03 Feb Groin Pain Rehab To Bulletproof Your Groin
Chronic groin pain can literally be a pain in the butt. The groin area is home to a multitude of different muscles, tendons, ligaments, and most importantly your private areas! Therefore, many times it’s hard to pinpoint the exact area of pain and thus when it comes groin rehab, I often times take the approach of strengthening everything and building tissue resiliency of all the muscles in that region. You can never go wrong with a strong and bullet-proof groin complex. Much like the sacroiliac joint which relies on all the muscles surrounding it to provide stability, a concept known as force closure, I treat the groin region similarly. The adductors, hamstrings, hip flexors, glutes, and most importantly the lower abdominals must all work in unison to provide stability to the groin complex. In this article, I will take you through a sample groin pain rehab program I use with patients in the clinic to bullet-proof every muscle in the groin!
As a physical therapist, my job often entails getting people out of pain. But rehab doesn’t stop there. The most important and overlooked aspect of rehab is bulletproofing the previously painful region to handle any and all future activities the patient may do. That requires meticulous programming on my end, but also a whole lot of dedication, blood, sweat, and tears from patients working their butts off with a strength and conditioning program.
You can not get brutally strong and expect to [P]Rehab your groin from future injuries without putting in the work.
This groin pain rehab program will be divided into two distinct phases. Phase I is the “get out of pain” phase. The main goal of this phase of rehab is to help get you out of pain and decrease the sensitivity of the tissues in your groin. Once we’ve tackled your groin pain as a team, Phase II begins. This phase is dedicated to getting your groin brutally strong. Once you have the adequate strength, we can begin to expose your groin to high levels of load, faster speeds, and multi-planar movements to truly bulletproof your groin.
You can download FREE copies of the Groin Pain Rehab Program Phase I and Phase II. Included are detailed video tutorials for each exercise, exercise instructions, sets, reps, and MORE. This program is an example of what PrehabX members can send to their patients/clients.
Groin Pain Rehab Phase I
These exercises will form the foundation and building blocks of the following two phases. First, we’ll start with exercises that directly load the tissues in the groin, namely the adductors and hip flexors. We can start with isometric exercises like side-lying hip adduction isometrics and supine hip flexor isometrics. The goal of these exercises is to gently put load through the adductors and hip flexors, the two most commonly implicated muscles that contribute to groin pain.
You are responsible for how hard you squeeze with these exercises. The goal is to ramp up as strong as a contraction as you can, but keeping it just below the threshold when you begin to feel pain in your groin.
Hip Adductor Isometrics
Don’t worry about how high you lift your leg here. Focus more on your ability to squeeze your adductors than how high you lift. If this exercise is painful, try doing the one below where all you have to do is squeeze the ball (or pillow) between your legs.
Hip Flexor Isometrics
Once you are able to build up a fairly strong contraction (>75% of your max effort), we can progress your exercises and begin to add movement (isotonics) in addition to focusing on other muscle groups. My go-to exercises for this next progression include isotonic sidelying hip adduction, bridges with isometric hip adduction, psoas marches, supine deadbugs (legs only), and side-lying clams.
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Isotonic Hip Adduction
Same concept as the isometrics, but only this time you are moving your leg up and down.
Bridges with Hip Adduction
Use a ball, wedge, firm pillow, or any other object between your legs. The goal is to constantly squeeze inwards and activate your groin, while simultaneously doing a bridge
I love this exercise as it hits the lower abdominals and hip flexors at the same time. The goal would be to do this away from the wall, but use a wall when learning.
Dead Bugs (Legs Only)
Keep the core engaged the entire time! The core (especially lower abdominals) is a hugely under-addressed region that we don’t emphasise enough in rehab.
I always start with clams for every lower extremity patient. I need to know without a doubt that my patient’s know how to fire their glutes and what it’s like to feel them so when we progress into higher level movements cueing is easier.
Stretching for Groin Pain?
I typically do not place a large emphasis on stretching the groin for a few reasons. First, we know that strengthening the tissues in the groin will lead to longer laster and better outcomes than stretching alone. Second, most people have already tried stretching – and it didn’t work. However, if stretching gives you a momentary bit of relief and it feels good, then go for it! But know that the long term solution to nipping your groin pain is strengthening, not stretching! If you feel you must stretch, adductor rock backs (with a twist) are my go-to groin stretch!
Adductor Rock Backs
Groin Pain Rehab Phase II
Now it’s time to get brutally strong. Not just your adductors and hip flexors, but your entire leg which includes the hamstrings, glutes, quads, and lower abdominals (in no particular order). You can get as creative as you want here, but some of my go to’s include all deadlift variations (sumo, traditional, Romanian), single-leg RDLs, lateral/posterior/sliders, elevated psoas march, standing hip adductions, supine leg whips, and some form of a Copenhagen plank.
There are so many different variations of Copenhagen planks. I included a few here but honestly, you can use whatever you find works best for you. A 2019 study by Haroy et al found that just adding one variation of Copenhagen planks decreased the risk of injury by 41% in a group of semi-professional soccer players.
I program a lot of deadlifts into my groin rehab. The Adductor Magnus (the biggest adductor muscle in your thigh) is actually primarily a hip extensor, especially in the last 30deg of hip extension. Thus while we are definitely getting great posterior chain activation (glutes and hamstrings) we are also getting phenomenal adductor magnus activation as well. The wider you go with your stance (ie sumo), the more you will be able to hit your adductors as well!
Standing Hip Adduction
Another favorite of mine for groin rehab. While you are definitely using your adductors on the moving leg with resistance, the key with this exercise is actual proximal core and hip control of your stabilizing leg. Pretend your hips are a ship – the ship cannot move!
Single Leg Deadlift
The goal of any lower extremity rehab program should to be to get brutally strong on one leg. Single leg exercises expose side to side differences and force you to work on controlling a movement.
Slider variations, in particular, the lateral and diagonal slider variations are my favorite exercise for groin rehab. The key with these is you have to “pull” your body back up to the start position by using your groin muscles.
Elevated Psoas March + Bridge
This one is a doozey! It’s similar to the standing psoas march, but now that you’re lying on your back it’s much harder on the core. Add in a single leg hamstring dominant bridge and I can guarantee you just found your next favorite exercise!
Supine Leg Whips/Slide Board
You can download FREE copies of this entire Groin Pain Rehab Program Phase I and Phase II. Included are detailed video tutorials for each exercise, exercise instructions, sets, reps, and MORE. This program is an example of what PrehabX members can send to their patients/clients.