Hip Adductor Mucle Injury

Also known as groin strain

Background

  • Injuries to the groin can be acute or chronic overuse syndromes.
  • Common mechanisms of injury include hyperabduction or forced passive abduction of the thigh during resistive adduction.
  • Overuse adductor muscle injury is also common during repetative directional change high velocity activities, such as during ice hockey or soccer (Morelli et al Am Fam phys 64:1405 2001).
  • Risk factors for adductor strain include adductor tightness (Ekstrand 1983; Arnason 2004), previous adductor injury (Tyler 2001), decreased combined IR and ER ROM (Ibrihim 2007), and hip adductor-to abductor strength imbalance (Tyler 2001). Two other studies found adductor tightness was not predictive of future groin injuries (Ibrihim 2007; Witvrouw 2003)
  • The adductor longus is the most commonly involved muscle of the adductors.
  • In a prospective study of professional hockey players (Tyler 2002), those who eventually sustained groin injuries during the season demonstrated preseason hip adduction strength 18% lower compared with that of uninjured players. Adduction strength was 95% of abduction strength in the uninjured players but only 78% of abduction strength in the injured players.
  • Groin injuries account for 10 to 18% of all soccer injuries (Holmich 1997; Dvorak 2000; Renstrom 1980)
  • Groin injuries in soccer matches account for 5 to 13% of all musculoskeletal injuries (Ekstrand 1983; Renstrom 1980)
  • Seward et al. (1993) reported a 32% recurrence rate for groin strains in Australian Rules Football over 12 months while Tyler et al (2001) recorded a 44% recurrence rate of groin injuries in ice hockey players over 24 months.
  • Cunningham (2007) demonstrated that adductor tendon dysfunction was the overwhelming cause of pubalgia in soccer players as diagnosed by MRI (compared to oseitis pubis)

Clinical presentation and Diagnosis

  • Differential diagnosis includes sports hernia, osteitis pubis, inguinal hernia, labral injury, stress fractures, psoas bursitis, psoas tendonopathy, and referred pain from the hip joint, sacroiliac joint, or lumbar region.
  • Adductor longus and brevis tendonopathy are most painful during resisted hip adduction with the hip in a neutral position (Robinson et al Skeletal Radiol 33:451 2004).
  • Gracilis tendonopathy is most painful with resisted hip adduction in the same position along with painful resisted knee flexion.
  • Pectineus tendonopathy becomes apparent with resisted hip flexion and adduction with the hip in 90 degrees of flexion.

Treatment

Active treatment appears to have better outcomes compared to passive treatment in patients with long-standing groin injuries (Homich et al 1999). In other words, strengthening appears to be superior to stretching and flexibility exercises for chronic groin injuries. It has been suggested that the adductor muscles shoulde be withing 80% the strength of the abductors in order to avoid reinjury (Tyler 2002). Research has also showed delayed onset of the transverse abdominus in those with chronic adductor injuries (Cowen 2004), so addressing core stability may be indicated in this population as well.

Prevention

Tyler (2002) et al showed that strengthening the adductor muscle group appears to be an effective method for preventing adductor strains in professional ice hockey players. The program consisted of 6 weeks of exercises aimed at functional strengthening of the adductor muscles.

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