Hip Adductor Related Groin Pain

If you follow Aussie Rules Football (or AFL), yesterday was the 2nd second semi final with GWS Giants defeating Port Adelaide 93-70. Aized and I had to help Aussie Rules football players back when we were  doing our post graduate physiotherapy studies in 2003. I still follow the AFL league from time to time. AFL footballers often suffer from groin pain.

Other than AFL footballers, soccer (also known as football), rugby players and those who play badminton and squash etc are involved in rapid acceleration, deceleration and sudden changes in direction are all more prone to groin injuries.

Athletes with a previous groin injury are at a greater risk than those with no previous injury. This can be up to 2.4 times greater over consecutive seasons with football players (Haglund et al, 2006).

The hip adductors

Football players have a yearly incidence of adductor related groin pain of 10-18 percent. 53 percent of theses cases are from overuse. Groin injuries in male club footballers accounted for 4-19 percent of all injuries and 2-14 percent in women club footballers.

Different types or groin pain

It can be difficult to diagnose groin injuries since there can be many different complex causes. Hip adductor related groin pain is defined as hip adductor tenderness and pain with resisted hip adduction testing. It is also the more common causes of groin pain. Other than hip adductor groin pain, the iliopsoas, inguinal and pubic symphysis are other causes of groin pain (pictured above).

Exercise therapy is commonly prescribed for groin pain although there is no specific exercise protocol. Exercises, particularly adductor eccentric strengthening seems to be beneficial for pain reduction and return to sports at 16 week follow up in comparison to stretching, electrotherapy (ultrasound, interferential currents) and transverse friction massage.

We do see many patients with groin pain in our clinics. However, our approach to treatment is different. We do not get our patients to do the strengthening exercises when they are in the clinic. We prefer to treat them using mostly our hands instead. For example, for a patient with groin pain, they may also have a higher hip on one side (pictured below).

R hip lower

We can treat the hip with respect to the shorter side. Short in terms of length. It also depends on what our assessments show. The patients can do the strengthening exercises they need on their own. We treat what they cannot do themselves in the time they have with us. Come see us in our clinics if you have groin or hip pain.

References

Haglund M, Walden M and Ekstrand J (2006). Previous Injury As A Risk Factor For Injury In Elite Football: A Prospective Study Over Two Consecutive Seasons. BJSM. 40: 767-772. DOI: 10.1136/bjsm.2006.026609

Weir A, Brukner P, Delahunt E et al (2015). Doha Agreement Meeting On Terminology And Definitions in Groin Pain In Athletes. BJSM. 49: 768-774. DOI: 10.1136/bjsports-2015-09486

Yosefzadeh A, Shadmehr A, Olyaei GR et al (2018). Effect Of Holmich Protocol Exercise Therapy On Long-standing Adductor-related Groin Pain In Athletes. BMJ Open Sp Ex Med. 4: e000343. DOI: 10.1136/bmjsem-2018-000343