The typical scenario for a sharp pain in the inner thigh or groin area goes like this:
- didn’t warm up properly, or cooled down after a break in play…
- sudden sprint, agility or cutting movement, or a cross-body kick…
- and BANG, feels like you got stabbed!
This type of injury is called an acute injury, which means it occurs suddenly and due to a single incident that overloads the soft tissue.
It causes a sharp pain at the inner thigh where the overload has occurred. It could a muscle injury, a tendon injury or even a bone injury (such as an avulsion fracture).
We’ll cover muscle injuries in this post but the same principles apply for acute tendon injuries.
The most likely culprit is one of the adductor muscles, a group of six muscles that move the leg inwards (as well as assisting with other movements).
They are:
- Obturator Externus (also known as External Obturator)
- Pectineus
- Adductor Brevis
- Adductor Longus
- Adductor Magnus
- Gracilis
Each of these muscles contribute to the adduction, or inwards movement, of the leg and can be injured during rapid or forceful muscle contractions or if the leg is suddenly resisted (eg. kicking the ground).
Working out the muscle injury grade
Muscle injuries are graded based on their severity. It’s a simple scale of 1-3, with a grade 1 being minor and a grade 3 being a major injury.
These grades help forecast the duration of recovery at the time of injury. But they shouldn’t be used to guide rehab progression (“a grade 2 injury should be doing xyz exercise at 3 weeks”). Progression is highly individual and should be guided by symptoms and function.
Tips for working out the injury grade
The day after you feel that sharp pain at your inner thigh, check for a bruise. If the injury causes a bruise, you’re looking at a grade 2 or 3 injury. That’s around 6-12 weeks before you’ll be back to high intensity running and agility/cutting.
Note that if there’s no bruising, that doesn’t mean it’s a grade 1. It could still be a grade 2 injury but deep within the muscle.
If it feels better the day after the injury, it’s probably a grade 1 injury or a low grade 2 injury. You could be back in 2-4 weeks.
If the injury feels worse the day after the incident, it’s probably a grade 2 or 3 injury.
What to do when the injury first happens
Don’t
Don’t panic. It’ll hurt to walk because the bleeding inside the muscle (with grade 2-3 injuries) takes up space and walking stretches the muscle, squeezing the injured area.
Don’t take anti inflammatories (Nurofen, Voltaren, Advil, etc). They increase bleeding and will extend your recovery time by weeks.
Don’t elevate it. You can’t ready elevate that part of the leg, the bleeding had nowhere to drain to and you’ll look like a goose.
Don’t stretch it. Stretching can damage the early tissue healing and increase pressure on the injury.
Don’t massage it. Massage will shift the bleeding around the injury and allow more bleeding to refill the area.
Do
Limp if you want to. If it’s more comfortable to limp, go for it. You’re best to compromise “normal” walking mechanics for an alternate method that doesn’t load the injury and hurt. It’s only for a few days.
Do compress it. An elastic bandage is great but compression tights (Skins, 2XU, etc) work well to.
Do ice it. Apply 10min of ice two or three times on the day of the injury to reduce pain. It’s not needed after that.
How to plan your rehab
Rehab for a groin/adductor muscle injury needs to follow two simple principles:
- It shouldn’t hurt, and
- It needs to progress in small increments
That’s it. Simple, but getting some guidance can definitely help with point #2.
Point #1 doesn’t mean that any sensation or awareness in that area is bad.
It’s still recovering so expect it to be noticeable, uncomfortable at times and mildly sore with loading. And that’s not a concern, that’s almost a necessary ingredient to ensure we’re loading the area sufficiently for recovery.
Point #2 sounds simple enough but a knowledge of biomechanics and function certainly helps. That’s why professional rehab is designed specific to your injury, sporting history and your requirements.
“It wasn’t hurting to walk so I tried a run”…
Never base a return to sport on the fact is doesn’t hurt any more! The brain will naturally adjust your movements to avoid bothering the injury. You’ll step shorter or reach your shoe in a different way.
It’s a huge step up to go from pain-free daily tasks to sports. It’s the most common reason for re-injury and extended recovery periods.
Typical progressions go from very small adductor activations, to low loads in neutral positions, then low loads away from the body and higher loads in neutral positions.
Once that’s done, you can add faster movements, higher loads away from the body and some running at easy paces.
The final step is to put it all together in fast, strong muscle activity – sprinting. On top of that you can add pre-planned agility/ cutting manoeuvres and finally, unplanned/unexpected movements.
