Adductor (Groin) Strains/Tears

Introduction

Adductor strains, commonly referred to as groin strains, represent one of the most frequent musculoskeletal injuries in athletes, particularly those involved in sports requiring rapid changes in direction, sudden accelerations, and kicking movements.

The adductor muscle group—including adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus—plays a vital role in hip adduction and pelvic stability. Due to their anatomical location and biomechanical demands, these muscles are highly susceptible to acute and overuse injuries. A comprehensive understanding of their definition, etiology, classification, clinical features, and evidence-based treatment approaches is crucial for physiotherapists managing these complex injuries.

Definition

• An adductor (groin) strain is the partial or complete tearing of muscle fibers or tendons within the adductor muscle group, predominantly affecting the adductor longus.

• Injury involves disruption at the muscle belly, musculotendinous junction, or tendon insertion on the pubic bone.

• Strains vary in severity from microscopic muscle fiber damage (Grade I) to full-thickness tears (Grade III).

• Chronic groin pain may develop if acute strains are not adequately managed or in the presence of repetitive microtrauma.
  

Cause

• Typically caused by acute eccentric overload during activities involving sudden hip abduction and extension while the adductors contract forcefully (e.g., side-stepping, cutting, kicking).

• Overstretching during rapid change of direction or tackling can lead to muscle fiber disruption.

• Risk factors include muscle fatigue, poor warm-up, prior injury, muscle imbalance (especially between adductors and abductors), and inadequate flexibility.

• Biomechanical factors such as pelvic instability and core weakness contribute to injury susceptibility.

• High incidence is noted in sports like soccer, hockey, rugby, and Australian football, where multidirectional movements are frequent.

• Chronic overuse and repetitive strain can lead to tendinopathy and persistent groin pain syndromes.
  

Classification

Adductor strains are classified by severity and anatomical involvement:

• Grade I (Mild): Small fiber tears, mild pain, minimal functional loss.

• Grade II (Moderate): Partial muscle or tendon tear, moderate pain, swelling, decreased strength.

• Grade III (Severe): Complete rupture of muscle or tendon with severe pain, swelling, ecchymosis, and significant functional impairment.

Anatomical classification:

• Muscle belly strains: Typically heal faster due to better blood supply.

• Musculotendinous junction injuries: More common and slower to heal.

• Tendon avulsions or chronic tendinopathy: May require surgical intervention if refractory.

Imaging with ultrasound or MRI aids in confirming diagnosis, grading severity, and treatment planning.

Signs and Symptoms

• Acute sharp or burning pain in the medial thigh or groin region, often during forceful movements.

• Tenderness and swelling localized to the adductor origin or muscle belly.

• Bruising/ecchymosis may appear after 24-72 hours.

• Pain exacerbated by resisted hip adduction and passive abduction stretching.

• Reduced strength and flexibility in the adductor muscles.

• Functional limitations such as difficulty running, changing direction, kicking, or cutting.

• Palpable defects in severe tears.

• Chronic cases may present with persistent groin pain and discomfort aggravated by activity.
  

Current Treatment Trends

• Acute management:

• Application of the POLICE protocol (Protection, Optimal Loading, Ice, Compression, Elevation).

• Early controlled mobilization to reduce stiffness and promote healing.

• Rehabilitation:

• Emphasis on progressive loading focusing on eccentric and concentric strengthening of the adductors.

• Neuromuscular control and core stability training to address biomechanical contributors.

• Flexibility and stretching exercises to restore range of motion.

• Functional and sport-specific training prior to return to play.

• Adjunct therapies:

• Manual therapy and soft tissue mobilization may assist recovery.

• Use of modalities such as therapeutic ultrasound or shockwave therapy has limited but emerging evidence.

• Surgical intervention:

• Reserved for chronic tendinopathy unresponsive to conservative care or complete tendon ruptures.

• Techniques include tendon repair or release, depending on pathology.

• Prevention:

• Focus on strength balance between hip adductors and abductors, core stabilization, adequate warm-up, and neuromuscular training.

• Current evidence supports individualized, criterion-based rehabilitation programs emphasizing early mobilization and progressive functional training to optimize outcomes and reduce reinjury risk.
  

Conclusion

Adductor (groin) strains are complex injuries with significant implications for athletic performance and daily function. Early recognition, accurate grading, and tailored physiotherapy management are key to effective rehabilitation. Progressive loading, neuromuscular training, and biomechanical correction are essential components of treatment, with surgery reserved for severe or refractory cases. Comprehensive patient education and multidisciplinary care enhance recovery and reduce the risk of recurrence.