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Adductor Pain - An Overview

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Medial leg and groin pain are due to the adductor muscle group injury of the thigh. To know more, read the article below.

Medically reviewed by

Dr. Anuj Nigam

Published At December 15, 2022
Reviewed AtJune 16, 2023

Introduction:

Adductor muscles are a group of muscles that help in body movements. The primary function of the adductor muscles- is adduction of the thigh and stabilization of the lower extremity and pelvis. Groin strain is a muscle-tendon injury that produces pain on palpation. Groin strain affects the inner thigh adductor muscles. During this, adductor longus muscles are mostly injured as it lacks mechanical structure and is more prone to injury.

What Are the Causes?

Several factors can lead to the development of adductor pain. Some of the etiological factors are listed below:

  • Stretching too far.

  • Working hard for a longer time.

  • Direct injury by a blow.

  • Getting stressed due to improper warm-up.

What Are the Risk Factors?

The chances of experiencing adductor pain are increased under the following conditions:

  • Previous hip or groin injury.

  • Age.

  • Weak adductors.

  • Muscle fatigue.

  • Decreased range of motion.

  • Inadequate stretching of the adductor muscle.

  • Biomechanical abnormalities- excessive pronation or leg-length discrepancy.

  • Suddenly changing direction.

  • Putting excessive force on the tendon.

  • Sudden acceleration in sprinting.

  • Jumping and overstretching are less common causes.

What Is the Pathophysiology of Strain?

The various mechanisms that can lead to adductor pain are listed below:

  1. Direct Blunt Trauma: Direct soft tissue injury results in muscle hematoma.

  2. Forceful Contraction: Muscle and tendon strain is the most common groin injury in athletes. Changing directions and kicking causes adductor muscle injury. Injury in football players occurs due to forceful contraction of the muscle. Injuries in ice hockey and soccer players occur due to repetitive twisting, turning, sprinting, and kicking.

  3. Microtrauma Due To Repetitive Injury: Overuse trauma and repeated minor injuries cause chronic groin pain.

  4. Muscle Strain Injuries Occur due to Overstretching on Muscle Activation: Damage occurs in the muscle-tendon junction due to muscle strain. Adductor injuries occur due to rupture or avulsion at the proximal site.

What Are the Clinical Features?

The clinical features of adductor pain are as follows:

  • Groin strain causes intense pain in the groin area.

  • Adductor strain causes pain in the inner thigh and tenderness along the muscle belly.

  • Muscle tear associated with avulsion.

  • Trouble walking.

  • Pain increases on adduction (movement of thighs towards the midline).

What Are the Stages of Adductor Strain?

  • First-Degree Strain: Pain with minimal loss of strength and motion. Muscle tears show normal or small areas of focal disruption with hematoma. Diagnosed with MRI.

  • Second Degree Strain: Tissue damage compromises muscle strength without losing strength and muscles. In acute strains, there is intense pain in the groin area followed by hemorrhage and swelling.

  • Third Degree Strain: Complete disruption of the muscle-tendon unit with loss of muscle function. Muscle tears with frayed margins and bunched or retracted.

Who Can Get Adductor Pain?

  • More common among soccer and hockey players.

  • Other sports related to adductor strain include football, basketball, tennis, skating, baseball, horseback riding, karate, and softball.

  • Physical activity without proper warm-up leads to muscle injury, especially in cold weather.

  • Doing more exercises than usual leads to muscle tiredness and muscle injury.

  • Extreme stretching, like in gymnastics, leads to muscle injury.

  • Doing physical activity before recovering from a previous injury.

How Is Adductor Pain Diagnosed?

Diagnosis of adductor pain is carried out through the following methods:

  • Proper questioning about the injury.

  • Proper questioning about the symptoms.

  • Clinical examination.

  • Other investigations - Plain radiograph, dynamic ultrasound, bone scan, computed tomography scanning, and magnetic resonance imaging (MRI).

How To Treat Adductor Pain?

Treatment of adductor pain involves a combination of methods including medications, physical therapy, exercise, and others. The common treatment options for adductor pain are as follows:

  • Most strains heal on their own.

  • Take rest and proper treatment for four to eight weeks.

  • Ice pack compression for two days on the injured site three-four times a day for fifteen minutes.

  • Use of elastic crepe to support the groin and to reduce swelling.

  • Lie down and raise the hips with the support of pillows.

  • Take painkiller medications if needed.

What Are The Preventive Measures?

  • It is good to start physical activity once it is completely cured. Going back to regular activity without proper healing will cause more risks.

  • Keeping the muscles strong and flexible through proper stretching exercises.

  • Increasing the exercise intensity and duration slowly over some time.

  • Stop doing the exercises that cause pain in the injured site.

What Are Phases in Adductor Strain Postinjury Program?

The adductor strain postinjury program focuses on identifying the origin of the injury and subsequently employing the management options. The various phases are as described:

Phase 1:

  • First 48 hours after injury- rest, ice compression, and elevation.

  • Medications like painkillers.

  • Massage.

  • Transcutaneous electric nerve stimulation.

  • Ultrasound.

  • Hip passive range of motion in a pain-free range.

  • Resistance exercises without weight in antigravity position- pain-free, low load, and high repetition.

  • Upper body and trunk strengthening.

  • Lower extremity strengthening.

  • Flexibility exercises for non-involved muscles.

  • Bilateral balance board.

Phase 2:

  • Bicycling or swimming.

  • Sumo squats.

  • Single-limb stance.

  • Standing with an involved foot on a sliding board moving in the front plane.

  • Standing on a cable column or resistance band.

  • Unilateral lunges with reciprocal arm movements.

  • Balance board squats with throwbacks.

  • General flexibility programs.

  • Multiplane trunk tilting.

Phase 3:

  • Phase 3 exercises increase speed, load, intensity, and volume.

  • Slide board.

  • On ice kneeling adductors pull together.

  • Lunges in all planes.

  • Correct ice skating techniques.

  • Adductor Strain Prevention Program:

  • Warm-up using a bike, adductor stretching, sumo squats, side lunges, and kneeling pelvic tilts.

Strengthening Programs - Ball squeezes, different ball sizes, seated adduction machine, adduction in standing on a cable column, concentric adduction with weight against gravity, standing with an involved foot on a sliding board, unilateral lunges with reciprocal arm movements.

Sports-Specific Training - On-ice kneeling adductor pull together, slide skating, standing resisted stride lengths on cable column to simulate skating, and cable column crossover pulls.

What Are the Simple Exercises?

Stretching exercises and therapy have gained much attention and application for the treatment of adductor pain. Some simple exercises that can be employed are enlisted below:

Floor Stretch:

  • Should lie on the floor facing upwards.

  • Legs should be outstretched.

  • Slowly move the right leg outside.

  • Return to the center position.

  • Do the same for the left leg.

Chair Lift:

  • Sit on a chair.

  • With a knee bent, lift the right foot below the hip level.

  • Hold for a few seconds and put down the leg.

  • Repeat with the other leg.

Side Lift:

  • Lean on the right elbow and support the body.

  • Raise the left leg upwards.

  • Repeat on the other side.

Knee Squeeze:

  • Place a soft ball between the knees in a sitting position.

  • Gently squeeze the ball and repeat for a few minutes.

Knee Bend:

  • Lie straight on the floor.

  • Outstretch the legs and bend the right knee.

  • Repeat with the other leg.

Conclusion:

Once the groin strain is relieved, the person can perform normal activity under a medical professional's advice. Rehabilitation programs will normalize lower extremity balance and protect the groin during sports.

Dr. Anuj Nigam
Dr. Anuj Nigam

Orthopedician and Traumatology

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