07 Sep Prehab Your Groin: How To Manage An Adductor Injury
If you have played in various sports such as ice hockey or soccer before, you are probably familiar with tweaking your groin muscle (adductor). A groin strain is an injury to the muscle-tendon unit of the adductor tendon or its insertion into the pubic bone. The reason groin strains are so common during hockey and soccer is that it requires such a strong eccentric contraction (muscle lengthening against gravity) of the adductor musculature. Other sports that require twisting, turning, kicking, and sprinting, such as tennis, rugby, football (American), basketball, and running have also been associated with groin strains. Moreover, adductor strains may happen with other activities involving general exercise if our body is not adequately prepared for various movements. Although common, there are plenty of ways to prehab your groin in an effort to prevent adductor injuries! This article will give you actionable exercises on how to prehab your groin strain!
What Are The Adductor Muscles?
The adductor muscles of the hip joint include the adductor longus, adductor magnus, adductor brevis, gracilis, obturator externus, and pectineus. Of these, it is the Adductor Longus that is most commonly injured during sporting activity.
All of these muscles perform adduction (bringing the hip closer to midline). In addition, the adductor magnus tendon attaches to the ischial tuberosity (our butt bone), which allows this muscle to extend the hip. In the closed chain (when our feet are fixed on the ground, the adductors help along with other hip musculature to stabilize the pelvis.
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 to groin rehab, we oftentimes 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 bulletproof groin complex. Much like the sacroiliac joint which relies on all the muscles surrounding it to provide stability, a concept known as force closure, we 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.
What Does Groin Pain Feel Like?
Groin injuries tend to occur in sports or movements that cause a quick contraction of the adductors, putting increased load and stress through the adductor tendons. An example of this would be sprinting, which is the most common mechanism of injury. Similar to hamstring strains, injury rates are higher in comparison to other soft tissue injuries.
Some of the common signs and symptoms of an adductor strain include:
- Pain anywhere along the adductor muscle region
- Localized tenderness to palpation (pressure on the involved structures)
- Potential bruising and/or discoloration
- Pain with contraction and/or stretching of the adductor muscle group
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Prehab Your Groin By Starting With The Basics
Most groin strains are treated conservatively. The amount of time that a groin injury needs to fully recover depends on the severity of the strain. For example a grade I minor strain could fully resolve within a couple of weeks, whereas a more severe Grade II may take up to two months. It is important to receive a proper diagnosis from a trained healthcare professional to ensure you have an understanding of the prognosis and a timeline for recovery. Read more about the concepts of tissue healing below.
These exercises will form the foundation and building blocks to prehab your groin. 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 of 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.
Groin Pain Treatment: Hooklying Hip Adduction Isometrics
Groin Pain Treatment: Hip Flexor Isometrics
Step 2: Time To Progress!
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.
Groin Pain Treatment: Isotonic Hip Adduction
Same concept as the isometrics, but only this time you are moving your leg up and down. Going through the concentric and eccentric contractions of a particular movement is known as an isotonic exercise.
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 emphasize enough in rehab.
Groin Pain Treatment: Sidelying Clams
I always start with clams for every lower extremity patient. I need to know without a doubt that my patients 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.
Step 3: Get Brutally Strong!
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.
Copenhagen Plank Variations
There are so many different variations of Copenhagen planks. 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 30 degrees 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 (i.e 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 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.
Struggling With Your Single Leg RDL?
Sliders For Groin Prehab
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.
Differences Between Sliders vs. Reaches
Elevated Psoas March + Bridge
This one is a doozy! 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!
Do you want to learn more advanced groin exercises? Read this article!
READ: ADVANCED GROIN TRAINING
What About Stretching?
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-lasting 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!
LISTEN: HOW MUCH DO I NEED TO STRETCH?
Adductor Rock Backs
Dynamic Mobility Groin Flow
Here are 3 exercises that progress from a static stretch to a dynamic stretch to an eccentric load to a concentric load of the adductor muscle group.
It is important to note that when creating a preventive program for groin strains, you want to additionally address core stability.
After reading this article, you have now gained a further understanding of what groin pain is, and what you can do to overcome an injury to this area of the body. The process can be tedious at first, yet patience is key! As discussed earlier, You creating an optimal environment for the body to heal itself is crucial for success. In order to do so, the initial part of your recovery is relative rest including avoidance of aggravating factors, followed by early mobility to enhance tissue healing, and ultimately returning to functional movements! Be sure to watch the videos here and read over the information provided to further understand how to manage groin pain!
- Epidemiology of Hip and Groin Injuries in Collegiate Athletes in the United States. Orthopedic Journal of Sports Medicine. 2018. Kerbel et al.
- Rehabilitation Of Soft Tissue Injuries Of The Hip and Pelvis. International journal of sports physical therapy. 2014. Tyler et al.
- Groin injuries in sports medicine.” Sports Health: A Multidisciplinary Approach. 2010. Tyler et al.