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Adductor Strain
Aka: Adductor Strain, Adductor Tendinitis, Groin Pull
- See also
- Hip Pain
- Hip Avulsion Fracture
- Epidemiology
- Most common musculoskeletal cause of Groin Pain in sports
- High Incidence in soccer, hockey and track
- Pathophysiology
- Muscle stretched or overloaded beyond normal range
- Kicking
- Directional changes
- Sprinting
- Jumping
- Strain of adductor muscles of the hip
- Common muscles involved
- Adductor longus muscle
- Gracilis muscle
- Other muscles less frequently involved
- Adductor magnus muscle
- Adductor brevis muscle
- Iliopsoas muscle
- Rectus femoris muscle
- Sartorius muscle
- History
- See Hip Pain
- Symptoms
- Acute proximal muscle pain over medial thigh
- Pain and stiffness in groin worse after Exercise
- Radiation of pain
- Along course of medial thigh
- Rectus abdominis
- Exam
- See Hip Exam
- Signs
- Local swelling and Bruising may be seen
- Focal tenderness over adductor muscles
- Provocative maneuvers on adduction against resistance
- See Hip Adduction Test
- Differential Diagnosis
- See Groin Injuries in Athletes
- See Hip Pain Causes
- Sports Hernia
- Osteitis Pubis
- Radiology for refractory cases
- MRI confirms muscle and Tendon Injury
- Ultrasound identifies muscle and tendon tears
- Management: Approach
- Determine biomechanical forces predisposing to injury
- Foot and lower leg malalignment
- Leg Length Discrepancy
- Muscular imbalance
- Gait Abnormality
- Identify tear location
- Acute tear at musculotendinous junction
- Aggressive rehabilitation program
- Acute partial tear of tendon insertion at pubic bone
- Requires period of rest before physical therapy
- Determine Chronicity of Injury
- See management strategies below
- Management: Acute
- Rest from provocative activities for 10 to 14 days
- Longer rest needed for tear at tendon insertion
- Physical Therapy
- Initial goals
- Restore range of motion
- Prevent atrophy
- Next goals
- Regain strength (return to sport when 70% regained)
- Regain flexibility and endurance
- RICE-M
- Cold therapy initially
- Heat therapy may be used chronically after 72 hours
- Compression Shorts or hip spica wrap
- NSAIDs for first 7 to 10 days
- Avoid local Ultrasound
- Risk of bleeding
- Risk of mutagenesis due to proximity to genitalia
- Cross-training with other aerobic Exercise
- Management: Chronic
- Stretching Program
- Low intensity Isotonic Exercise
- Consider active training Exercise program
- Consider surgical tenotomy
- Course: Period of rehabilitation to return to sport
- Acute strains: 4-8 weeks until return to sport
- Chronic strains: up to 6 months
- References
- Schleihauf (2019) Crit Dec Emerg Med 33(5): 19-28
- Akermark (1992) Am J Sports Med 20:640-3 [PubMed]
- Holmich (1999) Lancet 353:439-43 [PubMed]
- Morelli (2001) Am Fam Physician 64(8):1405-14 [PubMed]