Adductor injuries continue to plague athletes in multiple sporting codes. Measuring symptoms, strength, and performance can assist with early detection, monitoring, and rehabilitation. Lindsay Harris provides a clinical update on adductor-related pain.
Arsenal’s Beth Mead scores their third goal Action Images via Reuters/Paul Childs.
Hip adductor muscle and tendon injuries are the most common problems in athletes presenting with both acute and long-standing groin pain(1,2). The adductor complex includes the three adductor muscles (longus, magnus, and brevis), and the adductor longus is most commonly injured(3). The adductors have multiple functions. Adductor longus provides some medial hip rotation, whereas adductor magnus functions during hip extension due to its attachment to the ischial tuberosity. Notably, in open-chain activation, they function primarily as hip adductors. However, in closed-chain activation, they stabilize the pelvis and lower extremity during the stance phase of gait. Moreover, they have secondary roles, which include hip flexion and rotation.
This way, the adductors almost work as scissors and a bilateral force couple during sprinting, kicking, and skating. Depending on the sport, they have a critical stabilizing function and primary movement role in different specific and repetitive movement patterns. Due to their roles, they are highly involved in sports that include kicking, skating, and direction change(1).
A detailed subjective examination, including the mechanism of injury, is key in the clinical examination of adduction injury athletes. In the objective examination, clinicians should follow the basic guidelines of “look, feel, and move.”. Visual inspection of the groin and thigh may reveal a hematoma from an acute adductor rupture, which may track all the way down to the popliteal fossa(2). Palpation of the adductor longus tendon insertion may reproduce the patient’s symptoms, especially in long-standing and adductor-related groin pain(4). Most injuries to the adductors, acute or overuse, involve the superior part of the adductor longus tendon and its insertion (up to 70% of all groin problems)(3,4). Clinicians must include pain provocation tests, including muscle contraction against resistance, stretch (leg abduction), and palpation. Adductor-related pain is confirmed if the clinician reproduces the athlete’s pain via isometric adduction squeeze performed on straight limbs together with a tenderness on palpation of the adductor longus muscle (see figure 2)(4). Furthermore, clinicians can request other investigations, including ultrasonography and MRI, when suspecting other structures.
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