What is Adductor Related Groin Pain?
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).
Figure 1: Illustration of the muscles and their attachments at the front of the pelvis, abdomen and groin region.
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:
- Adductor tendinopathy, tendinitis or tear – tendon pain, inflammation or a tear of one or more of the inner thigh muscles
- Pubic aponeurosis tear – a tear in the blended fibrous tissue at the front of the pubic bone
- Rectus abdominis tendinopathy/enthesopathy, tendinitis or tear – tendon pain, inflammation or a tear of the rectus abdominis (‘six-pack’) muscle
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.
Figure 2: The Adductor muscles viewed from the front – pectineus, adductor brevis, adductor longus, adductor magnus and gracilis
What are the usual symptoms?
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:
- Standing on one leg
- Turning or changing direction while standing on the injured leg
- Lifting the leg to dress or move in and out of the car
- Coughing or sneezing
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:
- Running, especially when accelerating or decelerating
- Deep split lunges or side lunges
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.
What causes Adductor Related Groin Pain
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:
- Changing direction at speed
- Sliding sideways
The strongest risk factors for developing groin injury in sport (4) are:
- a previous groin injury – those who have one groin injury are at significantly higher risk of having another injury or ongoing problems
- weakness of the adductor (inner thigh) muscles
- playing in higher grades of field sports such as the football codes, and
- lower levels of sport specific training such as the FIFA 11 warm up before soccer/football
In some cases, other factors related to the way people move and share forces across all the hip and pelvic muscles may contribute to the development and/or persistence of groin pain.
Getting Help. What is the treatment for Adductor Related Groin Pain?
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:
- 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
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.
- Grimaldi, A. (2017). Understanding tendinopathies of the hip & pelvis. Iliopsoas and adductor related groin pain (Vol. 4).
- King et. al. (2015). Athletic groin pain: a systematic review and meta-analysis of surgical versus physical therapy rehabilitation outcomes. British Journal of Sports Medicine, 49, 1447-1451.
- Weir et. al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine, 49(12).
- Whittaker, J. et. al. (2015). Risk factors for groin injury in sport: an updated systematic review. British Journal of Sports Medicine .