II. Epidemiology

  1. Most common musculoskeletal cause of Groin Pain in sports
  2. High Incidence in soccer, hockey and track

III. Pathophysiology

  1. Muscle stretched or overloaded beyond normal range
    1. Kicking
    2. Directional changes
    3. Sprinting
    4. Jumping
  2. Strain of adductor Muscles of the hip
    1. Common Muscles involved
      1. Adductor longus Muscle
      2. Gracilis Muscle
    2. Other Muscles less frequently involved
      1. Adductor magnus Muscle
      2. Adductor brevis Muscle
      3. Iliopsoas Muscle
      4. Rectus femoris Muscle
      5. Sartorius Muscle

IV. History

  1. See Hip Pain

V. Symptoms

  1. Acute proximal Muscle pain over medial thigh
  2. Pain and stiffness in groin worse after Exercise
  3. Radiation of pain
    1. Along course of medial thigh
    2. Rectus abdominis

VI. Exam

  1. See Hip Exam

VII. Signs

  1. Local swelling and Bruising may be seen
  2. Focal tenderness over adductor Muscles
  3. Provocative maneuvers on adduction against resistance
    1. See Hip Adduction Test

IX. Radiology for refractory cases

  1. MRI confirms Muscle and Tendon Injury
  2. Ultrasound identifies Muscle and tendon tears

X. Management: Approach

  1. Determine biomechanical forces predisposing to injury
    1. Foot and lower leg malalignment
    2. Leg Length Discrepancy
    3. Muscular imbalance
    4. Gait Abnormality
  2. Identify tear location
    1. Acute tear at musculotendinous junction
      1. Aggressive rehabilitation program
    2. Acute partial tear of tendon insertion at pubic bone
      1. Requires period of rest before physical therapy
  3. Determine Chronicity of Injury
    1. See management strategies below

XI. Management: Acute

  1. Rest from provocative activities for 10 to 14 days
    1. Longer rest needed for tear at tendon insertion
  2. Physical Therapy
    1. Initial goals
      1. Restore range of motion
      2. Prevent atrophy
    2. Next goals
      1. Regain strength (return to sport when 70% regained)
      2. Regain flexibility and endurance
  3. RICE-M
    1. Cold therapy initially
    2. Heat therapy may be used chronically after 72 hours
    3. Compression Shorts or hip spica wrap
  4. NSAIDs for first 7 to 10 days
  5. Avoid local Ultrasound
    1. Risk of bleeding
    2. Risk of mutagenesis due to proximity to genitalia
  6. Cross-training with other aerobic Exercise

XII. Management: Chronic

  1. Stretching Program
  2. Low intensity Isotonic Exercise
  3. Consider active training Exercise program
  4. Consider surgical tenotomy

XIII. Course: Period of rehabilitation to return to sport

  1. Acute strains: 4-8 weeks until return to sport
  2. Chronic strains: up to 6 months

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