Diagnosing and Treating Groin Pulls

Diagnosing and Treating Groin Pulls

A groin pull is an injury to the muscles (a muscle strain) of the inner thigh. The groin muscles, called the adductor muscle group, consists of six muscles that span the distance from the inner pelvis to the inner part of the femur (thigh bone). These muscles pull the legs together and help with other movements of the hip-joint. The adductor muscles are important to many types of athletes including sprinters, swimmers, soccer players, and football players.

When a muscle is strained, the muscle is stretched too far. Less severe strains pull the muscle beyond their normal excursion. More severe strains tear the muscle fibers, and can even cause a complete tear of the muscle. Most commonly, groin pulls are minor tears of some muscle fibers, but the bulk of the muscle tissue remains intact.

A pulled groin is a common sports injury. Richard Boll/Photographer's Choice RF/Getty Images

An acute groin pull can be quite painful, depending on how severe the injury is. Groin pulls are usually graded as follows:

• Grade I Groin Strain: Mild discomfort, often no disability. Usually does not limit activity.
• Grade II Groin Strain: Moderate discomfort, can limit the ability to perform activities such as running and jumping. May have moderate swelling and bruising associated.
• Grade III Groin Strain: Severe injury that can cause pain with walking. Often patients complain of muscle spasm, swelling, and significant bruising.

Groin pulls are often seen in athletes who participate in sports such as ice hockey and soccer. The injury appears to be related to factors including hip muscle strength, preseason conditioning, and previous injury. Because of this, proper conditioning is of utmost importance to prevent groin strain injury. Athletes, especially hockey and soccer players, should incorporate adductor strengthening, pelvic stabilization, and core strengthening exercises into their workouts to prevent injury.

A pulled groin is usually a clear diagnosis. Most athletes know what the injury is before they seek medical attention. However, other conditions can mimic the symptoms of a groin strain. One condition that was previously not well-recognized is called a sports hernia. Sports hernias have been found in patients who were diagnosed with chronic groin strains. The sports hernia is a condition similar to a regular inguinal hernia, and is due to a weakening of the muscles that form the abdominal wall. The symptoms of a sports hernia are often nearly identical to those of a groin strain.

Other conditions that may mimic the symptoms of a groin strain include osteitis pubis (inflammation of the pubic bone), hip-joint problems (including early arthritis, labral tears, and other conditions), and low back problems (pinched nerves).

Once a strain is diagnosed, you can begin treatment for your groin pull. Most often, treatment can be accomplished with some simple steps. These include rest, stretching, and some oral medications. Rarely is more invasive treatment necessary.

Groin strain injuries can be a frustration for athletes and weekend warriors alike. The desire to return to full activity often conflicts with the duration of recovery. The length of time needed to recover from a groin strain will depend both on the severity of the injury and the healing of the injured individual. Doing the appropriate treatment can help to ensure healing progresses as quickly as possible.

However, it is important to allow your body the time it needs to complete the healing process. Without doing so, an athlete may risk re-injury and beginning the healing process over right back at square one. Having a physical therapist or athletic trainer help to guide you along the recovery path can be very helpful.

Athletes who sustain a groin strain will want to incorporate a stretching program as part of their rehabilitation. Some simple stretches can help ease the symptoms of a groin strain. Furthermore, stretching can be a useful part of preventing groin injuries from occurring.

As a general rule, the stretches should not hurt. There should be a gentle pulling sensation of the muscle, but this should not be painful.

The first stretch is the squatting adductor stretch:

• Squat to the ground with one leg in front of your body.
• Allow your opposite leg to extend behind you.​
• Stretch your legs apart by gently pushing over your front knee.

This adductor stretch is done while standing.

• Stretch one leg out to the side, keeping your other leg under your torso.
• Bend the knee underneath your torso to stretch the muscles of the inner thigh of the opposite leg.
• Your outstretched leg should have a straight knee, and you should feel the stretch on the inner thigh.

The butterfly stretch is done in a sitting position.

• Sit with your feet together and knees bent. Grasp your feet with your hands.
• Stretch your knees down towards the ground.
• Do not bounce. Feel the stretch along your inner thigh.

The cross-leg stretch is done while sitting.

• While sitting, cross one leg over the other.
• Press the knee of the crossed across the body to open up the hip.

This stretch will emphasize the muscles of the inner thigh and front of the thigh.

If you have symptoms of a severe groin pull, you should be evaluated for proper treatment. Some signs of a severe groin strain include:

• Difficulty walking
• Pain while sitting or at rest
• Pain at night

Severe groin pulls should be evaluated because, in some very rare situations of complete muscle rupture, surgery may be necessary to reattach the torn ends of the muscle. This is rarely needed, even in patients with Grade III groin strain injuries, as these patients can usually undergo successful non-operative treatment.

If you are unsure if you have a groin pull or the symptoms do not quickly resolve, then you should be seen by your doctor. As described above, other conditions can be confused with a groin pull, and these should be considered if your symptoms do not resolve.

Sources:

Suarez JC, Ely EE, Mutnal AB, Figueroa NM, Klika AK, Patel PD, Barsoum WK. "Comprehensive approach to the evaluation of groin pain" J Am Acad Orthop Surg. 2013 Sep;21(9):558-70.

Lynch TS, Bedi A, Larson CM. "Athletic Hip Injuries" J Am Acad Orthop Surg. 2017 Apr;25(4):269-279.

Original article and pictures take www.verywell.com site