Adductor Strains: How to Heal Faster and Prevent Groin Injuries
WARNING: If you are uncomfortable with any of the following words, you may want to practice saying all of them out loud at least 5 times until they no longer make you giggle, squirm, shiver, or uncomfortable. Even better, say them out loud to other humans so you can all experience it together. You can say them to your dog, but he will likely lick the area you may be referring to, which will probably enhance the awkwardness and thus be counterproductive. The following words will be said multiple times throughout this chapter, so familiarity and tolerability is a must:
Groin
Pubic/Pubis
Pelvic Floor
Kegel
Genitals or Genitalia
Penis - not really, but hope you say it out loud 5 times in front of your dog.
Butt
Butt cheek
Butt crack
Urination
Menstruation/Period
Moist - maybe, but unlikely.
Great, now that we have that out of the way, let’s talk about OUR GROINS! =D
The adductor muscle group includes the following: adductor magnus, adductor longus, obturator externus, gracilis, adductor brevis, pectineus, and sometimes adductor minimus.
SIDE BAR (and fun fact): Adductor Minimus is synonymous to the “Y” in the vowels of this group. Sometimes it is its own entity, sometimes it is considered part of adductor magnus. Either way - we celebrate you, Minimus. You are small, but you are mighty. END SIDE BAR
The adductors live along the inner part of your thigh and are called “adductors” because of the primary action they perform at the hip joint. When our leg/hip moves toward the center of our body (like the returning motion of a jumping jack), we call that “adduction” because we are “adding” it back to our midline. Some of the muscles (specifically Adductor Magnus and Gracilis) attach on the inside of the knee and assist in knee flexion (knee bending). In addition, muscles (not just the adductors) have secondary actions in which they become synergists for certain motions (SUPER helpful if you have a nerve injury, spinal cord injury, or amputation). The secondary action of the adductor muscle group is to assist with hip extension (bringing your leg/hip behind you). If your main hip extensor muscles are weak (cough cough - GLUTES - cough cough), then your adductor muscles may work overtime to help extend your legs while walking, running, hiking, etc. They are extending your hip while also flexing your knee, and adducting your hip. BUT THAT’S NOT ALL, FOLKS!
Lastly - and for my pelvic floor friends out there (woot woot to you all!), the adductors can become irritated if working overtime to stabilize the pelvis, or aid in control of bowel/bladder/genital function. This is one of the reasons why pelvic floor physical therapy is a growing speciality as what we used to label as “high hamstring pain” or “groin pain” was actually pelvic floor dysfunction. We will be discussing pelvic floor dysfunction more in a later chapter - don’t you worry (again, why you need to find comfort in loudly pronouncing the above 12 vocabulary words). However, let’s save that exciting topic and return to our adductor injuries.
Moist.
=]
How Does A Groin Strain Occur?
There are essentially two main injuries that occur to our adductors: strains or tendon injuries.
First, let us discuss how a muscle “strain” can occur. Typically, a muscle strain happens during an eccentric contraction of the muscle - or more simply - when the muscle is active as it is getting longer (i.e. think about when you're doing a bicep curl, but now you are lowering the weight down to your side slowly and controlled. The bicep is acting eccentrically as you bring the weight down). In considering the adductor muscles, this could be when landing a distant jump, kicking a soccer/football, or any other sport involving repetitive twisting, turning, sprinting, and/or kicking. Excessive force applied to a lengthening muscle will create strain; however, it can also be due to direct trauma or repetitive use (i.e. running, kicking). Strains become problematic when it affects our strength, quality of movement, OR - affects the bone where it is attached. Excessive irritation at the bone can lead to stress “reactions”, stress fractures, or avulsion (fracture of a bone due to a forceful pull of the tendon attached to it.
SIDE BAR (I promise I do not tangent this much in regular conversation) - BUT - I wanted to point out that as a clinician, I am not a huge fan of the term “stress reaction.” In fact, it was not something we discussed in graduate school as a real diagnosis and I was not aware of the term “stress reaction” until working as a physical therapist in Boulder, Colorado. To me, the term “stress reaction” is similar to the idea of “tight pants.” It has the implication for danger, but really we have no idea what is going on and it could in fact be a good, protective mechanism for our bodies.
Anyway - I dont think it is a great term and now it creates extra fear and anxiety without providing much guidance on a mechanism of injury or length of healing time. So let’s just not. I am having a stress reaction just talking about it. END SIDE BAR
Let’s get back to how these things come about. We’ve already discussed the traumatic, acute injury when the muscle takes on excessive force while in a lengthening position. In “adduct”ion (bahaha - puns), the adductor muscle group can be injured through repetitive motions (i.e. you guessed it - running) especially movements involving changes in direction (i.e. soccer, football, hockey). When combining these repetitive motions with poor mechanics, muscle imbalances, and/or a leg length discrepancy, we increase our risk of injury tenfold. A leg length discrepancy is actually very common because of how we sit, sleep, or become dominant in one side of our bodies. This form of leg length discrepancy is considered “functional” (versus structural) because it can be fixed with changes in posture and of course strengthening/stretching the imbalances. Do you always cross your legs while sitting at work? Do you always use your right leg first when going upstairs or hiking? This adds up friends and causes a change in our pelvic alignment and muscle lengths side to side. A structural leg length discrepancy is a different beast, and harder to “fix” without surgical repair of the difference in bone length. Typically, structural discrepancies are addressed with lifts or inserts placed in shoes to equalize the height of our pelvis side to side and allow for even weight distribution and force uptake through both legs as we walk, run, hike, bike, etc.
Was that a bunch of jargon?? Here is a summary of how these things occur. Keep in mind that the mechanism of injury is different for each person whether it is an acute/sudden injury or due to repetitive overuse.
Excessive force applied to a lengthening muscle - this includes kicking a soccer ball far away from our cent of mass, landing from a jump or fall or leap, or quickly changing direction while running/sprinting.
Repetitive Overuse with poor mechanics and muscle imbalances - this likely involves a functional leg length discrepancy, poor postures while sitting/standing for long hours, weak glutes (shocking….), and poor core strength.
Pelvic Floor Dysfunction and weak pelvic stabilization - this goes for men and women. Do you have groin pain AND pee a little when you run, leak when you do squat jumps, or have pain during sexual intercourse? Don’t belittle the necessity of a strong pelvic floor.
How Does a Groin Strain Feel?
The first and most apparent symptom of grain strains and adductor tendonitis is - well - pain in your groin. Now, I identify as a lady and walk around with the genitals of the lady sex. Groin pain to me is weird, uncomfortable, at times sharp and disturbing. However, the world of pain and discomfort that happens down there seems a little less “strange” to me and I have no problem at first attempting self massage, heating pads, and a glass of wine to reduce my pain. It works for other aches in the nether-regions, so wine-not??
That said, pain with this particular injury can be described as
A pulling sensation on your groin, inner thigh, in your glutes near the hamstring tendon, or even the inside of your knee.
A dull ache when standing or sitting for long periods of time.
A sharp pain with running, hopping, going up stairs, walking, or other weight bearing and impact activities. Less pain is generally felt with reduced-impact activities bike riding or swimming.
A loss of mobility in your groin or feeling like the inside of your hip and thigh are stiff.
At times, there can be swelling in the area of strain and/or bruising if the strain is more severe.
A feeling of weakness in the leg, especially during weight bearing activities, things that require single leg balance, and with lifting or bringing your leg inwards. It can even cause you to limp while walking if the sprain is more severe.
Another symptom felt by some is that sudden, scary, what feels SUPER loud, auditory “pop.” There are good pops and bad pops occurring in our body. “Good” pops happen in joints when we have a sudden release of pressure to create more mobility (i.e. think cracking your knuckles or seeing a chiropractor). However, a “bad” pop can be indicative of tissue damage. In this case, a sudden popping sound with acute sharp pain in your groin or inner thigh area is likely tearing of the muscle or tendon - also known as - a sprain. Here is a reminder of what differentiates the three grades of sprains:
What Activities are Safe with a Groin Strain?
Again, what we can and cannot do is highly dependent on the amount of damage done to the muscle, ligaments, tendons, etc. We are usually told to rest from activity, which is the most obvious, but most dreadful news to hear with any injury. Yes, rest is typically helpful. Rest allows for the healing process to take effect, for inflammation to subside, and for our bodies to reset after trauma or repetitive stress. HOWEVER - I am not a huge proponent of full rest. There is always something you CAN do, right? Micheal D’Aulerio said in his book, “A Runner’s Secret & The Ultramarathon Guide,” that “There is magic in movement. Yes, movement is medicine.” Each stage of recovery has an appropriate amount and type of movement that is helpful and healing. We just need to find what works for our bodies, our minds, and our sanity (seriously).
Now yes movement is medicine, but we must respect each stage of healing and understand that each stage comes with a certain percentage of rest. For example, if you are unable to walk without a limp and have moderate to severe pain with motion at the injured area, then more rest is needed to reduce risk of further injury. In this case, you can focus on isometric contractions to maintain the neuromuscular strength of your muscles while also creating muscle pumps to help reduce swelling. This includes exercises like quad sets, glute sets, hamstring sets or ball squeezes between your knees. Isometric exercises are also shown in the research to be highly beneficial for healing tendon inflammation as it brings blood flow to the injured area without contraction or overstretching the muscle/tendon. See the Appendix _____ for an explanation of these exercises.
We can also use this time to move other parts of our bodies or find other low-impact activities that provide therapeutic benefits while being helpful and healing. Upper body and core exercises are just as important for athletes as maintaining lower body strength. Working on posture, core stabilization, and arm strength is crucial for having optimum running form and increasing overall efficiency. Many of these exercises can be done without even moving your lower extremities or hips - so it is a great time to integrate this strengthening and mobility into your routine as your legs continue to “rest.” Again - most adductor injuries that are not traumatic are due to some amount of muscle imbalance - both in flexibility and in strength. Stretching, foam rolling, yoga, and mobility exercises can be done safely while “resting” so your body is ready and even when you get the green light to resume activity again. Swimming is a great alternative as it provides cardiovascular exercise as well as strengthening through water resistance. I mean - who doesn’t love a good ol’ fashion session of aqua jogging?
Let me make clear something that maayyyyyy have been stated lightly and briefly in the paragraphs above. Some rest is important. I am not usually in support of “full” rest, but again we must respect the stages of healing. In addition, sometimes injuries occur because our bodies have been trying to send signals of fatigue, over-training, and suppressed immunity, but we have cleverly chosen either not to listen or are blind to the signals. In the case of injury, some amount of rest is needed. Maybe it’s taking a break from the repetitive activity that lead to the injury. Maybe it’s taking a break from all vigorous activity for a week. Maybe it is integrating more “days off” or active recovery activities like yoga, reading, or walking into your routine so your body continues to feel good but now your mind can heal as well. Either way, listen to your body and be confident in the process.
Listening to our bodies is not easy, but we do have sensations like pain or soreness that provide some amount of communication. Pain is generally the benchmark of “ability” as far as recovery is concerned. At least, it is common to hear “let pain be your guide.” There is some truth to this, as pain signals are sent from the brain when our body is in danger and needs to protect itself from further damage. Pain signals can be influenced by other factors as well (i.e. anxiety, other disease, medication, etc); however, that is a whole separate topic with many books written about it. Anywhooooo - back to pain. Have you ever been asked “what is your pain intensity on a scale of 0-10?” ICK - I hate this scale. How the hell are we supposed to put a number to a physiological/psychological experience? ALSO - how the heck am I supposed to comprehend what YOUR 4/10 really means? I suppose it offers a reference point regardless of the person or situation. If your pain decreases from 9/10 to 5/10 then we know things are progressing and vice versa. So, okay - there is some use to this scale. That said, it is difficult for me to say “activity is okay if your pain stays below 3/10.” I may say that to my patients, but its because I have a better understanding of what THEIR specific 3/10 is in relation to their healing process. So, in recovering from this injury, let pain be your guide to a level that is tolerable and not increasing.
How Long Does It Take for a Groin Strain to Heal?
FOREVER
Hahah - just kidding.
Adductor injuries can take several weeks to heal mostly because of how they occur. Repetitive, overuse type injuries take months to manifest - so - we cannot expect them to heal quickly. Especially if it becomes chronic or recurring for you. There are likely bad habits, poor mechanics, and movement patterns that need to be changed through exercises in order for this injury to heal AND for it to never return.
Healing time for traumatic or sudden adductor injuries is similar to those of other sprains (i.e. refer back to chapter on ankle sprains). It depends on the amount of damage or tearing that has occurred; however, here is that wonderful chart of the standard healing times for different tissues in the body:
**reference: https://symmetryptaustin.com/healing-expectations-for-different-tissue-types/
Adductor injuries involve muscles and tendons - so, we are looking at anywhere from 2-6 weeks before the tissue is no longer damaged, torn, etc. However, without proper strengthening and stretching, pain will likely still occur because of continued inflammation if used too much too soon. Of course, the time frames above do not dictate when you can return to activity, as some amount of activity can be maintained while healing. Every human and every body is different - factors like nutrition, stress, other health-related issues, etc will affect your healing time. I’d give this guy at least 6-8 weeks before feeling near 100%. In that time, try some of these exercises and stretches below to kickstart your recovery. If you do not find full relief in 1 week, see your lovely, local physical therapist or other healthcare provider of choice. Your tolerance and response to these exercises will actually be very helpful for them as they work with you to figure out the cause of your injury and the best course of action for full and speedy recovery.
Helpful Exercises and Stretches for Groin Strains
Adductor Isometrics
Bridges with Adduction
Frog Bridges
Couch Stretch
Adductor Stretch/Groin Stretch
Dead Bug
Bird Dog
Fire-hydrants
Donkey Kicks
Clamshells
REFERENCES
https://www.physio-pedia.com/Groin_Strain
https://www.physio-pedia.com/Adductor_Tendinopathy
https://www.choosept.com/symptomsconditionsdetail/physical-therapy-guide-to-groin-strain