What is Adductor Strain?
A strain or injury to the adductor muscle group, which is common particularly among athletes, often results in pain in the inner part of the leg and groin. The adductor muscle group consists of three muscles: the longus, magnus, and brevis. Of these three, the adductor longus is the one most often injured. The primary function of these muscles is to draw the thigh inward, with the adductor longus also aiding in some inward rotation of the thigh. The adductor magnus has another function; it can extend the hip owing to its attachment on the ischial tuberosity, a protrusion in the hip bone.
When these muscles are activated while the body is in motion, their primary role is to draw the hip towards the middle of the body. However, when the body is stable, these muscles help to keep the pelvis and lower limb steady during the part of walking where the foot is on the ground. Additionally, they have secondary roles which include bending the hip and rotating it.
The adductor muscle group is also accompanied by three other muscles that support the same activity of drawing the thigh inward. These include the gracilis muscle, which is also involved in rotating the thigh inward and flexing the hip; the obturator externus, which also takes part in turning the thigh outward; and the pectineus, which helps flex the hip as well.
All these muscles are mainly controlled by the obturator nerve, which comes from the lumbar plexus, a network of nerve fibers in the lower spine. The adductor magnus also gets control signals from the tibial nerve, which originates from the lower part of the spinal cord.
What Causes Adductor Strain?
Adductor strain or a pulled muscle in the groin area is a frequent injury seen in those who play soccer and hockey. The risk of getting this injury is also high in activities such as football, basketball, tennis, figure skating, baseball, horseback riding, karate, and softball. Certain factors increase the likelihood of having an adductor strain. Topping this list is having previous injuries around the hip or groin region. Age, weak adductor muscles, muscle tiredness, limited movement range, and not stretching the adductor muscle enough can also contribute to the injury. Certain structural abnormalities like having one leg longer than the other or excessive foot rolling can also contribute to the risk.
The injury usually happens when a person quickly changes direction. This sudden move forces the hip to close against an opposing force, creating an exaggerated stress on the tendon. Or, during sprinting, when there’s a sudden acceleration. Less often, it can happen from jumping or overstretching the adductor tendon.
Risk Factors and Frequency for Adductor Strain
Muscle strains are the most common injury amongst athletes and are responsible for almost 1 in 3 visits to the doctor. Particularly in European soccer, injuries to the adductor muscles, located in the thigh, are the second most frequent, only coming in behind hamstrings.
- Muscle strains account for up to 31% of all athletes’ injuries.
- In European soccer players, adductor muscle injuries are the second most common, making up 23% of all injuries.
- Hamstring injuries are the most common in this group, at 37% of injuries.
- In a different study, 9% to 18% of all soccer player injuries were due to adductor pain or strain.
- In less professional, male soccer players, adductor strains were responsible for more than half (51%) of all cases of groin pain.
Signs and Symptoms of Adductor Strain
People who have injured their medial thigh or groin area often report that the pain came on suddenly, particularly during some sort of activity. This pain is typically severe and gets worse when moving. This can happen anywhere along the inside of the thigh where the adductor muscles are located.
In moderate to serious cases, you might see bruising or swelling. These individuals usually have a specific spot that’s very tender to touch, often along the upper attachment to the pubic bone. Pain can increase when they try to bring the hip inwards against resistance or when trying to stretch the area. If there is muscle or tendon damage involved, there might also be weakness in the affected muscles.
Testing for Adductor Strain
When checking for suspected thigh muscle strain, the first step usually involves X-ray examination. Forward-facing views of the hips and an angled view of the injury site are the primary images taken at first. In many cases, these images might show no damage, but sometimes they may reveal a fragment of bone that has been pulled away from the main bone. These images can also help determine other possible sources of groin pain including inflammation of the pubic bone, a bone fragment that has broken away from the main bone, and minor fractures in the pelvis or hip area.
If more detailed images are required, a technique called magnetic resonance imaging (MRI) is suggested. This can show if there’s puffiness in the muscles and any potential bleeding at the injury site. If the injury has affected the bone, the MRI can show this more clearly.
Another tool is the musculoskeletal ultrasound. This can give a better view of the tendons, attachment points of muscle to bones, muscles, ligaments, and nerves. This ultrasound can help identify the specific region and the degree of the injury. It can also be used periodically to monitor recovery during the healing process.
Treatment Options for Adductor Strain
Most pulled or strained adductor muscles are treated using a simple approach. This starts with taking a break from sports, using ice and compression, pain relief, and physical therapy. Pain relief usually comes from over-the-counter drugs like acetaminophen or anti-inflammatory medicines. The physical therapy will involve exercises to increase flexibility and strengthen the injured leg and the core of the body, followed by a slow return to sports. The recovery time can vary, with sudden injuries taking around one to two months to heal and chronic strains possibly needing several months for significant improvement.
Aside from this straightforward approach, there might be additional treatments for cases that don’t respond to the initial method. These could include a corticosteroid injection into the strained muscle or a procedure that involves piercing the tendon with a needle, both performed under the guidance of an ultrasound scan. These treatments are up to the doctor treating the injury.
Surgery is sometimes needed but it’s not always clear when. It’s typically considered if the regular treatments aren’t working and the patient is still experiencing weakness in the affected limb, especially in cases of severe muscle tears or injuries where the muscle has detached from the bone.
What else can Adductor Strain be?
The causes of groin pain can be wide-ranging and may be related to the muscles and bones in your lower body or from issues in other parts of your body. Here are some possible causes:
- Inflammation or swelling in your tendons like iliopsoas and rectus femoris (also known as tendonitis)
- Swelling in the iliopsoas (a powerful muscle located in the lower part of the body known as bursitis)
- Sports-related trauma which can come in the form of hernias from activities that require repetitive or high-energy motions
- Problems with the hip joint such as arthritis or issues arising from birth defects or injuries
- Infections or growths in the pubic bone (osteitis pubis)
- Discomfort or problems with the joint connecting the spine and the pelvis (sacroiliac dysfunction)
- Nerve-related pain that may be felt in the thigh or hip but is caused by issues in the lower back (neuropathic pain)
- Non-nerve, non-muscle related lower back pain (mechanical low back pain)
However, it’s essential to remember that not all groin pain is related to muscle or bone issues. Other possible causes can be:
- Urinary tract problems
- Presence of cancers or tumors
- Stomach or bowel issues
- Sexually transmitted infections
- In women, problems related to the female reproductive system
If you have persistent groin pain, don’t hesitate to consult a health professional to get an accurate diagnosis and treatment.
What to expect with Adductor Strain
The outlook for people with adductor strains, a type of injury common in athletes, is generally good. Given enough rest and correct rehabilitation, most athletes can get back to their sport with minimal discomfort and full function. But if they start playing too soon or don’t go through proper rehabilitation, their pain might turn into a long-term injury.
A study conducted by Renstrom and his team found that 42% of athletes who had muscle-tendon groin injuries weren’t able to get back to their physical activities until more than 20 weeks after they first got injured. However, targeted training programs that focus on strengthening and conditioning the pelvic muscles, especially the adductor muscles, can be very effective in treating patients who suffer from chronic groin pain related to adductor issues.
Possible Complications When Diagnosed with Adductor Strain
The main complications of adductor strains or pulls include severe pain and the inability to participate in sports or practice due to the injury. In certain cases, this pain may be long-lasting and may even lead to weakness and inability to return to sports.
Groin injuries linked to sports are a major reason for sportsmen and women to miss out on playing games. That’s why it’s important to prevent these injuries in athletes. This is primarily done via programs that focus on strengthening the adductor muscles. Keeping the strength of the adductor muscles at least 80% the strength of the abductor muscles has been proved to reduce injuries to the adductors.
For instance, a group of NHL players with weak abductors followed a 6-week program to strengthen their muscles before the season started. This resulted in lowering the incidence of pulled adductor muscles from 3.2 injuries per 1000 players per game to just 0.71.
Preventing Adductor Strain
Patients need to understand how to treat a groin strain properly. They should focus on protection, rest, applying cold compresses, tightly wrapping the area, and elevating the injury – a process known as PRICE therapy. It’s important that they avoid any physical activities or sports that could potentially worsen the injury and slow down recovery.
Undergoing physical therapy can help improve the strength, flexibility, and stretching ability of the affected muscles. It’s crucial that patients only return to their usual activities and sports based on how well their symptoms have improved and upon advice from healthcare professionals. If they rush back into activity before they’re ready, they risk causing more serious, long-term damage to their bodies.
