So you’re out on the basketball court, tennis court, ice rink, or gym floor - you go to cut, pivot, land, or jump, and all of a sudden you’re wincing from a sharp pain radiating from your inner thigh. In all likelihood, you’ve just suffered a groin strain.
This may be your first, or maybe you have a long history of groin pulls, either way, they are quite aggravating, painful, and can be a huge detriment to your training and sports performance. Most of us have been in this scenario, in fact, nearly 30% of all athletes and gym-goers will experience a groin strain over the course of their playing/training career. Now, when it comes to groin pulls/strains, most athletes go down one of two roads.
Option 1 - they hang up the nanos, cleats, skates, or racquet and decide that they will take the next few months off and let the groin pain heal on its own.
Option 2 (the majority of athletes I come in contact with) - continue to push through the pain by going out on the court, ice, or gym and hoping that if they just keep making performance progress, the pain will take care of itself. Spoiler alert: This doesn't work!
Option 3: What I want you guys to realize is that there is a 3rd option that is both immediately beneficial for that nagging pain and long-term participation in your sport/training of choice.
There are two major concepts to understand when dealing with muscle strains. Firstly, most muscle strains occur during the eccentric phase of contraction - meaning when the muscle is lengthening. For tennis players, this can be when they are pushing off their stance leg to move laterally in an explosive motion, or when a hockey player is using his back leg to create a powerful stride.
In both of these scenarios, the adductor muscle group that sits in the inside of each leg is becoming lengthened very quickly and must actively work to decelerate the limb from the initial explosive movement.
Adductor strains or groin strains are extremely common among sports and functional fitness athletes due in large part to the discrepancy between ADDuctor (moving the leg toward midline) and ABDuctor strength (moving the leg away from midline) at the hip. Many athletes spend a lot of time focusing on squatting and lunging movements that target the hip ABDuctors, however, very little focus is given to those muscles on the inside of the thigh.
The second major concept to understand pertaining to groin strains is that while the injury occurred due to this muscle group being asked to endure a force/load beyond its capability, the answer to fixing this problem is actually introducing controlled load. Contrary to popular belief, we want to actually load the adductor group to create a more robust muscle and tendon - but in a controlled manner that respects your body’s natural healing process!
When it comes to fixing your groin pain and getting back to the training/sports you love, there are 3 major phases, Below are examples of how one might go addressing this issue. This however is not a cookie-cutter approach to everyone solving their own groin pain. We highly recommend that you consult with us at Ground to Overhead PT before attempting to fix your groin strain on your own. The most important thing to ensure that 1, you’re dealing with a groin strain in the first place… and 2, you’re doing the right things for YOU to get you better and back in the game:
PHASE 1 - “Crap! I pulled my groin!” It hurts like the dickens, you can’t squat, run, cut, or skate without pain. You are like a duck, cool and collected on the surface but underneath you are freaking out!
During the first 1-2 weeks following a groin pull, I want you to focus on soft tissue work, gentle stretching, and light isometric exercises to allow for a decrease in pain and initial strengthening of the adductor muscles and tendons. For soft tissue work, try using a foam roller on the inner thigh, spending time on those areas that feel uncomfortable. For stretching, the adductor rock back is a great stretch to begin to open up the hips. You should feel this stretch in the target muscle group, but be careful not to be too aggressive with this stretch as we don’t want to cause a ton of pain while the body is healing. Lastly, for isometrics, lie supine and place that same foam roller between your knees with your legs bent, Press into the foam roller and hold the contraction for 10 seconds x 10 repetitions for a total of 100 seconds of contraction. For these, modulate how hard you are pressing into the foam roller by keeping your pain level at a 3 or lower on a 1-10 scale.
Links to adductor stretch, foam rolling, and isometric exercises:
Phase II - “I’m feeling a little better, but it still hurts.”
At this stage, your groin should be starting to feel better and your overall pain should be decreased. If you’re still having pain after 1-2 weeks, use the phase 1 exercises as a warm-up prior to the following strengthening exercises and consider scaling back on any painful movements you are doing in the gym or on the court. The main focus of phase 2 is to begin to strengthen that muscle and tendon so that you won’t run into this problem in the future. The 3 major strengthening exercises I want you guys/gals to try are the Copenhagen plank, adductor slide-outs, and the banded adductor pulls. For the Copenhagen planks, grab a workout bench and place the knee of the affected limb on top of the bench with the knees bent. From here, you’re simply going to hold a plank stance for 2-3 sets of 20-30 seconds. For the adductor slide-outs, you will need a furniture slider (most gyms have these) and a surface with low friction. Start by sliding the affected limb slowly out to the side or diagonally behind, then use your adductors to pull the limb back towards the body until you are standing at the starting position. Try for 3 sets of 8 repetitions for this exercise initially, increasing in repetitions each week as your body allows. For the banded adductor pulls, you’ll need a light band (red or orange should be appropriate initially). Attach the band to a squat rack, pole, or banister, and the other end should be placed around your midfoot. From here, slowly allow the band to pull your leg out to the side in a controlled manner, then actively squeeze the adductor group to bring the limb back to the starting position. Start with 3 sets of 15 repetitions for this exercise and focus on a slow eccentric portion of the repetition. All exercises and repetitions during this phase should be slow and controlled, focusing on muscle contraction, not the speed of movement.
Links to Copenhagen planks, slide outs, and banded adductor pulls:
Phase III - “I’m starting to feel like my old self again!”
For the third and final phase of recovery, we need to begin to load the adductor group at a higher velocity. When we are playing sports or training in the gym, injuries normally occur when our body moves too quickly in a direction that it doesn’t have the baseline strength & stability to support. During this phase, we need to begin to teach our bodies how to fire our adductors under load, with an added speed component. Try the following exercises: speed skater lunges and Russian speed lunges. Both of these exercises challenge your body’s strength and stability - one with a focus on single-limb stability, and one utilizing both limbs with a quick turnover. Try 3 sets of 20 repetitions for both of these exercises - you should move explosively, but not recklessly through these movements.
Links to speed skater lunges, Russian speed lunges:
Alright, guys! I hope this gives you also some ideas of where to get started after suffering a groin strain/pull. I know from personal experience that this can be a painful, nagging, and aggravating injury to overcome, however, this blog should give you some excellent foundational exercises to get you started and moving in the right direction!
Remember, oftentimes an injury is a clue that we need to get that area of the body stronger to meet the demands being placed on it. Give these exercises a try, and modify your training/sport participation in a way that doesn’t continually irritate that groin while you’re rehabbing it. Tune back in next month where I’ll break down another common injury and the road to recovery!
Dr. Brett Rolison
Do you have lingering hip pain? Do your hips tend to "flare-up" a few times a year? Do you fear hurting your hip again? Does this fear prevent you from living life fully, and training without limitations? I have good news for you, you don't need to live in fear of hip pain any longer!
The solution? Bulletproof your hips by fixing your foundational movement patterns and building strength within those movement patterns! Build resilience, lift heavyweight, and live your life without pain or worry.
Here at Ground to Overhead Physical Therapy, we help athletes all over the country resolve their chronic pain. We do this with in-person appointments for athletes local to our clinic. Remotely, we help athletes through individualized training programs designed to resolve the athlete's pain and achieve their goals. We coach the athletes through electronic communication, video analysis, and video calls; guiding them step by step along the process of eliminating their chronic problems.
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