What to do if you are an unlucky sufferer from groin strains, and what action you can take to avoid them
A 'groin pull' (aka groin strain) is often a bruise, stretching, or tearing of muscle fibres which run from the front of the hip bone to the inside of the thigh. These 'hip-adductor' muscles, namely the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus, actively move the thigh toward the centreline of the body ('adduction') and also help to control and limit movements of the thigh away from the body's centre. Thus, the adductor muscles stabilise the hip and leg during all sporting activities which involve running. In some groin pulls, the muscles themselves are okay, but the tendons attaching the muscles to the front of the hip bone are stretched and inflamed. In rare cases, there is an inflammation of the hip bone itself, or even a hair-line fracture of the hip bone. Groin pulls can keep athletes out of action for weeks and even months at a time ('Pelvis and Sacral Dysfunction in Sports and Exercise', Phys Med Rehabil Clin N Am, Vol. 11(4), pp. 805-836, November 2000).
What causes it?
Sports experts believe that groin strains can be caused by a variety of different factors, including:
(1) Overuse. Since the adductors must stabilise the hip with each footfall during the act of running, they are subjected to vertical-impact, front-to-back, lateral-plane, and rotational forces about 90 times per minute per leg. Strenuous workouts can put great strain on the adductors, and if the recovery periods between workouts do not permit adequate restoration, the adductor muscles and tendons may become increasingly more irritated.
(2) Inadequate warm-up prior to strenuous activity. If the adductor muscles are not warmed and loosened up prior to intense work, or if the warm-up fails to prepare the nervous system to control the adductors in an optimal way, sudden movements may place too great a strain on the adductors, leading to tearing.
(3) Sudden dynamic movements, such as initiating a sprint, changing direction powerfully, leaping to catch a ball, surging up a hill, or hitting the ground after a jump. All of these activities subject the adductors to greater-than-normal force loads, which may produce damage.
(4) Poor mechanics while lifting heavy objects. When a large weight is hoisted, there is a tendency for the thigh to undergo abduction, ie, movement away from the centreline. If this is not controlled, the adductors may experience excessive strain.
(5) A forceful contact with an external object, such as the head of a rugby player, a soccer goal post, or another competitor's leg. When groin pull occurs, the leg is usually struck from the inside and driven away from the centre of the body.
How to recognise it
During your sporting activity, if you feel a sudden sharp pain in your groin area which causes you to stop - or at least slow down - your movement, you can be fairly confident that you have 'pulled your groin'. Motion at your hip joint will usually produce pain, and your groin area will become tender to the touch. Within 24 hours, you'll often be cursed with significant swelling and inflammation, and the injured area may feel warm to the touch. The swelling may spread downward, and discolouration can appear within 48 hours (and also may spread downward). Walking creates pain, and quality running is usually impossible.
If you're an athlete and decide to visit your health professional (a wise idea), he/she will want to know when the injury occurred, if physical contact caused the problem, and if activity had to be immediately terminated. He/she will also want to know if the existing pain is long-term (chronic) or of new onset (acute). You'll be asked to move the injured-side leg through several positions and indicate when pain is caused or intensified. The health-care specialist might also palpate the site of injury to see if pain is produced and evaluate the extent and duration of discolouration. Should a condition more serious than groin strain be suspected, imaging procedures may be prescribed, such as an x-ray, CAT scan, or magnetic-resonance imaging.
What action to take
There are things you can to do control pain and spur recovery. As soon after the injury as possible, you should elevate the injured-side leg, compress the site of injury, and apply ice (put a styrofoam cup filled with water in your freezer; once the water is frozen, peel away the top edge of the cup to expose a core of ice, and gently rub this nub on the injured area for about 12 minutes at a time, recovering for 20 minutes between rubbings). You'll want to stay away from walking, jogging, and running for as long as moderate-to-severe pain persists. Some therapists believe that very gentle manual massage, working from the lowest area of discolouration toward the central area, may hasten recovery and reduce discolouration. A non-steroidal anti-inflammatory drug may be prescribed, as well as a diet rich in antioxidants (see accompanying article).
The length of time you'll be out of action depends on whether you have a first-, second-, or third-degree groin pull. Generally, first-degree groin sprains are simple bruises of the adductor muscles (or hip bone), with possibly a stretched tendon or a few stretched muscle fibres. If you have to have a groin pull, first-degree strains are the ones to have: major symptoms typically disappear within a week.
A second-degree groin sprain involves stretched tendons, stretched or torn muscle fibres, and often bruising of the hip bone and its muscular attachments. They are usually symptomatic for two to three weeks. Lastly, a third-degree groin pull is represented by many ruptured muscle fibres, severely stretched tendons, and perhaps separation of a tendon from either its muscle or bony attachment. Symptoms can persist for six to eight weeks - or even longer.
When can you go back?
Knowing when you can return to your sporting activity is fairly easy. When all of the movements associated with your sport can be performed without significant pain, you may return to participation. If your sport requires frequent and forceful changes of direction, as in soccer, for example, such movements must be painless when performed with the usual vigour. The return-to-action criterion is usually a bit different for the 'straight-ahead athlete', ie, the distance runner. If a distance runner can move along without pain during straight-ahead running, he/she usually has the green light to resume strenuous training. Note, though, that if such a runner feels pain during changes of direction, he/she is likely to be at increased risk of overuse-related groin pulls and may easily damage the groin further as a result of abrupt changes of direction during workouts or races (to avoid another runner, for example, or to avoid stepping on an uneven surface).
If you have had a groin pull, you are probably at increased risk for another one, compared to the athlete with no history of groin troubles. Thus, you'll want to unkink and warm up
your groin muscles thoroughly before your workouts and competitions (these groin-saving preparations should begin with about 10 minutes of easy movement, followed by exercises and drills which gently put the hips through their full range of motion; many of these moves should involve a high degree of coordination, in effect 'prepping' the nervous system to control the groin muscles efficiently). If you believe your groin pull was caused by overuse, it will be especially important to temper the quantity and quality of your training - and include more recovery (fewer days of training per week, more sleep, better nutrition). Naturally, you'll want to strength-train your groin muscles (see below), so that they will stand up to your training with less chance of injury. If your sport involves contact, you should wear protective padding over your groin area.
Try these adductor stretches...
Once the symptoms of your groin pull have subsided, you may engage in stretching exercises after your workouts are over to keep your adductor muscles non-taut. Try the following adductor stretchers:
(1) The groin and hamstring stretch. Simply sit on the floor with your legs extended forward and spread sideways as far as possible. Turn your toes upward, and bend forward at the waist to grasp your feet, flexibility permitting, or else your ankles. Bring your forehead as close to the floor as pain and flexibility permit, and hold this position for about 15 seconds, before returning to the starting position and resting for a short period. Perform this sequence about 10 times after a workout is over.
(2) Groin stretch. Sit on the floor with your head up and your back straight. Then, flex your knees and bring the soles of your feet together. Place your hands on your knees, and press your knees gently toward the floor as far as flexibility and pain permit. Hold this position for about 10 seconds, and then return to start position, resting briefly. Also perform this sequence 10 times after workouts.
...and these strengtheners
The following exercise is commonly recommended for strengthening the groin muscles:
(1) Inward leg presses. Simply sit on the floor, and place a volleyball, soccer ball, basketball, medicine ball, or even a large, tightly rolled towel between your knees. Squeeze your knees together as forcefully as possible (pain permitting). Hold this position for 15 seconds, return to the start position, and rest for a few seconds before repeating nine more times.
Note, however, that inward leg presses are not very functional. We must remember that gains in strength for particular muscle groups are specific to the actual movements utilised during strength training. Thus, inward leg presses make the adductor muscles strong during seated exercise, but few sporting activities are carried out in a seated position, and those that are conducted from a sitting posture have a low risk of groin injury. Thus, the following two exercises will do a better job of making the adductor muscles strong during movement:
(2) 'Indian-hop' for 45 seconds, rest for 15 seconds, and then Indian-hop for 45 more seconds. To Indian-hop, jog for a few strides and then jog diagonally to the right with your right foot. When your right foot makes contact with the ground, hop in place.. When your right foot comes down to earth from this single hop, explosively hop diagonally to the left, landing on your left foot. When your left foot strikes terra firma, hop once in place and then explode diagonally to the right. Your right foot, will then hit, hop, explode diagonally to the left (not literally), and so on. Stay relaxed at all times as you carry out this drill; try to move in a coordinated and rhythmic manner. Stop the exercise if groin discomfort arises. Carry out this exercise several times a week, but only after a thorough warm-up.
(3) One-leg squats on a wobble board. To do these, stand with your left foot forward and your right foot back, with your feet about one shin-length apart (they should be hip-width apart from side to side). Your left foot should be securely positioned in the centre of a wobble board which is set so that the instability occurs in a lateral plane (ie, from side to side). Place the toes of your right foot on a block or step which is six to eight inches high. Most of your weight should be directed through the heel to mid-portion of your left foot. Now, bend the left leg and lower your body until your left knee reaches an angle of 90 degrees between the thigh and lower leg, at the same time resisting the tendency of the wobble board to rock from side to side. Then, return to the starting position, maintaining upright posture with your trunk and holding your hands at your sides. Complete 12 reps, and then do the same thing with your right foot forward and your left foot back. Finally, carry out one more set with each leg (you should use this exercise four to five times per week, always following appropriate warm-up).
If a groin pull keeps you away from training for more than a
few days, maintain your cardiovascular fitness by swimming freestyle or cycling fairly intensely (cycling should not aggravate groin conditions, provided the bike seat is not set too high). Once you are symptom-free, you can resume regular training, using the above stretches and exercises on a regular basis.