region, there may be one or a number of structures or injuries in the adductor region that can be related to pain. This means that sometimes people are given a different diagnosis than someone they know, even though the pain is in the same area. Sometimes people are even given different diagnoses by different health professionals.
These diagnostic terms might include:
This might seem confusing, which is why a group of leading experts in groin injury from around the world came together to agree on a single diagnosis. It was agreed that the diagnosis, Adductor Related Groin Pain, would be most useful (3). This term encompasses all these other terms that are all part of the same picture and are largely treated in the same way.
People with adductor related groin pain usually experience pain high in the groin area, within the upper 1/3 of the adductor muscle region. If the pain is long standing however, the painful area may become less localised to the initial area of injury or pain. It can extend across the pubic region and into the lower abdomen. Sometimes it can also spread to the adductor region in the opposite leg.
Following an acute adductor injury pain may be experienced when:
If the pain in milder or has been around quite a while, there is usually little or no pain at rest or during normal low-level daily activities. Pain will usually occur during more strenuous or dynamic tasks such as:
Athletes with adductor related groin pain are often able to continue or return to their sport after the acute injury settles, but they may struggle to reach full speed and sporting performance due to pain or reduced power.
Typically, adductor related groin pain occurs in a more active and sporting populations. It often occurs or becomes more recurrent or persistent in the slightly older athlete, aged more than 25 years. Pain in the adductor region may also occur in association with hip joint conditions such as femoroacetabular impingement syndrome or osteoarthritis.
Adductor related groin pain may develop rapidly or slowly over time, without a clear injury.
Acute, traumatic injury resulting in a rapid onset of pain, is usually associated with sporting actions such as:
Typically, adductor related groin pain occurs in a more active and sporting populations. It often occurs or becomes more recurrent or persistent in the slightly older athlete, aged more than 25 years. Pain in the adductor region may also occur in association with hip joint conditions such as femoroacetabular impingement syndrome or osteoarthritis.
Adductor related groin pain may develop rapidly or slowly over time, without a clear injury.
Acute, traumatic injury resulting in a rapid onset of pain, is usually associated with sporting actions such as:
This is the type of injury that is best assessed and managed as soon as possible. Your Hip Pain Professional can provide a thorough examination and look for reasons underlying your condition. They will then develop a personalised recovery plan for you and put strategies in place for minimising the chances of reinjury.
Treatment almost always begins with some good advice and a targeted exercise program. Most people will get an excellent outcome with this approach. Early treatment is likely to lead to more rapid and complete recovery. For those that do not recover with education and exercise, there are extra options.
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.
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:
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.
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 (2). 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.
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