Adductor Muscle Pain, Strains & Tears

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A groin strain is an injury to the muscle tendon unit that produces pain on palpation of the adductor tendons or its insertion on the pubic bone with or without pain during resisted adduction. Adductor Tendinitis. In human anatomy, the groin is the junctional area between the abdomen and the thigh on either side of the pubic bone. This is also known as the medial compartment of the thigh.

The groin muscles consist of three large groups of muscles that can be injured: the abdominal, iliopsoas and adductors group. All these are innervated by the obturator nerve, with the exception of the pectineus, which receives innervation from the femoral nerve.

The adductors all originate on the pubic ramus as almost all insert on the linea aspera of the posterior femur. The posterior head of the adductor magnus has a proximal attachment on the ischial tuberosity antero-inferiorly and attaches distally on the medial distal femur at the adductor tubercle.

The gracilis insertion is on the medial border of the tuberosity of the tibia. The primary function of this muscle group is adduction of the thigh in open chain motions and stabilization of the lower extremity and pelvis in closed chain motion. The adductor longus is most commonly injured during sporting activity. Its lack of mechanical advantage may make it more susceptible to strain.

Groin strains are common amongst athletes who compete in sports that involve repetitive twisting, turning, sprinting and kicking. The exact incidence of groin muscle strains in most sports is unknown because athletes often play through minor groin pain and the injury goes unreported.

In addition, overlapping diagnoses can skew the incidence. Direct blunt trauma: An acute injury, typically a direct injury to the soft tissues resulting in muscle hematoma. Forceful contraction: The most common groin injury in athletes is muscle and tendon strain of the adductor muscle group. Change of direction and kicking have been described as the main actions resulting in adductor longus injury.

So a rapid muscle activation during a rapid muscle lengthening appears to be the fundamental injury mechanism for acute adductor longus injuries. The adductors attempt to decelerate an extending, abducting leg by using an eccentric contraction to adduct and flex the hip was the main cause of injury.

The injury may also occur during a forceful concentric contraction of the muscle. Microtrauma by repetitive injury: musculotendinous injuries to the groin are mainly a consequence of cumulative microtraumas overuse trauma, repeated minor injuries leading to chronic groin pain. The main sign of the adductor muscle injury is intense pain in the groin area. Muscle Strain injuries often arise from excessive stretching or stretching when the muscle is being activated.

When there is a strain in the muscle, the damage is often localized near the muscle-tendon junction. The muscle is getting weaker and the risk of further injury rises [16]. Clinically for an adductor strain, the patient presents with pain in the inner thigh and tenderness along the muscle belly, tendon or insertion.

The pain is exacerbated by adduction. There is no loss of strength or range of movement. The same mechanism of injury that results in a muscle tear in an adult may cause an apophyseal avulsion in an adolescent. There is a well-established clinical grading system for muscle tears, which has 3 components Grade 1 : no loss of function or strength.

Grade 2 : severe, with some weakness. In acute grade 1 or 2 strains of the adductor muscle, there is a very intense pain in the groin area, like a sudden stab with a knife, if the athlete attempts to continue the activity. Locally a haemorrhage and swelling can be seen a few days after the injury. A typical trauma history, localized tenderness and difficulties to contract the hip abductors. Grade 3 : complete muscle tear and complete functional loss.

Complete muscle tears or grade 3 strains are most often found in the distal musculotendinous junction located toward the insertion on the femur. In chronic cases , the symptoms of groin injury are often complex and uncharacteristic. With time, as the injury becomes more chronic, there is a tendency for the pain to radiate out distally along the medial aspect of the thigh or proximally toward the rectus abdominis.

In chronic and subchronic cases, the symptoms are often vague and diffuse in location. The most common symptoms are pain during exercise, stiffness after exercise and in the morning, as well as pain at rest.

Stress fractures of femoral neck or the inferior ramus of the pubic bone can be revealed by bone scintigraphy or repeated radiographic examinations. The literature provides no consensus on diagnostic criteria for the various causes of groin pain among athletes. First of all, there needs to be a patient history and an identification of the pain by the examination of the physiotherapist.

On evaluation, there is tenderness to palpation with focal swelling along the adductors and decreased adductor strength and pain with resisted adduction. The diagnosis can be made with focal findings on examination.

When this is followed by a clinical examination and sonographic and radiographic investigations, the differential diagnosis can be made up. A complete clinical examination should be performed for every patient with groin pain.

The injured athlete should first be examined by inspection in a standing position to evaluate the alignment of extremities. The patient should then be asked to lie in a supine position in order to be able to check the motion of the hip joint and the flexibility of the groin and hip muscles.

Resistive contraction tests of the knee extensors, knee flexors, abdominal muscles, and hip rotators, extensors and flexors, as well as hip adductors and abductors should be performed. If adductor longus muscle is injured pain will be elucidated to the injured area by resisting leg adduction and in passive stretching at full abduction of the hip. Tenderness on palpation is localized to the injury site at the origin of the adductor longus tendon or at the musculotendinous junction.

The location of the injury was based on a minimum of 1 positive finding on palpation, stretching, or muscle resistance testing [9]. Management is non-operative with rest, ice, compression, and gentle physical therapy or ROM.

Injection at the adductor longus enthesis is helpful for patients refractory to conservative management. There is a clear efficacy of nonsteroidal anti-inflammatory agents. Patients may return to sports or other activities after regaining full strength and ROM with resolution of the pain. However, if symptoms persist for more than 6 months after an appropriately administered physical therapy regimen and a period of protected weight bearing with crutches until the patient is pain-free, then surgical intervention should be considered.

Adductor tenotomy has been suggested as a technique to improve symptoms. However, this is an end-stage option to be tried only after all conservative methods have failed. Subsequent groin strains may occur, resulting in a recurrent problem. Hence primary and secondary prevention is equally important.

To identify the athlete at risk and possibly correct the predisposing factor s , the intrinsic and extrinsic risk factors for the injury type must be known. Previous groin injuries, reduced function scores, age, findings on clinical examination, and low isometric groin strength are associated with increased risk of new groin injuries.

A history of a previous acute groin injury and weak adductor muscles are significant risk factors [8]. Previously injured players have more than twice as high a risk of sustaining a new groin injury, while players with weak adductor muscles have 4 times higher injury risk.

Therefore it is important to have an adequate rehabilitation before a full return to play. Preventing the first injury should be a high priority to keep players from entering the vicious cycle of recurrent injuries to the same body part.

To accomplish this, the best method may be strength exercises of the adductors. Adductor strain injury prevention program [25]. The treatment of musculotendinous groin injuries is generally conservative. Surgical treatment in acute groin injuries is rarely indicated.

In the treatment of muscle-tendon injuries, immobilization should be limited to as short a period as possible to avoid the harmful effects of immobilization including muscle atrophy and loss of function. Immediate rest after the injury should be used until a diagnosis is secured. Adductor muscle strain injury program [25] :. Progressing the patient through the phases of healing has been developed by Tyler et al.

This type of treatment and rehabilitation programme, which combines modalities and passive treatment immediately, followed by an active training programme emphasising eccentric resistive exercise, has been supported throughout the literature. A simple adduction strengthening programme based on Copenhagen Adduction Exercise reduced the risk of a groin problem in footballer players according to the study published in the British Journal of Sports Medicine.

Squats can help in strengthening hip and knee muscles including the adductors. Exercises: [15]. There is support for an association of precious injury and greater abductor to adductor strength ratios as well as sport specificity of training and pre-season sport-specific training, as individual risk factors for groin strain injury in athletes. Core muscle weakness or delayed onset of transversus abdominal muscle recruitment may increase the risk of groin strain injury.

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Groin strain treatment & rehabilitation

Oct 01,  · Short description: Strain of adductor musc/fasc/tend unsp thigh, init The edition of ICDCM SA became effective on October 1, This is the American ICDCM version of SA - other international versions of ICD SA may differ. Aug 15,  · A groin strain is an injury or tear to any of the adductor muscles of the thigh. These are the muscles on the inner side of the thigh. Sudden movements usually trigger an Author: Lisa Baker. Hip adductor strain refers to an injury of the hip adductor muscles at the muscle belly, myotendinous junction, or tendon. It can be an acute or chronic injury. The hip adductor muscles include the adductor magnus, adductor brevis, adductor longus, pectineus, and gracilis muscles. All of these muscles are innervated by the obturator nerve with.

Everything you need to know to fix a pulled groin…

A groin strain is an injury or tear to any of the adductor muscles of the thigh. These are the muscles on the inner side of the thigh. Sudden movements usually trigger an acute groin strain, such as kicking, twisting to change direction while running, or jumping. Athletes are most at risk for this injury. Symptoms of a groin strain can range from mild to severe, depending on the degree of the injury. They can include:.

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