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 tendon to muscle 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.

READ: HOW TO MANAGE A HIP FLEXOR STRAIN

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!

 

Don’t Sleep On Your Groin Muscle Group!

The Groin [P]rehab Program is the ultimate resource for those looking to recover from a groin injury, prevent a groin injury, or to reach new levels as a rotational athlete by addressing the workhorse of our movement system. No matter your fitness level or equipment restrictions, we have a carefully thought out plan developed for you that can be tailored to your needs! We are excited that you are taking control of your body, utilizing the right information at the right time to earn those groin grains through safe and effective programming! 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.”

LISTEN: HAMSTRING STRAINS WITH DR. SHANE NHO

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.

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

Sample Groin [P]Rehab Program Exercise

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.

 

Med Ball Exercises To Enhance Groin and Core Performance

 

Copenhagen Adductor Max Rep Assessment

Sample Groin [P]rehab Program Assessement Video

 

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!

 

The Prehab membership is the anti-barrier solution to keeping your body healthy. Access state-of-the-art physical therapy, fitness programs, and workouts online in the comforts of your own home or gym! Taking control of your health with exercise & education from the palm of your hand has never been easier. Get access to 50+ programs, 100+ unique workouts, and 3000+ exercises to build your own workout routines. Trial it for free, and learn how to get out of pain, avoid injury, and optimize your health with [P]rehab!

 

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

From: Vigotsky and Bryanton 2016

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

Sample Groin [P]rehab Program Exercise Video

 

Med Ball – 2 Medial Hops To Sideways Scoop Throw

 

Closing Thoughts

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!

 

Take Ownership of Your Groin Health!

Offensive lineman, relief pitchers, stay at home defensemen, long snappers, caddies, and the groin; are all essential for performance and all are super underrated. The groin is the workhorse of the movement system, the true MVP of the hip. It’s time to give it the star treatment it deserves by building strength and resilience to put the thought of injury in the past!

 

ABOUT THE AUTHOR

Dillon Caswell, PT, DPT, SCS

[P]rehab Audio Experience Host and Head of Programs

 

 

 

DISCLAIMER – THE CONTENT HERE IS DESIGNED FOR INFORMATION & EDUCATION PURPOSES ONLY AND IS NOT INTENDED FOR MEDICAL ADVICE.