Adductor injuries account for 2-14% of all injuries in women and 4-19% in men participating in sport (Walden et al, 2015). The “adductors” are the six muscles that are responsible for bringing the leg towards the body’s midline. Anatomically, they lie on the medial or inside of the thigh, attaching to the pelvis and inserting into the femur. Injury or trauma to this muscle group is often referred to as a groin strain or tear.
Adductor strains are commonly seen in sporting populations, particularly in sports where change of direction, kicking, or stretching is repeated frequently, and at high velocities in the match. Examples include Football/soccer, AFL, Rugby and Hockey. Adductor trauma presents as the second most injured muscle group in footballers (behind hamstrings), and adductor pain/trauma represents anywhere from 9% to 18% of all football injuries (Keil & Kaiser, 2023).
The six muscles in the adductor muscle group are as follows: adductor brevis, adductor longus, adductor magnus, obturator externus, gracilis, and pectineus. The adductor longus is the most commonly injured muscle and accounts for 62% to 90% of cases.
Risk Factors
- Sports that involve rapid changes in direction, acceleration, and deceleration, such as soccer, hockey, football, and sprinting.
- Sports that involve kicking.
- Weakness in the muscles surrounding the hip and groin area, including the adductor muscles, hip flexors, and core muscles.
- Decreased range of motion in the hip, groin, and hamstring muscles
- Overuse of adductors can lead to muscle fatigue and increase the risk of injury, including adductor tears.
- Sudden increases in intensity or volume of training and playing
- Poor biomechanics
Diagnosis and examination
An adductor tear can be diagnosed and managed through physiotherapy consultation, with the mechanism of injury being a key component in assessment. Typically, an adductor tear or groin injury will present with a decreased range of motion, pain upon palpation, one sided weakness on groin squeeze strength testing (with both straight legs & bent knees), and potential swelling or bruising may be present.
Trauma to these muscles follows the standard classification of musculoskeletal injuries – a Grade 1 Tear involves minimal loss of function or strength, met with mild pain. A Grade 2 Tear is a more severe tear with notable weakness and pain. Grade 3 tears involve a full muscle tear and complete functional loss of movement in hip adduction.
When diagnosing an adductor tear it is critical to also assess the entire kinetic chain, as this can often give you insight into why the groin injury has occurred. Weakness and poor motor control along the kinetic chain may be the reason for overactivity and thus lead to a tear occurring. This may include, core weakness, altered biomechanics, poor hip stability or poor adductor-abductor strength ratios (abductors are the opposing muscles on the outside of the thigh). Interestingly, Rugby players with an adductor-abductor strength ratio of less than 80% are 17 times more likely to sustain an adductor injury (Eckard et al., 2017). Moreover, youth footballers should aim for an adductor-abductor strength ratio of 125%-160% to minimise the likelihood of groin strains (Griffin et al., 2016). In our clinic this is tested using the AxIT hand held dynamometer.
Physiotherapy Management
Immediately following adductor trauma, early physiotherapy intervention and treatment is highly effective and valuable for optimising long-term outcomes. Initially, the focus of treatment is to reduce pain, increase range of motion, and some aids to recovery include ice, compression, massage and non-irritable gentle strengthening and stretching exercises. Once acute symptoms begin to settle, a more graded exercise program can be established, with the aim to strengthen the adductors, and address biomechanical deficits in the thighs, hips, calves, and core (Schaber, et al. 2021). As patients recover, jumping training, plyometric drills, agility work, running training, and kicking drills are included in rehab often taking place as a “park” or “court” session. Rehabilitation is typically guided via use of our AxIT strength testing equipment, which gives us accurate data on muscle strength, rate of force development, and helps us understand strength ratio’s between muscles. After achieving some key milestones, a gradual return to sports/exercise minimises the risk of re-injury, alongside a maintenance strengthening program. Acute injuries may revover and athletes may return to sport as quickly as 4 to 8 weeks while chronic strains may take many months to achieve the desired results.
Prevention
At Five Dock Physiotherapy & Sports Injury Centre, we can provide objective pre-screening testing to establish baseline strength levels using the AxIT dynamometers and force plates, and assess biomechanics. Moreover, with a targeted program, our staff can address any strength deficits, biomechanical abnormalities or risk factors that may predispose our patients to an increased risk of adductor injuries, and other injuries in general. Our staff are trained
to deliver structured education, inform patients on how to manage load and prescribe individualised exercise programs.
Current evidence
Current evidence points toward exercise and strengthening programs as the most effective mode of injury prevention, and also, the most effective mode of treatment post-acute injury. (Schaber, et al. 2021). Hölmich et al. (2010) states that an 8-12 week strengthening program with targeted exercises for hip adduction, stabilisation, core strengthening, and balance training effectively treats chronic groin strains. It is therefore critical that individuals undergo an adductor specific injury program as we know this leads to greater functional outcomes and reduced return to play times amongst athletes
(King et al., 2018).
Exercise
Butterfly stretch:
Aim: To improve muscle length and flexibility of the adductor/groin muscles
How: Sitting on the floor, bend the knees to roughly 90 degrees. and place the soles of your feet together. Gently push both of your knees out with your elbows, as you sit up tall stretching the groin and adductor muscles on both legs.
Hold for 30 seconds
Adduction in side kneeling on the reformer:
Aim: To improve core and adductor strength
How: Start in side kneeling on the reformer, with the kneeing leg supported by the shoulder pad and opposite foot planted on the side rail in front of you. With your core engaged, adduct the kneeling leg into the shoulder pad towards the midline whilst maintaining a good posture. Adjust spring resistance to progress or regress this exercise.
Copenhagen level 1 :
Aim: Long or short lever isometric adductor strengthening
How: In a side plank position facing side on to a bench or chair, have one leg straight over the bench and the other resting on the floor. Actively push the leg on the bench down towards the ground lifting your hips. This can be regressed by having the top leg bent and progressed by adducting the bottom leg, lifting it off the ground. Hold 5-10 sec, repeat.
If you or someone you care for has an injury, a flare up, requires some rehabilitation or experiences an increase in pain, give the clinic a call on 9713 2455 or book online.