Table of Contents
- Overuse of the adductor muscle-tendon unit
- Symptoms and diagnosis
- Preventive measures
- Groin Injuries Treatment in Singapore
- Healing and complications
Groin pain in athletes is a common problem: it occurs in soccer in 5–13% of injuries in men and in 4–5% of injuries in women. It is one of the most difficult problems in sports medicine. A groin injury may be acute but if often leads to chronic pain with diffuse symptoms that are difficult to characterize, and these injuries are therefore often difficult to locate and to diagnose. Successful management, however, depends on correct diagnosis. The examining physician, physical therapist, or trainer must have a thorough knowledge of the differential diagnostic possibilities in the groin area. Teamwork is often necessary for a successful outcome: ideally this team should include not only an orthopedic surgeon and a primary physician, but also an experienced radiologist, a general surgeon, a gynecologist, and a neurologist. An experienced trainer and physical therapist should also be included.
The most common location for groin pain is the adductor muscle-tendon region, and the pain is usually caused by overuse injuries involving the adductor longus muscle-tendon junction. These injuries occur mostly in soccer and ice hockey, but are also seen in many other sports. Another common cause of groin pain is a hernia. In athletes with diffuse groin pain which is difficult to diagnose, the doctor should reasonably suspect a hernia. Hernia-related pain usually is centered on the inguinal region and spreads laterally along the inguinal ligament proximally in the muscles and to the opposite side. This pain can cause remarkable chronic discomfort. Radicular pain occurs in about 30%. These patients should be examined by a general surgeon. Herniography has shown to be successful in diagnosing intra-abdominal hernias. The syndrome of posterior inguinal wall weakness without a clinically obvious hernia causing chronic pain is increasingly recognized by practitioners. Other reasons for groin pain are osteitis pubis, hip pain of different etiologies, bursitis, snapping hip, nerve compression injuries, stress fractures, infections such as prostatitis and urinary infections, and tumors.
Information about chronic groin pain problems is still limited and mostly based on clinical experience. Groin injuries may in themselves not be serious. They may, however, lead to chronic pain and impair athletic ability and performance, if not correctly diagnosed and promptly treated.
The anatomy of the hip and groin is complex. In addition to numerous muscles and tendons, there are also glands, bursae, and other soft tissue areas that can be inflamed and involved in the injuries. The bones are the pelvic and the hip bones, the sacrum, and the coccyx. There is little movement across the joints of the pelvis and no muscles act on these joints. The pelvis serves as a weightbearing connection between the lower extremities and the trunk. The hip joint is very stable. The force transmitted across the force to 5 times body weight during the stance phase and 3 times body weight during the swing phase.
Overuse of the adductor muscle-tendon unit
The muscles that draw the leg inwards (adduct at the hip joint) are primarily the adductor longus, the adductor magnus, the adductor brevis, and the pectineus muscles. The gracilis muscle and the lower fibers of the gluteus maximus also work as adductors. However, it is usually the adductor longus that is damaged during sporting activity.
The adductor longus muscle tendon arises from the pubic bone and is inserted into the back of the midshaft of the femur. Overloading can be caused by sideways kicks in soccer, hard track training, and drawing the free leg inwards when skating. It is also common in team handball and ice hockey players, skiers, weightlifters, hurdlers, and high-jumpers. The symptoms may begin insidiously, perhaps at a training camp or during other intensive training periods.
Symptoms and diagnosis
- Pain can often be located in the origin or at the junction of the muscle-tendon unit and may radiate downwards into the groin. The pain often decreases after initial exertion and can disappear completely, only to return after training with even greater intensity. There is a risk that athletes will enter a cycle of pain in which case the condition is difficult to treat.
- Tenderness is felt at one particular point on the pubic bone over the origin of the muscle. This tenderness is distinct.
- The pain can be triggered by pressing the legs towards each other against resistance.
- Functional impairment is common. Sometimes the athlete cannot run but can manage to cycle. The athlete should not participate in explosive sports.
- An X-ray examination may show calcification around the origin of the muscle on the pubic bone.
- An MRI or ultrasound can be helpful.
The distance between the origins of the adductor longus and the rectus abdominis muscles is small, and inflammatory changes probably affect both muscles simultaneously.
Preventive training with specially designed strength and flexibility exercises is essential and should be included in every training program as an integral part of the warm-up and cool-down. The coach should be aware of the training levels of the different athletes and should, if possible, vary the training individually with this in mind. Athletes who undergo good basic fitness training are injured less often than others, and this is especially true of muscle injuries.
Groin Injuries (Pain) Treatment in Singapore
The athlete should:
- Rest from painful activities as soon as pain in the groin is felt; the condition will then resolve relatively quickly without any other treatment (this is based on the assumption that the injured athlete does not return to training and competition until there is no tenderness or pain when making movements with the leg under load);
- Use general heat treatment in the form of hot baths;
- Maintain basic fitness by cycling (preferably on an exercise bicycle) or swimming, using a crawl stroke, but only if these activities are pain-free;
- Apply local heat and use a heat retainer in chronic conditions.
The doctor may:
- Prescribe anti-inflammatory medication;
- Prescribe a special program of muscle training, preferably under the supervision of a physical therapist or athletic trainer;
- Administer a steroid injection around the muscle attachment or tendon attachment in question, and also prescribe 1–2 weeks’ rest from excessive exercise after the injection (the injection should only be given when there is distinct tenderness over the attachment into the bone);
- Prescribe local heat or other treatment;
- Operate in cases of delayed resolution. Surgery often consists of tendon release and/or local removal of damaged tendon tissue.
The following training and rehabilitation program is suitable for anyone who has injured the adductor longus muscle.
- Warm-up: a light dynamic training program, such as using an exercise bicycle, for 5–10 minutes.
- Isometric training without loading the adductor muscle, at different joint angles up to the pain threshold.
- Dynamic training without resistance.
- Isometric training, gradually increasing the external load.
- Dynamic training with gradually increasing load.
- Technique-specific coordination or proprioceptive training.
- Sport-specific training.
Healing and complications
The exercises and movements that caused the inflammatory condition in the adductor muscle should not be resumed until the pain and tenderness have disappeared.
If the affected athlete rests immediately pain begins, the condition will heal in 1–2 weeks, but if training is resumed too early treatment can be much more difficult.
If the condition is not managed properly there is a risk that it will become prolonged or chronic. Return to sport is often possible within 1–3 months but chronic cases may take a long time if not handled properly after surgery; a return to sport may be possible after 3–5 months.
Groin Injuries (Pain) FAQ
- Strained muscles, tendons, or ligaments in the leg
- Presence of a hernia
- Hip joint-related diseases or injuries
- Additionally, there are other potential causes
- Rest: Refrain from engaging in activities that may further strain or overstretch your muscles.
- After the initial 48 hours have passed, you can gradually introduce range of motion exercises and gentle strengthening activities that are within your pain tolerance level.
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