A Physical Therapy Guide to Groin Strain
A groin strain can limit your ability to complete daily tasks. Thus, it's important to know how to identify and treat a groin strain so that you can get back to your everyday activities as quickly as possible.
Groin strains are most common in men, particularly athletes, participating in sports like soccer and football that involve kicking and sudden changes in direction.1
In this guide, we will review symptoms, causes, diagnosis, and how to treatment a groin strain with physical therapy.
- Understanding Groin Strain
- Symptoms of Groin Strain
- Causes of Groin Strain
- Diagnosing Groin Injuries
- What to Expect from Physical Therapy for the Groin
- How Long Does It Take for a Groin Strain to Recover?
- Groin Strain Prevention Tips
- Is It Time for Professional Guidance?
A groin strain is a tear of any of the muscles that connect the abdomen to the leg across the pelvis. Traditionally, we think of the "groin" muscles as the adductors that run down the inside of the upper thigh, including the adductor longus, adductor brevis, adductor magnus, and gracillis. However, the abdominals and one of the hip flexor muscles (the iliopsoas) can also be involved in a groin strain.
The muscle most often involved with a strain is the adductor longus, one of the larger muscles of the inner thigh.2 Acute injuries typically involve the junction where the tendon and muscle meet. Chronic groin issues, on the other hand, can start to affect the junction between the tendon and pelvis (pubic bone).
What's the Difference Between a Groin Strain and a Sports Hernia?
Athletic publagia, also known as a sports hernia, is categorized as a chronic strain of the groin. However, instead of primarily affecting muscles, it is an injury fascia (strong connective tissue) of the groin and abdomen. Overall, a sports hernia is a complex diagnosis that requires expert guidance from a physical therapist.3
The most common symptom of a groin strain is pain. This can start as a dull ache that comes on with activity and then often progresses to sharp pain when the muscle is used.
You might notice:
- Pain with certain activities like running, jumping, pivoting, or kicking
- Difficulty completing full range of motion in the hip due to stiffness
- Tenderness when pressing on the affected muscle
- Bruising or swelling in the area
- Muscle spasms
Over time, it can lead to limping, weakness, and difficulty completing daily tasks.
There are several things that can contribute to a groin strain, including:
- Overuse: Repeatedly using the muscles can lead to small tears that can worsen over time. This is common in athletes who participate in sports that require a lot of kicking or sudden changes in direction.
- Trauma: A sudden and forceful contraction of one of the groin muscles. When the muscles are utilized in a stretched (eccentric) position, tearing is more likely.
Risk factors include:
- Muscle weakness or imbalances
- Poor flexibility of the hip, low back, or local groin muscles
- Too much high impact activity without rest
- Poor biomechanics with high level activities
If you are experiencing pain in your groin, the first step is to schedule an appointment with a CityPT physical therapist. They will ask you questions about your symptoms and medical history. They will also perform an online or in-person physical examination.
This might include tests like:
- Hip and spine range of motion
- Core and leg strength
- Palpation (feeling for tenderness or swelling)
- Coordination with activity
- Special tests to rule out other pathology of the the hip, knee, and spine
Although not typically needed, your CityPT physical therapist can collaborate with your primary care physician or orthopedist if you need imaging to rule out other potential causes. An MRI can determine the grade of tear if needed as well (grade 1 partial tear to grade 3 full tear)
Remember, you don't need a referral to see a CityPT physical therapist in all 50 states!
The primary goal of physical therapy is to help you return to your prior level of activity and sport. In order to do this, your therapist will focus on reducing pain and inflammation while restoring strength, flexibility, and coordination.
Your individualized treatment plan will likely include:
- Education: Most importantly, your therapist will provide you with information about your injury, how to prevent future injuries, and what to do if symptoms return.
- Exercise: A combination of stretching, strengthening, and coordination exercises will help to improve flexibility and muscle control. Exercises will start out simple and progress as you get stronger. For athletes, there are evidence based protocols that can be follow to improve hip and core control with sport-specific movement.4
- Manual Therapy: Techniques like soft tissue massage or mobilization can help to reduce pain and inflammation initially.
- Modalities: Depending on the severity of your symptoms, your therapist might use electrical stimulation or heat/cold therapy to help reduce pain and inflammation for short term pain relief.
Most people will see significant improvement within a few weeks of starting physical therapy. Typically, athletes will be getting close to their previous level of activity after 4 to 8 weeks.5
If you are an athlete, working with a sports performance physical therapist can help to ensure a safe return to sport. They will focus on improving hip and core control as well as developing a specific home exercise program to help prevent future injury.
What if I need surgery?
Surgery is typically not recommended groin strain, except in rare and severe cases when the tendon pulls pieces of bone with it, known as an avulsion.
Recurrent groin pain, whether it be from a strain or other hip related issue, is a relatively common complain among high risk athletes — such as those with previous injuries or that play sports that involve kicking. Thus, initial prevention (and subsequent prevention) is important for staying active and pain free.
Let's review some prevention tips:
- Warm up and cool down properly, with activities like dynamic stretching and light cardio, to promote optimal tissue health and extensibility.
- Address any muscle imbalances or weakness, particularly of the hip and core.
- Practice optimal technique with high risk moves, such as kicking and sprinting.
- Participate in a regular strength routine for the lower body that complements your specific sport (ask your CityPT physical therapist for tips!).
- Practice other healthy lifestyle habits to optimize tissue health, such as getting enough high quality sleep, a nutrient dense diet, proper hydration, and adequate stress management.
If you've been struggling with persistent groin pain or recurrent injuries, it might be time to seek professional guidance from a CityPT physical therapist. As soon as you notice an imbalance that is causing pain, a movement expert can help. On the other hand, it's never to late to ask for help if you've been putting it off.
With an individualized treatment program, you can get back to your sport and normal activities pain free. You can then focus on reaching your full potential as an athlete and beyond.
Ready to get started? Book an appointment with a CityPT sports physical therapist today!
Orchard JW. Men at higher risk of groin injuries in elite team sports: a systematic review. British journal of sports medicine. 2015 Jun 1;49(12):798-802.\ ↩
Paksoy M, Sekmen Ü. Sportsman hernia; the review of current diagnosis and treatment modalities. Ulus Cerrahi Derg. 2015 Aug 18;32(2):122-9. doi: 10.5152/UCD.2015.3132. PMID: 27436937; PMCID: PMC4942157. ↩
Yousefzadeh A, Shadmehr A, Olyaei GR, Naseri N, Khazaeipour Z. The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol. Rehabilitation research and practice 2018;1-10. ↩
Elattar O, Choi HR, Dills VD, Busconi B. Groin Injuries (Athletic Pubalgia) and Return to Play. Sports Health. 2016 Jul;8(4):313-23. doi: 10.1177/1941738116653711. Epub 2016 Jun 14. PMID: 27302153; PMCID: PMC4922526. ↩