How to resolve long standing groin pain
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Introduction
Long standing groin pain is common issue amongst athletes of all levels (1). It is one of the top five regions to be injured in multidirectional sports (1). It can be a tricky area for clinicians to assess and treat due to the complexity of the area. What is complex about it? Simply, there are many structures which can get injured (2,3).
Work has been done through expert meetings, to try and refine the assessment process so that patients receive more accurate assessments, leading to more suitable management (2,4). What is consistently recommended is adductor strengthening. Particularly, the ability to generate force while being still and to control the leg as it stretches sideways (1).
What is the solution?
So how do we best strengthen the adductors? There are a few popular ways these days and as always, there are many ways to achieve the same end-goal. Patient preference, skill level and access to equipment needs to be taken into consideration.
One could start with a lower load exercises like ball squeezes or side lying leg raises (5). If you need a higher load exercise, the Copenhagen exercise is a good low equipment option (6). Or, one could start with an exercise where load can be titrated based on an individual’s symptoms. This is demonstrated in today’s video.
Standing hip adduction is a good option for increasing your groin strength (7). A study looked at how 8 weeks of supervised standing hip adduction (mid-season) affected groin strength in sub-elite soccer players (7). Thirty-four players were randomised into two groups. One group did the exercises. One did not. Over the 8 weeks, the intervention group went from 3x15 rep max to 3x8 rep max and from twice to three times a week. They found that eccentric strength increased by 30% compared to baseline. The control group increased by 17%. Notably, the between group differences were significant.
Side lying hip adduction
Standing hip adduction
Copenhagen exercise
Standing groin or adduction isometrics
When should you do this?
An interesting point to make is that once one has returned to full activity, that regular activity may be sufficient to maintain the strength and architecture of the groin muscles (8). This is a really salient point as commonly, athletes are encouraged to ‘do more’ outside of training. On the flip side, if you miss a training, or are not getting full playing minutes every weekend, it might be worth having this and other exercises ready to go to ‘supplement’ the minutes missed playing.
References:
1. Vergani L, Cuniberti M, Zanovello M, Maffei D, Farooq A, Eirale C. Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts. Sports Medicine - Open. 2022 Jan 18;8(1):11.
2. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015 Jun;49(12):768–74.
3. Short SM, MacDonald CW, Strack D. Hip and Groin Injury Prevention in Elite Athletes and Team Sport – Current Challenges and Opportunities. IJSPT. 2021 Feb 1;16(1):270–81.
4. Thorborg K, Reiman MP, Weir A, Kemp JL, Serner A, Mosler AB, et al. Clinical Examination, Diagnostic Imaging, and Testing of Athletes With Groin Pain: An Evidence-Based Approach to Effective Management. J Orthop Sports Phys Ther. 2018 Apr;48(4):239–49.
5. Serner A, Jakobsen MD, Andersen LL, Hölmich P, Sundstrup E, Thorborg K. EMG evaluation of hip adduction exercises for soccer players: implications for exercise selection in prevention and treatment of groin injuries. Br J Sports Med. 2014 Jul;48(14):1108–14.
6. Ishøi L, Thorborg K. Copenhagen adduction exercise can increase eccentric strength and mitigate the risk of groin problems: but how much is enough! Br J Sports Med. 2021 Oct 1;55(19):1066–7.
7. Jensen J, Hölmich P, Bandholm T, Zebis MK, Andersen LL, Thorborg K. Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomised controlled trial. Br J Sports Med. 2014 Feb;48(4):332–8.
8. Alonso-Calvete A, Lorenzo-Martínez M, Padrón-Cabo A, Rey E. Effects of Copenhagen Adduction Exercise on the Architectural Characteristics of Adductors in U-17 Male Soccer Players: A Randomized Controlled Trial. International Journal of Environmental Research and Public Health. 2021 Jan;18(24):12956.
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