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Groin Strain (Groin Pulled)

A groin pull is an injury to the muscles of the inner thigh. The groin muscles, called the adductor muscle group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone). These muscles pull the legs together, and also help with other movements of the hip joint. The adductor muscles are important to many types of athletes including sprinters, swimmers, soccer players, and football players.

A groin pull is an injury to the adductor muscles called a muscle strain. When a muscle is strained, the muscle is stretched too far. Less severe strains pull the muscle beyond their normal excursion. More severe strains tear the muscle fibers, and can even cause a complete tear of the muscle. Most commonly, groin pulls are minor tears of some muscle fibers, but the bulk of the muscle tissue remains intact.

Symptoms of a Groin Strain

An acute groin pull can be quite painful, depending on the severity of the injury. Groin pulls are usually graded as follows:

  • Grade I Groin Strain: Mild discomfort, often no disability. Usually does not limit activity.
  • Grade II Groin Strain: Moderate discomfort, can limit ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
  • Grade III Groin Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant bruising.

Groin pulls are often seen in athletics who participate in sports such as ice hockey and soccer. The injury appears to be related to factors including hip muscle strength, preseason conditioning, and previous injury. Because of this, proper conditioning is of utmost importance to prevent the occurrence of a groin strain injury. Athletes, especially hockey and soccer players, should incorporate adductor strengthening, pelvic stabilization, and core strengthening exercises into their workouts to prevent the occurrence of a pulled groin.

A pulled groin is usually a clear diagnosis. Most athletes know what the injury is before they seek medical attention. However, other conditions can mimic the symptoms of a groin strain. One condition that was previously not well recognized is called a sports hernia. Sports hernias have been found in patients who were diagnosed with chronic groin strains. The sports hernia is a condition similar to a regular inguinal hernia, and is due to a weakening of the muscles that form the abdominal wall. The symptoms of a sports hernia are often nearly identical to those of a groin strain.

Other conditions that may mimic the symptoms of a groin strain include osteitis pubis(inflammation of the pubic bone), hip joint problems (including early arthritis, labral tears, and other conditions), and low back problems (pinched nerves).

When do I need to see a doctor for a groin pull?
If you have symptoms of a severe groin pull, you should be evaluated for proper treatment. Some signs of a severe groin strain include:

  • Difficulty walking
  • Pain while sitting or at rest
  • Pain at night

Severe groin pulls should be evaluated because in some very rare situations of complete muscle rupture, surgery may be necessary to reattach the torn ends of the muscle. This is rarely needed, even in patients with Grade III groin strain injuries, as these patients can usually undergo successful non-operative treatment.

If you are unsure if you have a groin pull or the symptoms do not quickly resolve, then you should be seen by your doctor. As described above, other conditions can be confused with a groin pull, and these should be considered if your symptoms do not resolve. Once a strain is diagnosed, you can begin treatment for your groin pull.

Treatment of a groin pull is usually guided by the severity of the injury. Resting a groin pull is the key to successful treatment. As a general rule of thumb, if you have a groin pull, you can do activities that don’t aggravate your injury. You should rest until you are pain free to allow the injured muscle to heal. Resting inadequately may prolong your recovery.

The following are the common treatments used for groin strains:

  • Rest
    It is important to rest following the injury to allowed the injured muscle to properly heal. Allow pain to guide your level of activity; this means that activities which cause symptoms should be avoided.
  • Stretching
    Gentle stretching is helpful, but it should not be painful. Stretching excessively can be harmful and slow the healing process.

    • Adductor stretches
  • Ice the Injury
    Apply ice to the injured area in the acute phase (first 48 hours after injury), and then after activities. Ice will help calm the inflammatory response and stimulate blood flow to the area.
  • Heat Applications
    Before activities, gentle heating can help loosen the muscle. Apply a heat pack to the groin prior to stretching or exercising. As a general rule of thumb, remember to heat before, and ice after.

    • Know when to ice and when to heat an injury
  • Anti-inflammatory Medications
    Oral anti-inflammatory medications (such as Ibuprofen, Aleve, or Motrin) can help relieve symptoms of pain and also calm the inflammation.
  • Physical Therapy
    Physical therapists can be helpful in guiding treatment that may speed your recovery. Some people find modalities such as ultrasound, therapeutic massage, and specific exercises particularly helpful. You should see your physician to determine if these would be appropriate for your condition.

What can be done to prevent groin strains?
New research is shedding light on factors that can be helpful in preventing groin injuries. Competitive athletes who participate in soccer, ice hockey, or similar sports that are prone to groin injuries should focus some energy on groin injury prevention. Exactly what exercises and stretches are most important in still being worked out, but some suggestions for groin injury prevention include:

  • Adductor stretching
  • Hip adductor and abductor strengthening
  • Pelvic stabilization exercises
  • Core stability, including abdominal and lumbar strengthening

Together, these exercises and stretches can help control the movements of the hip and pelvis, and hopefully prevent many groin strains.

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Groin Strain (Adductor muscle tear)

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A groin strain is a tear or rupture to any one of the five adductor muscles. If it isnt treated properly it can recur causing problems in the future.

What is a Groin Strain?

A groin strain is a tear or rupture to any one of the adductor muscles. There are five adductor muscles, the pectineus, adductor brevis and adductor longus (called short adductors which go from the pelvis to the thigh bone) and the gracilis and adductor magnus (long adductors which go from the pelvis to the knee).

The main function of the adductors is to pull the legs back towards the midline, a movement called adduction. During normal walking they are used in pulling the swinging lower limb towards the middle to maintain balance. They are also used extensively in sprinting, playing football, horse riding, hurdling and any sport which requires fast changes in direction.

A rupture or tear in the muscle usually occurs when sprinting, changing direction or in rapid movements of the leg against resistance such as kicking a ball. This is especially likely if a thorough warm-up has not been undertaken first! Repetitive overuse of the groin muscles may result in adductor tendinopathy.

Classification of Groin Strains

Groin strains, as with all muscle tears, are graded 1, 2, or 3 depending on how bad they are.

Grade 1

A minor tear where less than 10% of fibres are damaged.

Grade 2

A moderate tear which can be anything from 10 to 90% of fibres torn. For this reason, grade 2 injuries are often termed 2 or 2-.

Grade 3

The most serious, being either partial or full ruptures.

Symptoms of a Groin Strain

Grade 1

  • Discomfort in the groin or inner thigh. This may not be noticed until after exercise stops.
  • The groin muscles will usually feel tight.
  • There may be an area which is tender to touch.
  • Walking is normal, discomfort may only be when running or even just on changes in direction.

Grade 2

  • A sudden sharp pain in the groin area or adductor muscles during exercise.
  • Tightening of the groin muscles that may not be present until the following day.
  • There may be minor bruising or swelling (this might not occur until a couple of days after the initial injury).
  • Weakness and possibly pain on contracting the adductor muscles (squeeze your legs together).
  • Discomfort or pain on stretching the muscle.
  • Walking may be affected.
  • Running is painful.

Grade 3

  • Severe pain during exercise, often on changing direction suddenly when sprinting.
  • Inability to contract the groin muscles (squeeze your legs together).
  • Substantial swelling and bruising on the inner thigh within 24 hours.
  • Pain on attempting to stretch the groin muscles.
  • It may be possible to feel a lump or gap in the muscles.

Treatment of a Groin Strain

What can the athlete do?

  • Apply R.I.C.E. (Rest, Ice, Compression, Elevation) immediately.
  • Use crutches if needed.
  • Gently stretch the groin muscles provided this is comfortable to do so.
  • See a sports injury professional who can advise on rehabilitation of the injury.
  • For a suspected grade 3 strain seek professional help immediately.

What can a sports injury specialist or doctor do?

  • Use ultrasound or laser treatment.
  • Tape the groin to take the pressure off the area.
  • Use sports massage techniques after the acute phase.
  • This is extremely important.
  • Operate if the muscle has torn completely.
  • Advise on a rehabilitation programme consisting of stretching and strengthening exercises

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