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Jun 13 2011

Pulled Groin

Whether it’s a guy violently passing your guard or you throwing too high of a kick, it is fairly easy to pull your groin in Combat Sports. Unlike many other injuries, subjectively speaking, groin strains can be incredibly nagging and persistent. They are with you every moment of the day and like to remind you of their presence regularly. Regular workouts? Nearly impossible. Since the topic is so pleasant, lets talk some more about it.

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Adductor Group

As usual, some basic information to get started:

  • Even though there are a host of injuries that can present as groin pain, when thinking of a pulled groin, people generally mean an injury of the adductor muscle group. This group of six muscles is located along the inner thigh and is responsible for moving the leg towards the midline of the body (inwards).
  • Of that muscle group, the Adductor Longus is most frequently injured.
  • Most notable symptom is groin pain during adduction against resistance (for example by putting a medicine ball between your thighs and trying to squeeze it together).
  • Improperly treated groin injuries are incredibly persistent, may become chronic and eventually even threaten the end of an athletic career.
  • The rate of re-injury is extremely high and can likely be blamed on incomplete or inappropriate rehab. A pattern especially common to athletes is that not enough time is taken off to allow for proper tissue repair.
  • Adductor injuries are classified into three grades, depending on severity. Grade one is just a minor strain with little to no exercise time lost, grade two includes damaged muscle but not complete loss of function, which would be grade three.

Risk Factors & Prevention:

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The most obvious risk factors are a general weakness of the hip muscles, previous injuries to the area and an inadequate experience level. At this point, weak core muscles and overly high BMI are also being discussed, but the evidence is (not yet) fully convincing (nonetheless, watching your weight and strengthening your core is not a bad idea). Another important risk factor is the strength ratio between the adductor muscle group and the opposing abductor muscle group. Studies have shown that the rate of injury is much higher, the more imbalanced the strength ratio is (generally, the adductor group is too week).

With the risk factors in mind, it makes sense that the best prevention is to incorporate hip and adductor strengthening exercises in the weekly routine. Good exercises are sumo squats, side lunges, ball squeezes as well as numerous adductor machines you can find at the local gym, just to name a few.

Treatment:

Before going into this, I want to point out that passive physical therapy programs consisting of massage and stretching have proven ineffective as a treatment for chronic groin strains (it may feel good, but it does not speed up the healing process). As I have mentioned before, proper rehab is absolutely crucial to prevent re-injury. Grade two and three injuries should be taken care of under professional supervision. The immediate steps after injury should include:

  • RICE (Rest, Ice, Compression, Elevation)
  • NSAIDs (no working out!!!)
  • light massage and even lighter stretching (below pain threshold)
  • depending on severity, passive movement of the hip as well as electric stimulation and ultrasound may be in order.

Treatment of the subsequent phases (past acute injury) depends on the severity as well. Basically, the focus is on slowly regaining function by strengthening the adductor muscles while at the ¬†same time allowing the damaged muscle tissue to fully heal (FYI, you may easily be looking at 8-12 weeks of rehab here, so don’t jump the gun!).

After 6 months of persisting symptoms under appropriate conservative therapy, surgery might become an option. Some notes about the surgical solution:

  • It’s a last resort: improvements can be expected, but not all patients were able to return to previous levels of performance. Some were not able to return to their sport at all.
  • The process is incredibly time consuming. The surgery cannot be performed until you are completely pain free, which requires intense physical therapy and walking on crutches before the surgery even happens. Afterwards, you are looking at a lengthy rehab process.

As always, I am open to further questions or topic suggestions via the contact form or the discussion section below. And don’t forget to tell your training partners about what you have learned!

 

Sources:

Nicholas SJ, Tyler TF. Adductor Muscle Strains in Sports. Journal of Sports Medicine 2002;32:339-344.

Maffey L, Emery C. What are the Risk Factors for Groin Strain Injury in Sport? Journal of Sports Medicine 2007;37:881-894.

Credits:

Image taken from Wikipedia under Wikimedia Commons License.

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