GROIN

PAIN

Maryam Mubshra
Naheed Shoukat
Syed Muhammad Aun
Luqman Ali
Mateh Ur Rehman

This Photo by Unknown Author is licensed under CC BY-SA-NC

When someone
Experience of Groin Pain,
they have Experienced of
tear to the adductor
muscle of Hip or iliopsoas
strain.
Anatomy
• There are 5 muscles in adductor
compartment:
• Gracillias
• Pectineus
• Adductor longus
• Adductor Brevis
• Adductor Magnus
 Adductor muscle strain
 Adductor muscle injuries were the second most injured muscle
group (23%) behind hamstrings (37%)

 The most often injured adductor muscle is adductor longus . That is

probably because of its great role, not only as an adductor but also as a
pelvis stabilizer.

• The onset is acute, and pain is usually well localized either to the belly
of the adductor, or the proximal musculotendinous junction or the
tendon near its origin on the inferior pubic rami.
Continue….
The adductors play a major role
in dampening the contraction of
the gluteus Medius after the
propulsion phase of running.

They also work synergistically

with the hip abductors to
maintain the stability of the
pelvis during the stance phase

Adductor strain is a common

injury among soccer and hockey
players.
Adductor
Tendinopathy
• The difference between groin tendinopathy and strain
are:

• First, strains are acute, and tendinosis is chronic.

Tendinosis is a repetitive strain.
• The second difference is that acute injuries are more
often localized in the musculotendon junctions and
chronic injuries are localized at the tendinous insertions
on the pubic bone.
Continue….
• Adductor tendonitis/tendinopathy typically occurs slowly
over time due to increased loading of the adductor muscles
and subsequent overloading of the tendon.

• Repeated or forceful movements, or sudden change in

direction during certain sports activities such as tennis,
football and hockey, can sometimes strain the adductors,
causing injury or degeneration of the tendons that attach
the muscles to bone.
 Premature stretching of these muscles can lead to a
tendinopathy.

The pain tends to persist during activity and may migrate

Adductor either to the contralateral groin or to the suprapubic
region.
Tendinopathy
Examination findings include local tenderness over the
adductor origin, with pain on passive hip abduction and
resisted hip adduction
MANAGEME
NT OF
ADDUCTOR
Phase 1: Acute First 48 hours after injury: RICE (rest, ice, compression, elevation)
Nonsteroidal anti-inflammatory drugs
Massage
Transcutaneous electrical nerve stimulation
Ultrasound
Submaximal isometric adduction with knees bent → with knees straight progressing to
maximal isometric adduction, pain free
Hip passive range of motion in pain-free range
Nonweightbearing hip progressive resistance exercises without weight in antigravity position
(all except abduction): pain free, low load, high repetition
Upper body and trunk strengthening
Contralateral lower extremity strengthening
Flexibility program for noninvolved muscles
Bilateral balance board
Clinical milestone Concentric adduction against gravity without pain
Phase 2: Subacute Bicycling/swimming
Sumo squats
Warm-up Bike

Adductor stretching

Sumo squats

Side lunges

Kneeling pelvic tilts

Strengthening program Ball squeezes (legs bent to legs straight)

Different ball sizes

Concentric adduction with weight against gravity

Adduction in standing on cable column or elastic resistance

Seated adduction machine

Standing with involved foot on sliding board moving in sagittal plane

Bilateral adduction on sliding board moving in frontal plane (ie, simultaneous bilateral adduction)

Unilateral lunges with reciprocal arm movements

Sports-specific training On ice kneeling adductor pull togethers

 The iliopsoas muscle is the strongest flexor of the hip joint.

The iliopsoas muscle overleaf. It arises from the five

lumbar vertebrae and the ilium and inserts into the lesser

Iliopsoas trochanter of the femur.

Strain Iliopsoas related pain is one of the most frequent soft

tissue pathology responsible for groin pain, especially in
runners.
Causes It is occasionally injured acutely; however,
it frequently becomes tight when there is
neural restriction, lumbar, pelvic, and groin
pain, restriction in range of movement at
the hip. lumbar and sacral regions, or poor
lumbo-pelvic dynamic stability.

The iliopsoas muscle is frequently injured

during kicking activities. Kicking is an
asymmetrical, ballistic task that combines
hip flexion with lumbar rotation. The
asymmetrical nature of kicking can lead to
muscle imbalance and injury
 Athlete often present with a poorly
localized ache that is usually described
as a deep ache, or a sensation of
snapping/clicking in one side of the
groin
Sign and
Symptoms Pain is often reproduced on palpation, stretch,
and muscle strength tests.
Pain on iliopsoas stretch that is
exacerbated on resisted hip flexion in the
stretch position suggests the iliopsoas as
the source of the pain.
Physical Examination

• It is important to examine the lumbar spine as there is frequently an

association between iliopsoas tightness and hypomobility of the upper
lumbar spine from which the muscle originates.
• Thomas Test For iliopsoas Tightness
• To perform the test, the patient lies on his or her back. The patient is asked to pull the
non-testing leg toward the chest until the bulge in the lumbar spine smoothes out.
• The test is positive when the extended leg lifts off the treatment table and the patient
feels a stretch in the groin. If adduction of the extended leg is observed, the so-called
J-sign, this could indicate a shortening of the iliotibial tract.
 Management
Immediately following an injury, or at the onset of pain, the R.I.C.E.R. regimen should be employed.. It is
critical that the R.I.C.E.R. regimen be implemented for at least the first 48 to 72 hours.

The next phase of treatment (after the first 48 to 72 hours) involves several physiotherapy techniques.
The most common methods used to do this include ultrasound, TENS, heat and massage. The
application of heat and massage is one of the most effective treatments for removing scar tissue and
speeding up the healing process of the muscles and tendons.
Next, start to incorporate some very gentle range of motion exercises for the large muscle groups
around your hips. The lower back, buttocks, hamstrings, quadriceps and groin are a good place to start.

Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your
treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the
muscles and tendons that have been injured.
Preventing Iliopsoas Pain

There are several preventative techniques that will help to prevent both
iliopsoas tendinitis and iliopsoas syndrome.
• A thorough and correct warm-up will help to prepare the muscles and
tendons for any activity to come..
• Rest and recovery are extremely important; especially for athletes or
individuals whose lifestyle involves strenuous physical activity. Be sure to let
your muscles rest and recover after heavy physical activity.
• Strengthening and conditioning the muscles of the hips, buttocks and
lower back will also help to prevent iliopsoas tendinitis and iliopsoas
syndrome.
• Flexible muscles and tendons are extremely important in the prevention of
most strain or sprain injuries.