Background & Etiology

A groin strain, or a pulled groin, is an injury to the muscles of the inner thigh. Called the adductor muscles, these six muscles run from the inside of the pelvis to the inside of the femur (thigh bone.) A strained muscle occurs when the muscle is stretched or pulled beyond its normal range. This can cause small tears in the muscle fibers, or even in severe cases a complete muscle tear.

There are three grades of groin strain

Grade I – slight pain or discomfort, with a limited impact on physical ability

Grade II – moderate pain or discomfort, and a noticeable impact on physical ability particularly during running or jumping activities

Grade III – severe pain and discomfort that impedes the ability to walk, often accompanied by muscle spasm, swelling, and bruising.

A groin strain is a common sports injury, particularly among athletes who participate in ice hockey and soccer. Several factors can impact groin strain, including hip muscle strength, conditioning, and previous injury. Common causes of groin muscle strain include:

  • Sudden changes in training, particularly running
  • Sharp movements that require changing direction quickly to run, jump, or kick
  • Pain that makes sleeping difficult
  • Pain that continues while sitting or resting

The symptoms of a groin strain can be very similar to the symptoms of a sports hernia. It is important to consult a doctor for a proper diagnosis.

  • Sudden, sharp pain in the groin area
  • Difficulty walking, running, or jumping
  • Swelling along the pelvis
  • Bruising at the site of the injury
  • Muscle spasm

If an individual suspects groin strain the initial treatment should consist of avoiding the positions and activities that produce the pain. A course of conservative treatment is usually recommended that would include rest and immobilization, ice, physical therapy and non-steroidal medications to reduce inflammation.

If symptoms persist, treatment by your physician may be necessary. This may include steroidal medication or injections, in conjunction with therapy. In severe cases where the muscle is completely torn surgery may be needed to reattach the ends of the torn muscle.

Physical Therapists are professionals, educated and trained to administer interventions. As stated in The Guide to Physical Therapist Practice, interventions are the skilled and purposeful use of physical therapy methods and techniques to produce changes consistent with the diagnosis, prognosis and goal of the patient or client. Common interventions in the treatment of groin strain include:

  • Manual Therapeutic Technique (MTT): hands on care including soft tissue massage, deep friction massage and joint mobilization by a physical therapist to regain mobility and range of motion of the leg and hips.
  • Therapeutic Exercises (TE) including stretching and strengthening exercises to regain range of motion and strengthen the groin muscles.
  • Neuromuscular Reeducation (NMR) to restore stability, retrain the lower extremity, and improve movement technique and mechanics (for example, running or jumping activities) in daily use of the involved lower extremity.
  • Modalities that can include the use of ultrasound, electrical stimulation, ice, cold laser and others to decrease pain and inflammation at the groin.
  • Home program that includes strengthening, stretching and stabilization exercises and instructions to help the person perform daily tasks and advance to the next functional level.

Procedures that your physician may recommend and perform in addition to physical therapy that include:

  • REST and ICE
  • The use of NSAIDS (Non Steroidal Anti-Inflammatory Drugs)
  • Steroidal injections to reduce inflammation
  • Pain medication to reduce the discomfort and allow the patient to perform the recommended exercises
  • Surgery to correct underlying pathology or the cause of the groin strain.

Prognosis

Most people recover full function following a course of conservative care that includes physical therapy, medication and/or injections. It is important that once the pain and inflammation is reduced, and motion and strength are restored, the patient gradually returns to full activities.

Stretching and strengthening exercises of the adductor muscles can help prevent the occurrence of groin strain. Core stability training that helps improve control of the abdomen and hips can also help prevent muscle injuries. Instruction in daily activities or sport performance is helpful for reducing a reoccurrence of groin strain.

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