How Bad Can a Groin Strain Be?

I have to laugh when friends ask me, “what’s the big deal about a simple groin strain?!”  My reply is always the same and their answer is always “No“.

I simple ask them, “You’ve never strained your groin before have you?

If they had ever experienced either a groin strain or had an M80 explode in their front pocket, they’d have no need to ask such a question.

A groin strain is a painful injury and a troubling problem for skilled athletes who’s sport or position requires them to change directions quickly.  If you’re looking to ink that huge fantasy football trade this week with your friend in the marketing department, you might want to avoid the star running back or the speedy wide receiver with the bad hip adductor strain.

The Five Muscles of the Groin

Most people assume “the groin” consists of one (1) muscle when it is actually formed by the following five (5) muscles:

  • Adductor Brevis
  • Adductor Longus
  • Adductor Magnus
  • Gracilis
  • Pectineus

Understanding the Groin

The main role of the groin, commonly referred to as the hip adductors, is to both pull the leg inward.  This inward motion is also referred to as adduct the lower extremity.  Based on the position of these muscles, they also control the speed and direction the leg is allowed to move outward.  In other wards, when any combination of the groin muscles contract and shorten, the leg is pulled inward towards the midline of the body.  When any combination of the groin muscles are contracted and lengthen, the leg is allowed to move away from the midline in a controlled manner.

To complicate it even more, the varying angles and attachments of these five (5) muscles also directly or indirectly controls rotation of the entire lower extremity.

If you’re saying to yourself, “these muscles sure do just about everything”, you’re correct!  Vision a defensive back or a running back on any given play changing direction and aggressively rotating over their leg.   Now you can get a better understanding of the important role these muscles have and how debilitating an injury it is for such an athlete to have a weak and painful groin strain.

Does this give you more insight as to why my answer to the question; “what’s the big deal about just a groin strain?” is so easy?

Not All Groins are Created Equal

As a runner, triathletes and adventure racer, most of my training and racing is done in a straight line.  I learned this fact the hard way.  In 1996, I ran in the Empire State Building Run-up in NYC, the New Zealand Ironman Triathlon in Auckland, NZ and the Boston Marathon in my home-state of Massachusetts….all withn 6 1/2 weeks.  During the historic 1ooth running the Boston marathon I was position in the very back with my Dana Faber Cancer Marathon teammates.  Because of the large number of runners and my position in the back of the pack, I started weaving and zig-zagging through the 42,000 or so runners.  Based on my finishing time of 3:13, I had weaved around approximately 20,000 runners.

By the time I reached the base of the famous Heartbreak Hill at mile 18, both of my groins were in spasm and extremely painful.  I had not trained to move side-to-side nor weave like I was doing and my groins made that point loud and clear.  Although I had already completed two other extremely intense races in the previous 45 days, my groins were by far the most painful part of my body after the race.

Hockey players and soccer players tend to have the strongest hip adductors based on the demands of their sports.  They rely on their groin muscles so they address them with their strength work, their flexibility and their preventative rehabilitation.  If I suffer a strained groin in a marathon, I’m slowing down.  If they suffer a pulled groin in a hockey game, they’re game is over and they start rehab 5 minutes later.

The Lingo

A muscle “pull” or “tweak”, the non-medical terms, is the same as a “strain”, the proper medical terminology.   So the next time you hear someone say, “it’s not a pull, it’s just a tweak” know that’s someone just trying to make their coach feel better.

The Solution

Depending upon how badly it’s injured, the length of time for return to play will vary.  After suffering a hip adductor strain, the two key steps to take immediately are:

  • Ice your groin for 10-15 minutes no less than 5 times per day.
  • Do not stretch the groin muscles for at least 3 days.

I list these two sports medicine rehab tips on their own for one simple reason: If you implement them immediately after you suffer a pulled groin, you can literally cut your rehab time in half!  Think about that for a minute.  In other words, if you accidentally do the opposite and put heat on the injury and start aggressively stretching a tweaked groin, the bleeding will worsen and the downtime will be lengthened.  No one wants that to happen.

Bike riding, pool running, elliptical trainer, single/double leg balance drills, flexibility work around the injured muscles, massage and aggressive core stability should be included in every rehab plan that involves a lower extremity soft tissue injury.

As for returning to their sport, the athlete should initially start with straight ahead running and then progress with more side-to-side movements.  Progressing with speed, intensity and the number of reps can all be used to both evaluate and rehab an injured groin.

The next time you read about athlete with the “bad groin”, now I hope you show him some love!

 

9 replies
  1. Lisa B. Minn
    Lisa B. Minn says:

    Good advice and good story about your Boston marathon experience. Excellent example of the potential consequences of skipping the cross training.

    My two cents: after three days or whenever you are ready to start gentle stretching, try the restorative yoga posture reclined bound angle. It can improve blood flow, decrease muscle holding patterns and provide a very gentle and prolonged stretch. And you can make it progressive by gradually reducing the amount of support under the injured leg.

    Reply
    • Mike Ryan
      Mike Ryan says:

      Great points, Lisa. Your yoga technique will address both the muscle and the ever-important connective tissue associated with the entire groin/pelvis region. THAT is the best way to safely recover from any soft tissue injury and to minimize your chance of a reinjury.
      Thanks for sharing your thoughts!

      Reply
  2. Doc Warnock, LMT
    Doc Warnock, LMT says:

    Great Story…I have suggested all the athletes I work with to read it. I treat many hockey players and groin strain is the #1 injury I see every day. All your suggestions are great.
    I find that trigger point therapy can heal groin strains much faster and more completely than typical PT. Even before the injury, trigger points have probably formed in any or all of the 5 groin muscles…so sportsmassage can also be a preventive program.
    By the way, the psoas can also contribute to groin strain, especially where there is a short leg, which I find in many hockey, soccer, and lacrosse players or anyone using lateral movement as part of the sport.

    Reply
    • Mike Ryan
      Mike Ryan says:

      Thank you, Doc. Working with hockey players, I’m sure you’re an expert in preventing and treating groin injuries.
      I couldn’t agree with you more that the psoas major and the illiacus, commonly known as the hip flexor, plays a huge role in groin strains and most hip/pelvis issues.
      I appreciate you taking the time to share your thoughts with me and my readers.

      Reply
  3. Mike Slemons
    Mike Slemons says:

    Mike

    You made some great points!! Runners are
    predominately grooved in the in the sagittal plane.

    Two points I would make:
    1. Restoring the groin flexibility in 3 planes, because
    the groin is 3 dimensional. I think people do the
    standard groin stretch without addressing the other
    planes which will not provide authentic restoration.
    2. If we are speaking of a right groin strain,
    the groin may be limited in it’s eccentric
    capability by poor flexibility of the opposite
    hip abductors.

    Reply
    • Mike Ryan
      Mike Ryan says:

      Great advice, Mike. I like how your suggestions look at the body as a whole. This helps address problems on the opposite side of the body, a common reason why groin injuries can be so slow to heal. Thanks for being so smart and sharing your thoughts, Mike.

      Reply
  4. Ahimsa Porter Sumchai MD, NSCA-CPT
    Ahimsa Porter Sumchai MD, NSCA-CPT says:

    I worked with a triathlete and dentist and a gymnastics instructor with the American Gymnastics Club in San Francisco with chronic groin strains and understand how debilitating they can be. I believe iliopsoas is affected and should be included in the groin anatomy. I am convinced the hip flexors and adductors are involved.

    Reply
    • Mike Ryan
      Mike Ryan says:

      Hello Ahimsa, You’re 100% correct about the hip flexor being a big factor for athletes with groin injuries. As I replied to Doc Warnock a couple of days ago, an athlete’s hip flexors are always involved with lower extremity injuries.

      Reply
  5. Dan
    Dan says:

    I have a long history of chronic groin injuries: An left adductor strain, a left hernia, surgery, months of rest, stretching, physical therapy, and now a RIGHT groin strain!! Given my history, I’ve done a whole lot of reading about adductor/groin/hernias. I find the whole pathology of the groin seems to be convoluted, confused, and out-dated. This is partially why I am in school to become a PT myself! It’s very helpful to see concise advice from a trustworthy source: YOU. Thanks for writing this!

    Reply

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