GROIN STRAIN (ADDUCTOR MUSCLE RUPTURE)

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 most common muscle to be injured is the adductor longus muscle which connects from the pubic ramus to the medial (inner) surface of the femur (thigh bone). The main function of the adductors is to pull the legs back towards the midline, a movement termed adduction. During normal walking they are used in pulling the swinging lower limb towards the middle to maintain the body’s balance. They are also used extensively in sprinting, playing football, horse riding and hurdling. 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.

Symptoms of groin strain

•     Tightening of the groin muscles that may not be present until the following day.
•     A sudden sharp pain in the groin area or adductor muscles during exercise.  
•      Bruising or swelling (this might not occur until a couple of days after the initial injury)
•      Inability to contract the adductor muscles (squeezing the legs together or possibly lifting the leg out in front).
•       A lump or gap in the adductor muscles.

Grade 1, 2 or 3

•          Groin strains are graded 1, 2, or 3 depending on how bad they are.
•          The athlete with a grade 1 strain might feel mild discomfort, possibly a little tenderness at a particular point but no swelling.
•          Grade 2 strains might feel more painful with swelling, pain to touch, reduced range of motion and interference with running.
•          A grade 3 strain may be very painful, lots of swelling and total inability to run or even walk.

Groin strain treatment

What can the athlete do?

•          Apply R.I.C.E. (Rest, Ice, Compression, and Elevation) immediately.
•          Rest and use crutches if needed.
•          See a sports injury professional who can advise on rehabilitation of the injury.
•          For a grade 3 strain seek professional help immediately.

What can a sports injury specialist or doctor do?

•          Use ultrasound or laser treatment.
•          Use sports massage techniques after the acute phase. These are extremely important.
•          Operate if the muscle has torn completely.
•          Advise on a rehabilitation programme consisting of soft tissue treatment, stretching, strengthening and sports massage.

A partial rupture of the adductor muscles will often lead to inflammation of the groin after the initial rupture has healed.

Rehabilitation

The following is an example and we recommend seeking professional advice before embarking on any form of rehabilitation.

Aims of rehabilitation

•             Reduce pain and swelling

•          Improve flexibility and condition of the muscles.

•          Strengthen the muscles.

•          Gradual return to full fitness.

Groin strains are graded 1, 2 or 3 depending on how bad they are. It is important to get the correct diagnosis to base the rehabilitation programme on.

Grade 1 Reducing pain and swelling

•          Rest. This may involve avoiding activities that produce pain. It may be necessary to rest grade 1 strains from competition or training for up to 3 weeks. A general guide for safety is 5 days. If pain allows, a lower level of activity such as jogging, cycling or swimming may help prevent the muscle tightening up.
•          Apply ice or cold therapy with compression for 20 minutes every 2 hours for the first couple of days.
•          Wear a compression support to help reduce swelling.

Improving flexibility muscle condition

•          Stretching exercises may be done from day 1 as long as they can be done without pain. If pain is felt then stop and wait.
•          Stretching should be done regularly - at least twice a day in the early stages of rehabilitation (pain free).
•          Sports massage techniques are exceptionally useful after the initial acute stage (usually 48 hours). This will relax the muscle, loosen and help prevent scar tissue formation and encourage blood flow and healing of the muscle.

Strengthening

•          Strengthening the muscles is important to avoid re-injuring the muscles. It is especially important to strengthen the muscles in the same direction / way that they were injured.
•          Light strengthening exercises can begin after the acute stage or as soon as pain allows. If they are painful then stop and wait. It may be 5 days before strengthening exercises may be started.
•          Exercises may be done on a daily basis in the early stages of rehabilitation and as intensity increases and full activity is regained they may be reduced to 3 times a week.
•          Stretching exercises should be continued throughout the strengthening process both before and after a strengthening session.

Return to full activity

•          This should be a gradual process. Do not go straight back into sprinting immediately but build up gradually from slow jogging.
•          When the athlete can jog for 30 minutes without problems then gradually build up speed.
•          An example speed session might be 10 x 50m at 50% effort, day 2, gentle jog, day 3, 10 x 50 m at 70% effort and so on.
•          This stage of rehabilitation should also include more functional activities or those specifically related to the athletes sport. For example if your sport involves changing direction at speed then this should be included in the rehabilitation process with a gradual build up.
•          Only when the athlete can comfortably manage specific training and speed work should they be returned to competition.
•          A return to full activity may take 1 to 2 weeks.

Grade 2 Reducing pain and swelling

•          Apply ice or cold therapy with compression for 20 minutes every 2 hours for the first couple of days.
•          Rest. Crutches may be requiring for 3 or 4 days. The athlete may expect to do no training for at least 5 days. Wear a compression support for the first 5 days to help reduce swelling.
•          If pain allows after day 5, a lower level of activity such as jogging, cycling or swimming may help prevent the muscle tightening up.

Improving flexibility muscle condition

•          Gentle stretching exercises may be done from day 3 as long as they can be done without pain. If pain is felt then stop and wait.
•          Stretching should be done regularly - at least twice a day in the early stages of rehabilitation (pain free).
•          Sports massage techniques are exceptionally useful after the initial acute stage (usually 48 hours). This will relax the muscle, loosen and help prevent scar tissue formation and encourage blood flow and healing of the muscle.

Strengthening

•          Strengthening the muscles is important to avoid re-injuring the muscles. It is especially important to strengthen the muscles in the same direction / way that they were injured.
•          Static contractions should begin as soon as they can be done pain free. This may be between 3 and 5 days following injury. If they are painful then stop and wait. It may be 5 days before strengthening exercises can be started.
•          More advanced resistive exercises may begin from day 7 following injury.
•          Stretching exercises should be continued throughout the strengthening process both before and after a strengthening session.

Return to full activity

•          This should be a gradual process. Do not go straight back into sprinting immediately but build up gradually from slow jogging.
•          When the athlete can jog for 30 minutes without problems then gradually build up speed.
•          An example speed session might be 10 x 50m at 50% effort, day 2, gentle jog, day 3, 10 x 50 m at 70% effort and so on.
•          This stage of rehabilitation should also include more functional activities or those specifically related to the athletes sport. For example if your sport involves changing direction at speed then this should be included in the rehabilitation process with a gradual build up.
•          Only when the athlete can comfortably manage specific training and speed work should they be returned to competition.
•          A return to full activity may take 3 to 4 weeks.

Grade 3 Reducing pain and swelling

•          Apply ice or cold therapy with compression for 20 minutes every 2 hours for the first 2 to 3 days.
•          Rest. The leg might be totally immobilized to prevent further damage. Crutches should be used for 3 or 4 days. The athlete may expect to do no training for at least 2 weeks. Wear a compression support permanently for the first 5 days to help reduce swelling.
•          If advised by a professional then following day 14, a lower level of activity such as jogging, cycling or swimming may help prevent the muscle tightening up.

Improving flexibility muscle condition                   

Stretching should be avoided in the early stages of rehabilitation. It may be 2 weeks before stretching can begin pain free. Sports massage techniques are essential in optimum recovery, however may be dangerous if performed too early. Light massage may be possible from day 5. This will relax the muscle, loosen and help prevent scar tissue formation and encourage blood flow and healing of the muscle.

Strengthening                   

 Strengthening the muscles is important to avoid re-injuring the muscles. It is especially important to strengthen the muscles in the same direction / way that they were injured. Static contractions (isometric contractions) should begin as soon as they can be done pain free. This may be 5 days following injury or longer. If they are painful then stop and wait. It may be 5 days before strengthening exercises can be started. More advanced resistive exercises may begin from day 7 following injury. Stretching exercises should be continued throughout the strengthening process both before and after a strengthening session.

Return to full activity

•          This should be a gradual process. Do not go straight back into sprinting immediately but build up gradually from slow jogging.
•          When the athlete can jog for 30 minutes without problems then gradually build up speed.
•          An example speed session might be 10 x 50m at 50% effort, day 2, gentle jog, day 3, 10 x 50 m at 70% effort and so on.
•          This stage of rehabilitation should also include more functional activities or those specifically related to the athletes sport. For example if your sport involves changing direction at speed then this should be included in the rehabilitation process with a gradual build up.
•          Only when the athlete can comfortably manage specific training and speed work should they be returned to competition.
•         A return to full activity may take 6 to 8 weeks or longer.

SPORTS MASSAGE

The following sports massage guide is intended for information purposes only. We recommend seeking professional advice before attempting any self help treatment.

What equipment is required?

A lubricant is needed to allow the hands to glide smoothly. A number of massage oils are available to buy. A cheap but effective alternative is simple baby oil. Do not use too much oil. Enough to allow for smooth, controlled movement is required but too much will mean a lack of control. A firm, flat surface to lie on in order to apply pressure

How can sports massage benefit the rehabilitation of this injury?

                    The aim of sports massage is to release tension in the muscle and stimulate blood flow and healing. For more details of the benefits click here. Massage must not be performed during the acute stage of this injury - usually 48 hours after injury. For grade two and three strains, massage may not be suitable for over a week. This is because if the is still bleeding then heat and massage will increase bleeding, not stop it.

Technique 1: Effleurage

Aim - light stroking to warm up the area in preparation for deeper techniques.

•         With the hands stroke lightly but firmly upwards from just above the back of the knee to the top of the hamstring muscle.
•          Always stroke upwards towards the heart as this is the direction of blood flow. The other way can damage veins.
•          Then lightly bring the hands down the outside of the leg keeping them in contact but do not apply pressure.
•           Repeat the whole movement using slow stroking techniques, trying to cover as much of the leg as possible.
•          Repeat this technique for about 5 to 10 minutes, gradually applying deeper pressure on the up strokes.

Technique 2: Petrissage

Aim - kneading movements to manipulate and loosen the muscle fibers more.

•          With the hands apply a firm, kneading technique. Try to pull half the muscle towards you with the fingers of one hand whilst pushing half the muscle away with the thumb of the other hand.
•          Then reverse to manipulate the muscle in the other direction.
•          Work your way up and down the muscle, trying to cover as much of the surface as possible.
•         Apply this technique for around 5 minutes, alternating with light stroking (above) occasionally.

Technique 3 and 4: Stripping the muscle and Circular frictions

Aim - to apply sustained pressure along the muscle, ironing out any lumps, bumps and knots.

•          With the thumb of the right hand (for the right leg), apply deep sustained pressure along the full length of the muscle.
•          This technique should be slow and deliberate to 'feel' the muscle underneath (image 5).
•          Repeat this 3 to 5 times in a row, alternating with petrissage for 5 to 10 minutes.
•          If the therapist comes across and tight, tender knots in the muscle (usually at the point of strain or rupture), these can be worked out with deep circular frictions to the sore spot.
•          Massage should be deep but not so deep that the athlete tightens up with pain.

Finishing off

•          The therapist can finish off with more petrissage techniques and then finally effleurage again. The whole process should not last more than half an hour.
•           Massage therapy can be applied every day if it is performed lightly however deeper techniques may result in a day’s recovery period to allow tissues to 'recover'.
•         For rehabilitation of muscle strains, sports massage is very important in softening / preventing scar tissue forming at the site of injury and re-aligning the new healing fibers in the direction of the muscle fibers. This may help prevent re-injury.