1. Adductor Related Groin Pain

2. Normal Anatomy Adductors are a group of 6 muscles on the inner thigh
Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
All originate from the inguinal region at the pubis at various points
Attach onto linea aspera of femur
Adduct the thigh
Also have roles in flexion/extension depending on amount of hip flexion
Also have stabilisation roles on pelvis
Direction of pull is opposite to rectus abdominus

3. Pathology
Pain in the adductor region most commonly onto the insertion into the bone
Takes into consideration muscle strains, ruptures, tendinopathies
Term “Adductor Related Groin Pain” used following Doha Agreement

4. Mechanism of Injury Traumatic Insidious Acute pull in the muscle
Over stretching or a tackle
Insidious
Load placed on tissue greater than tissue capacity

5. Subjective Examination
History indicates overstretching trauma or periods of increased load
Pain in the adductor region which increases with exercise

6. Objective Examination
Pain on palpation of the adductor region
Pain in the adductors on resisted adduction

7. Objective Examination
Pain on palpation of the adductor region
Pain in the adductors on resisted adduction

8. Objective Examination
Pain on palpation of the adductor region
Pain in the adductors on resisted adduction

9. Further Investigation
MRI

10. Management Similar approach to treating tendinopathy
Active exercises strongly proven within the literature
Interventions should be targeted at the adductors AND the rest of the kinetic chain

11. Conservative Reduce Pain Restore Normal Range of Movement
Remove the abuse load
Isometrics
Soft Tissue Massage
Joint Mobilisation
Joint Manipulation
Ice
NSAID’s
Restore Normal Range of Movement
Lumbar spine, hip and knee
Stretching

12. Conservative Restore Normal Muscle Activation and Strength
Adductors, lumbar spine and entire kinetic chain
Isotonic and Isometric Exercise
Core work with abducted hips
Restore Dynamic Stability
Proprioceptive Exercise
Report to Sport Specific Training
Gradual increase of sport specific drills

13. Conservative Restore Normal Muscle Activation and Strength
Adductors, lumbar spine and entire kinetic chain
Isotonic and Isometric Exercise
Core work with abducted hips
Restore Dynamic Stability
Proprioceptive Exercise
Report to Sport Specific Training
Gradual increase of sport specific drills

14. Plan B
Surgical Intervention depends on imaging and arthroscopic findings

15. References
Branci, S., K. Thorborg, M. B. Nielsen and P. Holmich (2013). "Radiological findings in symphyseal and adductor-related groin pain in athletes: a critical review of the literature." Br J Sports Med 47(10):
de SA, D., P. Hölmich, M. Phillips, S. Heaven, N. Simunovic, M. J. Philippon and O. R. Ayeni (2016). "Athletic groin pain: a systematic review of surgical diagnoses, investigations and treatment." British Journal of Sports Medicine.
Holmich, P. (2015). "Groin injuries in athletes--development of clinical entities, treatment, and prevention." Dan Med J 62(12): B5184.
Holmich, P., P. Uhrskou, L. Ulnits, I. L. Kanstrup, M. B. Nielsen, A. M. Bjerg and K. Krogsgaard (1999). "Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial." Lancet 353(9151):
Ibrahim, A., G. A. Murrell and P. Knapman (2007). "Adductor strain and hip range of movement in male professional soccer players." J Orthop Surg (Hong Kong) 15(1):
Nicholas, S. J. and T. F. Tyler (2002). "Adductor muscle strains in sport." Sports Med 32(5):
Tyler, T. F., S. J. Nicholas, R. J. Campbell and M. P. McHugh (2001). "The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players." Am J Sports Med 29(2):
Valent, A., A. Frizziero, S. Bressan, E. Zanella, E. Giannotti and S. Masiero (2012). "Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review." Muscles Ligaments Tendons J 2(2):
Weir, A., P. Brukner, E. Delahunt, J. Ekstrand, D. Griffin, K. M. Khan, G. Lovell, W. C. Meyers, U. Muschaweck, J. Orchard, H. Paajanen, M. Philippon, G. Reboul, P. Robinson, A. G. Schache, E. Schilders, A. Serner, H. Silvers, K. Thorborg, T. Tyler, G. Verrall, R. J. de Vos, Z. Vuckovic and P. Holmich (2015). "Doha agreement meeting on terminology and definitions in groin pain in athletes." Br J Sports Med 49(12):
Weir, A., J. A. Jansen, I. G. van de Port, H. B. Van de Sande, J. L. Tol and F. J. Backx (2011). "Manual or exercise therapy for long- standing adductor-related groin pain: a randomised controlled clinical trial." Man Ther 16(2):