Adductor strains frequently affect active individuals in competitive sports.
Common sports with adductor strain risks include football, soccer, hockey, basketball, tennis, skating, baseball, karate, and softball.
Hip adductor injuries commonly occur during forced push-offs. High forces strain adductor tendons during sudden directional shifts in athletes.
Adductor strain in soccer players often results from forceful thigh abduction during adduction.
This motion happens when an athlete kicks the ball but faces resistance from an opponent kicking it the other way.
Unilateral strength deficits in an athlete’s proximal leg muscles increase injury risk, particularly in sports that favour the dominant side.
Patient experiences morning groin pain and stiffness at the start of athletic activity with brief intense pain.
Pain and stiffness improve after warming up but frequently return. Findings show tenderness at adductor longus/gracilis origin and pain during resisted adduction.
Hip adductors include magnus, minimus, brevis, and longus muscles. All adductor muscles receive obturator nerve innervation which receives femoral nerve innervation.
Epidemiology
Muscle strain is common in sports accounts for up to 30% of primary care sports medicine visits.
Increased age elevates strain risk due to reduced connective tissue elasticity in injuries. Scandinavian soccer studies show 10-18 groin injuries per 100 players.
Groin injuries constitute 5% of soccer and 2.5% karate injuries. A literature review indicates that men playing the same sport as women have a higher risk of groin injury.
Anatomy
Pathophysiology
The musculotendinous junction commonly injures in muscle strains, as studies show its sarcomeres are less elastic than those in the muscle’s central region.
Adductor tendons attach to periosteum-free bone with a poor blood supply and rich nerves to significant pain and poor healing in strains.
Musculotendinous junction is vulnerable to excessive force-induced muscle injury.
Muscle strain injuries occur due to forcible stretching of activated muscles. Muscle strain injuries commonly occur during eccentric contraction.
Etiology
Injury to hip adductors often results from forced push-off during side-to-side motion, where significant stress occurs on adductor tendons as muscles rapidly contract to shift force due to the athlete’s momentum.
Common injury mechanisms include rapid hip adduction, forced abduction stretching tendons, and sudden acceleration during sprinting.
Jumping is less involved than abduction linked to hip flexor strains rather than adductor overstretching.
Inadequate stretching and weakness of the adductor muscles elevate injury risk, as weaker muscles have a significantly lower threshold for failure under load.
Genetics
Prognostic Factors
Improper management of adductor strains can cause chronic injuries if rushed back to play.
Renstrom and Peterson found 42% of athletes with groin injuries could not return to activity after 20 weeks.
This prolonged length of time seems to indicate the importance of proper management of these injuries in the acute stage.
Athletes with grade 0-II injuries achieved a pain-free state in 13 days, completed controlled sports training in 17 days, and returned to full team training in 18 days.
Clinical History
Collect details including mechanism of injury, symptom onset and progression and medical history to understand clinical history of patient.
Physical Examination
Range of Motion Testing
Strength Testing
Functional and Dynamic Testing
Age group
Associated comorbidity
Associated activity
Acuity of presentation
Acute symptoms are:
Immediate sharp pain in the groin, difficulty continuing activity or sudden cessation of movement due to pain, audible pop or tearing sensation, visible swelling
Chronic symptoms are:
Chronic dull ache in the groin or inner thigh, intermittent pain during and after activity, tightness or mild weakness in the adductors.
Differential Diagnoses
Osteitis Pubis
Mechanical Low Back Pain
Physical Medicine and Rehabilitation for Stress Fractures
Laboratory Studies
Imaging Studies
Procedures
Histologic Findings
Staging
Treatment Paradigm
Treatment Paradigm:
Initial adductor injury management includes protection, rest, ice, compression, and elevation.
Avoid painful activities and use crutches initially to relieve discomfort.
Crutches may relieve pain initially as painless movement encouraged after 48 hours to prevent excessive scar tissue formation.
Steroid injections in adductor strains are controversial due to tendon rupture risk.
Regenerative PRP injections offer a new treatment for adductor strains.
Avoid rushing athletes back to sports to prevent chronic injuries. Acute strains may become chronic without sufficient healing time.
Start passive range-of-motion exercises when the patient is pain-free.
Active muscle exercises progress from isometric without resistance to dynamic exercises
Strengthening abdominal and hip flexors helps groin injury rehabilitation.
Measure hip adductor strength with a device during the groin squeeze test.
No pain should occur during or after exercises with gradual load increase for adductor muscle strengthening.
Surgery is needed for ruptured acute strains and select chronic strains unresponsive to treatment.
use-of-phases-in-managing-adductor-strain
In the acute diagnosis phase, the goal is to reduce pain, protect the injured area from further damage and minimize loss of strength and mobility.
Pharmacologic therapy is effective in the treatment phase as it includes the use of nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, and local anesthetics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Adductor strains frequently affect active individuals in competitive sports.
Common sports with adductor strain risks include football, soccer, hockey, basketball, tennis, skating, baseball, karate, and softball.
Hip adductor injuries commonly occur during forced push-offs. High forces strain adductor tendons during sudden directional shifts in athletes.
Adductor strain in soccer players often results from forceful thigh abduction during adduction.
This motion happens when an athlete kicks the ball but faces resistance from an opponent kicking it the other way.
Unilateral strength deficits in an athlete’s proximal leg muscles increase injury risk, particularly in sports that favour the dominant side.
Patient experiences morning groin pain and stiffness at the start of athletic activity with brief intense pain.
Pain and stiffness improve after warming up but frequently return. Findings show tenderness at adductor longus/gracilis origin and pain during resisted adduction.
Hip adductors include magnus, minimus, brevis, and longus muscles. All adductor muscles receive obturator nerve innervation which receives femoral nerve innervation.
Muscle strain is common in sports accounts for up to 30% of primary care sports medicine visits.
Increased age elevates strain risk due to reduced connective tissue elasticity in injuries. Scandinavian soccer studies show 10-18 groin injuries per 100 players.
Groin injuries constitute 5% of soccer and 2.5% karate injuries. A literature review indicates that men playing the same sport as women have a higher risk of groin injury.
The musculotendinous junction commonly injures in muscle strains, as studies show its sarcomeres are less elastic than those in the muscle’s central region.
Adductor tendons attach to periosteum-free bone with a poor blood supply and rich nerves to significant pain and poor healing in strains.
Musculotendinous junction is vulnerable to excessive force-induced muscle injury.
Muscle strain injuries occur due to forcible stretching of activated muscles. Muscle strain injuries commonly occur during eccentric contraction.
Injury to hip adductors often results from forced push-off during side-to-side motion, where significant stress occurs on adductor tendons as muscles rapidly contract to shift force due to the athlete’s momentum.
Common injury mechanisms include rapid hip adduction, forced abduction stretching tendons, and sudden acceleration during sprinting.
Jumping is less involved than abduction linked to hip flexor strains rather than adductor overstretching.
Inadequate stretching and weakness of the adductor muscles elevate injury risk, as weaker muscles have a significantly lower threshold for failure under load.
Improper management of adductor strains can cause chronic injuries if rushed back to play.
Renstrom and Peterson found 42% of athletes with groin injuries could not return to activity after 20 weeks.
This prolonged length of time seems to indicate the importance of proper management of these injuries in the acute stage.
Athletes with grade 0-II injuries achieved a pain-free state in 13 days, completed controlled sports training in 17 days, and returned to full team training in 18 days.
Collect details including mechanism of injury, symptom onset and progression and medical history to understand clinical history of patient.
Range of Motion Testing
Strength Testing
Functional and Dynamic Testing
Acute symptoms are:
Immediate sharp pain in the groin, difficulty continuing activity or sudden cessation of movement due to pain, audible pop or tearing sensation, visible swelling
Chronic symptoms are:
Chronic dull ache in the groin or inner thigh, intermittent pain during and after activity, tightness or mild weakness in the adductors.
Osteitis Pubis
Mechanical Low Back Pain
Physical Medicine and Rehabilitation for Stress Fractures
Treatment Paradigm:
Initial adductor injury management includes protection, rest, ice, compression, and elevation.
Avoid painful activities and use crutches initially to relieve discomfort.
Crutches may relieve pain initially as painless movement encouraged after 48 hours to prevent excessive scar tissue formation.
Steroid injections in adductor strains are controversial due to tendon rupture risk.
Regenerative PRP injections offer a new treatment for adductor strains.
Avoid rushing athletes back to sports to prevent chronic injuries. Acute strains may become chronic without sufficient healing time.
Start passive range-of-motion exercises when the patient is pain-free.
Active muscle exercises progress from isometric without resistance to dynamic exercises
Strengthening abdominal and hip flexors helps groin injury rehabilitation.
Measure hip adductor strength with a device during the groin squeeze test.
No pain should occur during or after exercises with gradual load increase for adductor muscle strengthening.
Physical Medicine and Rehabilitation
Arrange seating to prevent adductor muscle overstretching and use ergonomic chairs for hip and groin support.
Provide ice packs or cold compresses for frequent use in the first 48 to 72 hours.
Eliminate tripping hazards and keep frequently used items at waist level to reduce muscle strain from bending or reaching.
Wear supportive shoes to enhance biomechanics and lower adductor muscle stress.
Chairs should have adjustable height and tilt for pelvic neutrality.
Proper awareness about adduction strain should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Physical Medicine and Rehabilitation
Ibuprofen:
It has anti-inflammatory and antipyretic mechanisms of action to inhibit prostaglandin synthetase.
Naproxen:
It inhibits inflammatory reactions to decrease the activity of cyclooxygenase.
Physical Medicine and Rehabilitation
Cyclobenzaprine:
It relieves local skeletal muscle spasm and reduces tonic somatic motor activity.
Tizanidine:
It is a centrally acting muscle relaxant metabolized in the liver and excreted in urine.
Carisoprodol:
It is a short-acting medication with depressant effects on the spinal cord.
Physical Medicine and Rehabilitation
Lidocaine:
It decreases permeability to sodium ions in neuronal membranes. It is used for pain relief associated with postherpetic neuralgia.
Physical Medicine and Rehabilitation
Surgery is needed for ruptured acute strains and select chronic strains unresponsive to treatment.
Physical Medicine and Rehabilitation
In the acute diagnosis phase, the goal is to reduce pain, protect the injured area from further damage and minimize loss of strength and mobility.
Pharmacologic therapy is effective in the treatment phase as it includes the use of nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, and local anesthetics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
Adductor strains frequently affect active individuals in competitive sports.
Common sports with adductor strain risks include football, soccer, hockey, basketball, tennis, skating, baseball, karate, and softball.
Hip adductor injuries commonly occur during forced push-offs. High forces strain adductor tendons during sudden directional shifts in athletes.
Adductor strain in soccer players often results from forceful thigh abduction during adduction.
This motion happens when an athlete kicks the ball but faces resistance from an opponent kicking it the other way.
Unilateral strength deficits in an athlete’s proximal leg muscles increase injury risk, particularly in sports that favour the dominant side.
Patient experiences morning groin pain and stiffness at the start of athletic activity with brief intense pain.
Pain and stiffness improve after warming up but frequently return. Findings show tenderness at adductor longus/gracilis origin and pain during resisted adduction.
Hip adductors include magnus, minimus, brevis, and longus muscles. All adductor muscles receive obturator nerve innervation which receives femoral nerve innervation.
Muscle strain is common in sports accounts for up to 30% of primary care sports medicine visits.
Increased age elevates strain risk due to reduced connective tissue elasticity in injuries. Scandinavian soccer studies show 10-18 groin injuries per 100 players.
Groin injuries constitute 5% of soccer and 2.5% karate injuries. A literature review indicates that men playing the same sport as women have a higher risk of groin injury.
The musculotendinous junction commonly injures in muscle strains, as studies show its sarcomeres are less elastic than those in the muscle’s central region.
Adductor tendons attach to periosteum-free bone with a poor blood supply and rich nerves to significant pain and poor healing in strains.
Musculotendinous junction is vulnerable to excessive force-induced muscle injury.
Muscle strain injuries occur due to forcible stretching of activated muscles. Muscle strain injuries commonly occur during eccentric contraction.
Injury to hip adductors often results from forced push-off during side-to-side motion, where significant stress occurs on adductor tendons as muscles rapidly contract to shift force due to the athlete’s momentum.
Common injury mechanisms include rapid hip adduction, forced abduction stretching tendons, and sudden acceleration during sprinting.
Jumping is less involved than abduction linked to hip flexor strains rather than adductor overstretching.
Inadequate stretching and weakness of the adductor muscles elevate injury risk, as weaker muscles have a significantly lower threshold for failure under load.
Improper management of adductor strains can cause chronic injuries if rushed back to play.
Renstrom and Peterson found 42% of athletes with groin injuries could not return to activity after 20 weeks.
This prolonged length of time seems to indicate the importance of proper management of these injuries in the acute stage.
Athletes with grade 0-II injuries achieved a pain-free state in 13 days, completed controlled sports training in 17 days, and returned to full team training in 18 days.
Collect details including mechanism of injury, symptom onset and progression and medical history to understand clinical history of patient.
Range of Motion Testing
Strength Testing
Functional and Dynamic Testing
Acute symptoms are:
Immediate sharp pain in the groin, difficulty continuing activity or sudden cessation of movement due to pain, audible pop or tearing sensation, visible swelling
Chronic symptoms are:
Chronic dull ache in the groin or inner thigh, intermittent pain during and after activity, tightness or mild weakness in the adductors.
Osteitis Pubis
Mechanical Low Back Pain
Physical Medicine and Rehabilitation for Stress Fractures
Treatment Paradigm:
Initial adductor injury management includes protection, rest, ice, compression, and elevation.
Avoid painful activities and use crutches initially to relieve discomfort.
Crutches may relieve pain initially as painless movement encouraged after 48 hours to prevent excessive scar tissue formation.
Steroid injections in adductor strains are controversial due to tendon rupture risk.
Regenerative PRP injections offer a new treatment for adductor strains.
Avoid rushing athletes back to sports to prevent chronic injuries. Acute strains may become chronic without sufficient healing time.
Start passive range-of-motion exercises when the patient is pain-free.
Active muscle exercises progress from isometric without resistance to dynamic exercises
Strengthening abdominal and hip flexors helps groin injury rehabilitation.
Measure hip adductor strength with a device during the groin squeeze test.
No pain should occur during or after exercises with gradual load increase for adductor muscle strengthening.
Physical Medicine and Rehabilitation
Arrange seating to prevent adductor muscle overstretching and use ergonomic chairs for hip and groin support.
Provide ice packs or cold compresses for frequent use in the first 48 to 72 hours.
Eliminate tripping hazards and keep frequently used items at waist level to reduce muscle strain from bending or reaching.
Wear supportive shoes to enhance biomechanics and lower adductor muscle stress.
Chairs should have adjustable height and tilt for pelvic neutrality.
Proper awareness about adduction strain should be provided and its related causes with management strategies.
Appointments with physician and preventing recurrence of disorder is an ongoing life-long effort.
Physical Medicine and Rehabilitation
Ibuprofen:
It has anti-inflammatory and antipyretic mechanisms of action to inhibit prostaglandin synthetase.
Naproxen:
It inhibits inflammatory reactions to decrease the activity of cyclooxygenase.
Physical Medicine and Rehabilitation
Cyclobenzaprine:
It relieves local skeletal muscle spasm and reduces tonic somatic motor activity.
Tizanidine:
It is a centrally acting muscle relaxant metabolized in the liver and excreted in urine.
Carisoprodol:
It is a short-acting medication with depressant effects on the spinal cord.
Physical Medicine and Rehabilitation
Lidocaine:
It decreases permeability to sodium ions in neuronal membranes. It is used for pain relief associated with postherpetic neuralgia.
Physical Medicine and Rehabilitation
Surgery is needed for ruptured acute strains and select chronic strains unresponsive to treatment.
Physical Medicine and Rehabilitation
In the acute diagnosis phase, the goal is to reduce pain, protect the injured area from further damage and minimize loss of strength and mobility.
Pharmacologic therapy is effective in the treatment phase as it includes the use of nonsteroidal anti-inflammatory drugs, skeletal muscle relaxants, and local anesthetics.
In supportive care and management phase, patients should receive required attention such as lifestyle modification and surgical interventional therapies.
The regular follow-up visits with the physician are scheduled to check the improvement of patients along with treatment response.
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