Most common groin injuries are adductor muscle strains, osteitis pubis and sportsman’s hernia.
Adductor strain
Adductor strains are most common especially with sudden eccentric loading. Adductor longus is most commonly involved. Hip range of motion and muscle weakness / imbalance are predictors of future strains. Early season strengthening is needed as a injury prophylactic.
Charles Poliquin suggests that piriformis tightness is the biggest predictor of groin strains and the split squat are a key exercise in preventing groin strains.
Signs
Recalling an acute strain or mechanism of injury, TOP in the belly or MTJ, pain on squeeze tests.
3-phase rehab:
· Acute phase: rest, ice compression, elevation, crutches
· Subacute phase: Use isometric exercises and soft tissue release to preserve ROM and prevent atrophy. Correct biomechanics of the Cx, Lx and pelvis. Use corrective stretching, core conditioning and proprioception exercises. Progress from isometric to concentric to eccentric closed chain exercises (stretching the groin is not important).
· Sports specific: Progress bike to running work and late stage rehab include ball work.
· Typical rehabilitation is 4 – 8 weeks.
· Return to sport when full ROM pain free and adductor strength >90% unaffected side.
Chronic adductor pain related to recurrent adductor strains or tendonopathy. Rehab as per strain but 8 – 12 weeks.
Osteitis pubis
Gradual insidious or traumatic onset. Check for associated systemic signs such as fevers, chills or night sweats. Liase with medics for CRP, ESR and white cell count.
Signs
Dull ache over the symphisis occasionally radiating to the lower abdomen, proximal adductors, testicles, scrotum and perineum. TOP over symphisis, pain with passive stretch and active contraction. Associated with SIJ dysfunction, decreased ROM of the hips and adduction / abduction weakness. There will be a positive squeeze test, thomas test cross over sign and bone marrow oedema on MRI.
Adductor strain
Adductor strains are most common especially with sudden eccentric loading. Adductor longus is most commonly involved. Hip range of motion and muscle weakness / imbalance are predictors of future strains. Early season strengthening is needed as a injury prophylactic.
Charles Poliquin suggests that piriformis tightness is the biggest predictor of groin strains and the split squat are a key exercise in preventing groin strains.
Signs
Recalling an acute strain or mechanism of injury, TOP in the belly or MTJ, pain on squeeze tests.
3-phase rehab:
· Acute phase: rest, ice compression, elevation, crutches
· Subacute phase: Use isometric exercises and soft tissue release to preserve ROM and prevent atrophy. Correct biomechanics of the Cx, Lx and pelvis. Use corrective stretching, core conditioning and proprioception exercises. Progress from isometric to concentric to eccentric closed chain exercises (stretching the groin is not important).
· Sports specific: Progress bike to running work and late stage rehab include ball work.
· Typical rehabilitation is 4 – 8 weeks.
· Return to sport when full ROM pain free and adductor strength >90% unaffected side.
Chronic adductor pain related to recurrent adductor strains or tendonopathy. Rehab as per strain but 8 – 12 weeks.
Osteitis pubis
Gradual insidious or traumatic onset. Check for associated systemic signs such as fevers, chills or night sweats. Liase with medics for CRP, ESR and white cell count.
Signs
Dull ache over the symphisis occasionally radiating to the lower abdomen, proximal adductors, testicles, scrotum and perineum. TOP over symphisis, pain with passive stretch and active contraction. Associated with SIJ dysfunction, decreased ROM of the hips and adduction / abduction weakness. There will be a positive squeeze test, thomas test cross over sign and bone marrow oedema on MRI.