It can be a hockey player’s nightmare. Groin strains and tears not only stop a player in his or her tracks but they take their time to heal. If they are not treated properly a player can face the prospect of the injury reoccurring.
A groin strain is a stretch, tear, or complete rupture of the muscle that extends from the pubic bone to the inside of the thigh. It is the main muscle that allows you to move the leg from an outside to an inside position from the hip (initiating a crossover step in directional change in hockey, for example). A pulled or strained groin is painful and takes time to heal. You might not even notice the injury during normal daily activities, but it will get your full attention if you move with a sudden start. Returning to training or competition too soon is a common mistake.
How It Happens
Like many sports injuries, a strained groin can be caused by overuse of the primary inner thigh muscle (adductor longus), by a sudden contraction of that muscle, or by both. Sprinting, changing directions, over stretching in a hockey tackle are examples of actions that could trigger the injury. Inadequate warm-ups, poor technique and taking a blow to the groin area are also possible causes.
Symptoms
- A mild (Grade 1) groin strain may not be very painful and may not limit mild or moderate physical activity.
- A moderate (Grade 2) sprain causes moderate discomfort and limits or prevents running and jumping.
- A severe (Grade 3) strain causes pain doing almost anything and could include any of the symptoms below:
- A stabbing pain in the groin area
- Swelling and/or bruising that may develop several days after the injury
- Inability to move the leg inward or across the front of your body
- Loss of upper leg strength with certain movements
- Muscle spasms
- In rare cases, muscle deformity
Initial Treatment
- Rest. Take 5-7 days off, then evaluate your condition.
- Apply ice packs to the area for 15-20 minutes, 3-4 times a day to minimize swelling and pain.
- Use an elastic wrap or bandage to apply pressure and limit swelling.
- Aspirin, acetaminophen, ibuprofen, and naproxen may relieve pain. Aspirin, ibuprofen, and naproxen may relieve pain and reduce inflammation.
- See a doctor if there is a noticeable loss of strength in the muscle or if symptoms don’t significantly subside within two weeks.
Comeback Strategy
Use symptoms (or the lack of symptoms) to determine your comeback timetable, not a certain number of days or weeks. Generally, speaking, Grade 1 symptoms usually disappear within a week; Grade 2 symptoms last 2-3 weeks; and Grade 3 symptoms can persist for 6-8 weeks or longer.
- Don’t try to come back too soon. Absence of symptoms while performing normal daily activities is deceiving and different from the forces involved in training or competition.
- No brisk walking, jogging, or running as long as you have moderate-to-severe pain.
- Once the pain disappears, gradually increase the intensity, duration, and frequency of training.
- Go through all the movements required in your sport without pain before returning to action.
Groin Strengthening – Basic Exercises
To begin with, the following basic groin strengthening exercises should be performed approximately 10 times, 3 times daily. As your groin strength improves, the exercises can be progressed by gradually increasing the repetitions and strength of contraction provided they do not cause or increase pain.
Adductor Squeeze (Crook Lying)
Begin this groin strengthening exercise lying on your back in the position demonstrated with a rolled towel or ball between your knees (figure 2). Slowly squeeze the ball between your knees tightening your inner thigh muscles (adductors). Hold for 5 seconds and repeat 10 times as hard as possible and comfortable pain free.
Figure 2 – Adductor Squeeze (Crook Lying)
Adductor Squeeze (Supine)
Begin this groin strengthening exercise lying on your back in the position demonstrated with a rolled towel or ball between your knees (figure 3). Slowly squeeze the ball between your knees tightening your inner thigh muscles (adductors). Hold for 5 seconds and repeat 10 times as hard as possible and comfortable pain free.
Figure 3 – Adductor Squeeze (Supine)
Groin Strengthening – Intermediate Exercises
The following intermediate groin strengthening exercises should generally be performed 1 – 3 times per week provided they do not cause or increase pain. Ideally they should not be performed on consecutive days, to allow muscle recovery. As your groin strength improves, the exercises can be progressed by gradually increasing the repetitions, number of sets or resistance of the exercises provided they do not cause or increase pain.
Resistance Band Hip Adduction
Begin this groin strengthening exercise standing at a bench or chair for balance and a resistance band around your ankle as demonstrated (figure 4). Keeping your back and knee straight, slowly take your leg inwards tightening the muscles in the inner thigh / groin (adductors). Perform 3 sets of 10 repetitions as far as possible and comfortable provided the exercise is pain free.
Figure 4 – Resistance Band Hip Adduction (right leg)
Lunges
Begin this groin strengthening exercise standing with your back straight in the position demonstrated (figure 5). Slowly lower your body until your front knee is at a right angle. Keep your knee in line with your middle toe and your feet facing forwards. Perform 3 sets of 10 repetitions provided it is comfortable and pain free.
Figure 5 – Lunges
Movement Prep
Incorporate these exercises into your dynamic warm-up:
- Knee Hug Lunge – Elbow to Instep
- Lateral Lunges
- Leg Cradles
Do not increase the intensity, frequency, or duration of your exercise routine more than 10 percent each week.
References
1. Jennifer Lewis, PT, DPT, ATC, Performance Physical Therapist, Athletes’ Performance, Phoenix, Arizona
2. Clinical Journal of Sport Medicine
3. Complete Guide to Sports Injuries
4. eMedicine
5. New York University Langone Medical Center
6. Sports Injury Bulletin
7. University Hospital, Syracuse, New York
