Download Groin Injuries. - Roland Jeffery Physiotherapy

Groin Injuries.
Groin injuries are very common amongst football players. The hip joint is the
largest joint in the body, and as it is the site of much movement, the hip joint
bears a lot of weight and it is subject to repetitive stress. This makes it very
vulnerable to injury. Even minor groin injuries can be
difficult for a football player to rehabilitate and
potentially can lead to long-term problems.
Most groin injuries are related to the stress and strain on
the hip joint and the surrounding bony and muscular
support structures of the pelvis (See Figure 1).
Figure 1: Groin muscles.
Figure 1: Groin muscles.
The most common groin injuries are; 1) strains of the
muscles, and 2) soft tissue contusions and haematoma’s
that result from direct force. Acute groin injuries are often
the result of direct trauma when playing football. Muscle
strains are common when the groin is forced outwards,
such as in a tackle, or when over stretching for a ball (See
Figure 2).
Figure 2: Groin Injuries.
What are the groin (adductor) muscles?
There are 5 main adductor muscles. There are three short adductors: the pectineus, adductor brevis and
adductor longus, which go from the pelvis to the thigh bone. There are also two long adductors, the gracilis
and adductor magnus, which go from the pelvis to the knee (See Figure 1). The main function of these
muscles is to pull the legs together. They are also used a lot in sprinting and in other aspects of playing
football. Inflammation of the tendons that attach the muscles to the bone can occur, as a result of previous
injury such as a groin strain or tear, or as a result of overuse.
© Roland Jeffery Physiotherapy 2011
Ph (09) 444-7643 Website www.rjphysio.co.nz
What are the symptoms of a Groin injury?
The player will have pain in the groin at the top
of the adductor muscles that can radiate down
the leg or pain at a specific point when the
player touches their pelvic bone in the groin
region. When the player is training or playing
football they will have difficulty in running especially sprinting and changing direction, as
well as when kicking a football. The player will
also have pain when they press their legs
together against resistance. Usually a player will
remember injuring their groin playing football,
but sometimes groin injuries can occur
gradually over time.
Groin injuries can be
divided into various categories:
‘Groin Strains’.
Groin strains of the muscles around the pelvic area are common. Falling, sprinting, quickly changing
direction, or kicking or doing the splits (unintentionally in a fall) can result in these injuries. Groin injuries
can cause pain into the groin and pain that radiates down the thigh.
The injury is usually to the muscle or tendon attachment and involves disruption of the muscle fibers to
various degrees. These muscles can be repaired but can be ‘weakened’ and susceptible to repeated injury.
Sometimes, the muscles may actually tear loose from their bony attachments taking a piece of bone with
them. These are called avulsion fractures. If these avulsion fractures include severe displacement, surgical
repair may be required.
However, most groin strains and tears respond to physiotherapy – including rest, ice, compression, stretching
and strengthening exercises, and a gradual return to football.
Injuries to the Muscle-tendon Units.
Muscle-tendon units are commonly strained and injured in football. The
muscles commonly injured and strained are these in the abdomen and
adductor longus muscle (large groin muscle).
The rectus abdominus strain is an injury that may cause acute or chronic groin
pain. This strain from involves injury to the rectus muscle of the abdominal
wall, which attaches to the pubis. This injury can be slow to recover (See
Figure 3).
Figure 3: Abdominal Wall Anatomy.
© Roland Jeffery Physiotherapy 2011
Ph (09) 444-7643 Website www.rjphysio.co.nz
Adductor Origin Strain or Tendinopathy.
An adductor tendinopathy can occur after a specific incident (strain or tear) at football or appear gradually
over time. The player will notice symptoms that include local tenderness over the adductor muscle and over
the pubic bone, with pain on stretching and any resisted hip movement. Some sports doctors and
physiotherapists believe that premature stretching of the groin muscles after an injury can lead to a
tendinopathy. An adductor tendinopathy causes groin pain ‘high up’ near the pelvis, which has a tendency to
warm up with increasing activity. If an adductor tendinopathy remains untreated, the pain tends to persist
during activity and may transfer either to the other side or to the pelvis and lower stomach area.
Treatment of an adductor tendinopathy includes relative rest, physiotherapy treatment, sports massage
therapy and eccentric strengthening exercises.
Eccentric strengthening exercises are specific exercises
designed by your physiotherapist to help strengthen your groin and prevent a re-occurrence. An adductor
tendinopathy that is not responding to treatment could require surgery, to release the adductor tendons, but
this should be used as a last resort.
What can the player do?
A football player can avoid groin injuries by ensuring the muscles are strong and flexible through
strengthening
and
stretching exercises.
A
sports
physiotherapist can
advise you on what
muscles
need
stretching
and
strengthening
(See
Figure 4).
Figure 4: Groin Stretches.
If a player sustains a groin injury the most important thing they can
do is rest – this is very important. The player should see a sports
injury professional for a diagnosis and treatment plan.
Wearing specifically designed ‘under shorts’ can also take some
strain off the groin muscles (See Figure 5).
Figure 5: Sports Shorts
What can a sports injury professional do?
Figure 6: Sports
Massage.
A sports injury professional will examine the player’s injury and be able to give you a diagnosis. They will
design a rehabilitation program, usually involving eccentric strengthening exercises and stretching exercises.
They will advise you on a return to training and playing football. A physiotherapist may use sports massage
techniques and stretching techniques to aid in the healing of the groin muscles (See Figure 6). Most
importantly the sports injury professional will advise you on what you should do to prevent the problem
reoccurring again.
© Roland Jeffery Physiotherapy 2011
Ph (09) 444-7643 Website www.rjphysio.co.nz