04 Feb Advanced Groin Training and [P]Rehab
What do offensive lineman, relief pitchers, stay at home defensemen, long snappers, caddies, and the groin muscles all have in common? They are all under-appreciated but play a crucial role in their respective systems! The groin is one of the most commonly injured muscle groups in athletes, especially in rotational athletes. In this article, you will learn the importance of completing advanced groin training at the end stages of a groin strain and with specific prehab interventions in order to prevent a groin injury in the first place!
What Causes A Groin Injury?
The anatomy of the groin can become very complicated along with the terminology that surrounds it when injured. For example, the term “sportsman hernia” or “athletic pubalgia” has been used to describe a lower abdominal or groin injury although a true hernia is not present. The complexity and confusion are attributed to all of the structures that pass through, along with the structures that have a home or attachment point to the pelvis. In regards to the groin musculature, there are 6 muscles that are “adductors”, however, we will focus our discussion here mainly on the adductor magnus and longus. The adductor longus is the most common injured group from the groin and this is thought to be caused by its poor muscle to tendon ratio at its muscle attachment origin. The adductor magnus is a massive muscle, taking up 27 percent of thigh mass, and has multiple jobs allowing it to play a huge role in performance!
We also have to account for both the hip flexors, hip extensors, and lower abdominals that share a close relationship with the adductor/groin muscles. An injury to any of these structures can mimic other injuries as their symptoms may radiate to other areas.
In any case, we know that groin injuries hurt and if not taken care of properly can lead to chronic pain! The tendons in this area tend to have a poor blood supply, along with a dense network of sensory nerves due to the proximity of our private areas, leading to a heightened pain response. Furthermore, depending on where the muscle is injured at the tendon or muscle-tendinous junction (MTJ) will dictate how aggressive the rehab can be in the initial phases as the MTJ has a better blood supply and can tolerate earlier loading. Therefore, it is important for us to understand how a groin injury happens, how to identify that it is truly a groin muscle strain, and lastly how to implement advanced groin training to get back on the field, golf course, ice, track, mat, or horse!
Groin injuries tend to happen in sports that require quick changes in direction, kicking, reaching out a leg to plant, or powerful rotations seen in sports such as baseball, hockey, soccer, softball, and golf (Kerbel et al 2018). Furthermore, chronic groin pain in the form of overuse leading to adductor tendinopathy is commonly seen in runners and horseback riders (Niemuth et al 2005). In both cases, the individual with a groin muscular injury will have discomfort on the inner thigh, reduced strength on an adductor squeeze test, and typically reduced hip internal range of motion (Mosler et al 2015). If this sounds like you and you want to get rid of that grumpy groin, no worries conservative management is very successful, surgery is highly unlikely to be needed, and the rest of this article will help you in how to fully restore adductor function through advanced groin training and more importantly how to [P]Rehab this area! For information on treatment in the early phases of rehab, we refer you to this article!
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The Hip [P]Rehab Program is a physical therapist developed, step-by-step program that teaches you how to optimize your hip health. This 3-phase program will expose you to various hip and lower body strengthening and stabilization exercises supported by science. This program will bulletproof your hips for anything life throws at you! Learn more HERE!
First Step To Prevention: Taking Control Of Risk Factors
As common as adductor or groin strains are, research is showing great potential for decreasing the risk! Tyler et al 2002 showed that identifying professional hockey players at high risk and implementing an adductor strength program decreased injury rates from 3.2 per 1,000 player-game exposures down to .71 per 1,000!
The most common risk factor, as with all other injuries, is a previous injury to the area, making the case for advanced groin training to ensure a full return to function. The tricky part is the groin needs extra conditioning due to the nature of its function. The adductor magnus along with being an adductor is a dynamic stabilizer for the hip joint, a powerful hip extensor, and flexor, and has the ability to assist internally and externally rotating the hip. Meaning when you move your leg in any direction, it’s highly likely the adductor magnus is helping. Furthermore, Donald Neuman 2010 states, “…during complex movements it is likely that the adductor groups are bilaterally and simultaneously active to control both the hip moving on the pelvis and the pelvis moving on the hip.”
From a performance and functional point of view, Neuman 2010 states “The bidirectional sagittal plane torque potential of most of the adductor muscles is useful for powering cyclic activities such as sprinting, bicycling, or descending and rising from a deep squat”. End phase power training of the adductors is not recommended, it is crucial! However, in order to earn the right to complete power training aka “the sexy training”, a fundamental base of mobility and strength is needed. Better said by Cormie et al 2011, “a fundamental relationship exists between strength and power, which dictates that an individual cannot possess a high level of power without first being relatively strong.” Leading to our next discussion points on mobility and strength ratios!
Fundamental Adductor Strength And Mobility
Another risk factor for a groin injury that has emerged is a limitation in total hip rotational mobility, specifically limited hip internal rotation (Tak et al 2016). Sticking with the mobility theme we have to include the thoracic spine. To be successful as a rotational athlete, one must be able to dissociate upper spinal from lower body movement. This is shown at elite levels in golf, baseball, and softball. These athletes have mastered the ability to rotate the hips and thoracic spine to pre-load the swing spring and then letting it fly in a proximal to distal sequence. Gaining hip mobility and dissociating upper spinal from lower quarter movement is low hanging fruit that we must grab and continue to eat if we want to [P]Rehab the groin.
Want To Become A Better Rotational Athlete? Overhaul Your Thoracic Spine Mobility!
Thoracic spine mobility is a precursor to optimal neck health, shoulder health, and so much more. Yet, the average person is bound to be stiff and limited in this region and the rest of their mid back! We can blame 21st century workplaces and lifestyle habits, but the good thing is the thoracic spine and mid back region respond really well to the right dose of exercises. If your thoracic spine mobility is limited and your entire upper body is paying for it, this program will get you moving better and feeling better! Learn more HERE!
Below is an all-in-one exercise that will address adductor flexibility, hip pelvis on femoral internal rotation mobility, and dissociation of thoracic spine from lower body motion!
Adductor Open Book
The next biggest risk factor we can take control of is the strength ratio of adductors to abductors (inner thigh: outer thigh muscle strength). This has emerged as a risk factor for a groin injury, specifically if the ratio is more than 90 percent being representative of full-strength recovery and less than 80 percent being predictive of future adductor strain (Thorborg et al 2011, Tyler et al 2001). Furthermore, Tyler et al 2001 showed a player was 17 times more likely to sustain an adductor muscle strain if adductor strength was less than 80% of abductor strength! These ratios are typically found using handheld dynamometers, however, you can get a general sense of your adductor strength using the assessment below.
Copenhagen Adductor Max Rep Assessment
Copenhagen Sideplank Exercise Progressions and Regressions
If you find the adductor muscle group feels deconditioned or weak you can use these exercises to build it back up! Copenhagens are a staple for advanced groin training!
The last big risk factor we will talk about is motor control of the core and overall strength. For high-level movement, the core must be effective at transferring energy!
What Is The Core?
If the core is feeling like it needs some work, check out our Core [P]Rehab Program! You will gain access to more, one-on-one focused instructional videos similar to this one, as well as a step-by-step approach to bulletproofing your core!
Advanced Groin Training and [P]erformance
If you hit the above checklist of strength and mobility, congrats you have earned the right for the sexier performance-based exercises. The key in this phase is to be and feel explosive in different planes of motion. As stated above our adductors are always busy and play a significant role in our ability to complete complex movements such as cutting, forcefully pushing off a skate, rotating and preloading our swings, sprinting, and getting out of the bottom of a deep squat. Research by Vigotsky and Bryanton 2016 shows us the adductor magnus is responsible for more than half of our hip extension torque during a squat.
Muscle Contributions ToHip Extension During A Squat
Kubo et al 2019 further show that squats are secretly an adductor dominant exercise as subjects completing full depth squat had a 6.2 increase, half-depth squat 2.7 increase in the adductor group, whereas the hamstrings had less than a 1 percent increase!
Maybe squatting isn’t your thing and you would identify yourself as a rotational athlete. The key to being a rotational athlete is the power that can be created in the hips and then through the core to the upper extremities. Research done by Burden et al 1998 on movement analysis in professional golfers found total swing time is 1.21 ± 0.14, showing us power needs to be a component of training for any golfer. Also, research done on baseball pitchers has shown the adductors play a big role in creating power to help deliver the pitch. Research by Yamanouchi 1998 concluded, “strengthening the adductor and the antagonist abductor groups could therefore be useful for enhancing pitching performance and avoiding injury.” Let’s keep the ball rolling and talk about soccer. Doctor and Irani 2019 showed that by increasing adductor strength footballers significantly improved instep kick distance, front kick distance, and kick velocity. Lastly, research by Chimera et al 2004 showed a plyometric/jumping program was successful in women collegiate athletes to improve early adductor preactivation, which improves the ability to safely position the knee during deceleration, along with improvements in vertical jump and sprint speed.
No matter what type of athlete you are, training the adductors in a power-based fashion will not only prevent injury but improve your overall athletic performance! Below is an example of a progressive power-based program training the adductors that you can start today. We will start will lower complexity velocity-based movement and progress to more challenging ones.
Copenhagen Plank – Quick
Med Ball – Back Step, Side Scoop Throw
Med Ball – 2 Medial Hops To Sideways Scoop Throw
Med Ball – Crow Hop, Rainbow Rotational Slam
Agility – Half Kneeling, Turn, Sprint
The adductors are second only to the hamstrings for being crowned the most common hip injury seen in athletes. By taking control of risk factors and ensuring we have proper thoracic mobility, hip rotational mobility, strong adductors, we earn the right for advanced groin training. Building powerful adductors will not only decrease the risk of injury but unlock further performance potential!
ABOUT THE AUTHOR
[P]Rehab Audio Experience Host
[P]Rehab Writer & Content Creator
Dillon is a Sports Physical Therapist, performance coach, and adjunct professor residing in Syracuse, NY whose passion is providing holistic solutions to improve all aspects of human performance. Along with working with clinical athletes across the lifespan, he provides on-field coverage for youth and semi-professional teams. After his undergraduate studies at Syracuse University, he earned his Doctorate in Physical Therapy from SUNY Upstate Medical University. He practices wellness, prevention, and solution-based health care out of Goldwyn & Boyland, PT, and Core Fitness. In his free time, he enjoys family dinners, playing with his dog, and competing as a fitness athlete. Dillon honors the opportunity to join the [P]Rehab guys to influence and educate in a people-first system!