Why groin strain injuries are difficult to rehab

Groin strain

Groin strain injuries, also called “Adductor muscle strains”, typically occur when the muscle is subjected to a sudden overload. This can happen during fast cutting/agility movements, sprinting or direct loading such as a soccer tackle.

Groin strains can prove difficult to rehab and are prone to recurrences. This is because of their unique biomechanical role.

The adductor (groin) muscles perform two primary functions. The first is to pull the leg inwards. This occurs during agility movements such as side stepping or pivoting and when kicking a ball.

The second function is to assist with rapid and high power movements of the leg. The adductor muscles help move the leg during sprinting, generating both flexion and extension moments. They’re also active during a squat movement.

It’s these differing functions that make rehab difficult and prone to recurring strains. Moderately paced, straight line running only provides slight loading to the adductor group. But adding in agility or sprint speeds to running drills causes a huge increase in groin muscle loading.

So the main principle of rehab programs – to expose the injured area to gradually increasing incremental loads – proves difficult for groin strains.

So here’s our Sports Physio’s insights into successful groin strain recovery.


KEY POINTS FOR GROIN REHAB PROGRAMS

The rehab program for a groin strain needs to take the injury right through to a successful return to sport. So the sporting goal must dictate the program, with a few common elements. Avoid prefabricated programs that seem generic and without specific outcomes.

Every groin injury is different – different muscles involved and different severity, just to name two aspects. So following a time-based progression of any program doesn’t make sense. Programs may be written as “Week 1”, “Week 2”, etc but don’t feel pressured to follow those timeframes.

Only progress to the next rehab phase when the current level becomes easy, doesn’t seem as challenging and doesn’t cause an increase in symptoms.


SAMPLE PHASES OF A GROIN STRAIN PROGRAM

GENERAL PHASES

This is used to let the injury settle and build in some basic strength work

  1. Walking without pain – yep, boring old walking. But if you can’t walk without pain, there aren’t any exercises that can help yet
  2. Standing leg cycling – leaning forward with hands on wall, make a slow cycling movement with one leg (like you’re riding a bike)
  3. Standing leg cycles with resistance band – as per #2 but with a resistance band around the ankle, pulling the leg outwards
  4. Full depth squats – with bodyweight resistance and a standard stance, progress as deep as comfortable into a full squat
  5. Loaded full depth squats – barbell back squat is ideal, with progressively increasing depth

SPRINTING & AGILITY RUNNING PHASES

This is useful for any athlete progressing back to running sports, including football, basketball and netball.

See our post on running phases for returning to football for the full details of this part of the program.


KICKING & TACKLING PHASES

Building back up to kicking a ball or performing a soccer tackle is a challenge for any rehab program. It’s a difficult action to mimic with reduced loading or speed.

These steps provide a framework for this part of a program, although it may need to be modified for different styles of kicking.

  1. Low lateral lunge – comfortably wide stance, stay low while moving sideways (like you’re moving under a low bar)
  2. Jump squats – focus on increasing height of jump and depth of landing
  3. Adductor plank – this is a high load strength exercise. You can reduce the loading by moving the contract point with the bench higher up the leg
  4. Lateral (sideways) hops in both directions – stand on one leg and hop left, get your balance, then hop right and balance
  5. Lateral hops with kettlebell at chest – same as #4 but with a kettlebell held at your chest to add momentum to your landing

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