Sports-Related Groin Pain: Full Intervention Strategy

Sports-related groin pain may be a long-lasting complication that occurs with change of direction and reaching groin injuries.  These injuries are commonly associated to sports like soccer and hockey, but groin injuries are actually among the most prevalent lower limb injuries in most sports.

In training for these sports, most of our time is spent on strengthening the glutes / hip abductors.

Because they are the key to powerful hips, right?  

Fair enough.  

But the adductors have a huge role to play.

Of the many factors that contribute to the prevalence and persistence of sports-related groin pain, there is research to show that hip range of motion, deficits in adductor strength and previous injury may have a significant impact.

It is time to revisit our intervention strategies to target the elements of sports-related groin pain specifically in order to better prepare individuals to the demands of sport.

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HIP RANGE OF MOTION AND SPORTS-RELATED GROIN PAIN

Given the prevalence of groin injuries and sports-related groin pain, there is a large body of research on risk factors.  

One 2015 study in the American Journal of Sports Medicine found that decreased hip ROM in professional soccer players was associated with more hip- and groin-related symptoms (1).  Many other studies propose decreased hip range of motion as a predisposing factor for chronic sports-related groin pain (2).

The question that remains is usually: 

Which came first, the chicken or the egg?  It remains unclear whether decreased hip range of motion is the cause of sports-related groin pain or whether it is the result of previous injury.

Indeed,

previous injury may result in hip range of motion deficits that perpetuate the cycle of sports-related groin pain

Given this, and what we know about the positions athletes need to get into during sports, restoring range of motion is certainly an important aspect of a preventative and rehabilitation strategy.

If your assessment reveals hip range of motion deficits, this is definitely a starting point for your Mobilization sequence.   For example, lateral traction mobilization with a band is a great tool for improving general mobility:

THE IMPORTANCE OF ADDUCTOR STRENGTH

Groin injuries resulting from change of direction and reaching are characterized by forceful hip extension and abduction with external rotation.  Imagine pushing through the lower extremity to reach towards the ball as depicted in the image below:

In sports like soccer and hockey, the importance of hip abductor strength is a notion that needs no introduction.  But these movements create a lot of strain to the groin area – namely to the adductors.  

Several studies have shown that limitations in adductor strength as well as an adductors-to-abductors strength imbalance have been associated with adductor muscle strains (2, 3, 4).

The powerful movements involved in kicking, reaching, skating and changing direction require that the adductors decelerate the lower limb.  

The hip joint also serves as a central pivot for the body, and the adductors are involved in controlling the pelvis moving on the hip.

This means 

the adductors need both rotation strength for stabilization and eccentric strength for deceleration

By the way, I discuss adductor function at length in my article Developing Adductor Function and Strength for Hip Power,  so make sure to give that a read!

From a rehab perspective, or if returning from an injury, this can start very simply with anti-rotation exercises such as a wide-stance horizontal chop hold.  This exercise has an anti-rotation demand through the hip while placing the adductors in a lengthened position:

MAKE SURE TO WATCH THE MAIN VIDEO OF THIS ARTICLE FOR MORE ON THIS EXERCISE!

The article linked previously also features many other exercises to load the adductors eccentrically.

INTEGRATING SPORTS-SPECIFIC STRENGTH 

Once we’ve improved or restored range of motion and worked on creating intentional force within that range, the next step is to replicate the specific strength demands of sports as much as we possibly can.

As mentioned earlier in the article, we know that limitations in adductor strength are associated with increased risk of groin injury in sport.  There are two important components to adductor function in the sports environment:

• Powerful rotation of the pelvis on the hips or hips on the pelvis
• Powerful eccentric contraction for deceleration

So, while there is no question that the adductors contribute to explosive power, strength underpins this capacity.  

As such, it is always a good idea to start with loaded controlled movements that involve internal and external rotation of the hip as part of a sports-specific adductor strengthening regime.  

In other words,

training ONLY frontal plane hip adduction is not sufficient

And as far as resistance bands go, they can be useful to replicate rotational patterns but have their limitations (and come with their own risks?):

But seriously, a Bulgarian landmine rotation is a much better option, and a great way to load the hip with rotational forces.  Now we are working on loading that rotation of the pelvis on the hips or hips on the pelvis.

MAKE SURE TO WATCH THE MAIN VIDEO OF THIS ARTICLE FOR MORE ON THIS EXERCISE!

And if you are looking for some other rotational exercise ideas (still without the band risks), there are some different ones in this article.

Next, we also need to target the eccentric contraction for deceleration.

INTEGRATING SPORTS-SPECIFIC DEMANDS

In a systematic review published by the British Journal of Sports Medicine, there was evidence to show that along with previous injury and adductor strength deficits, lower levels of sports-specific training were also associated with the risk of groin injury and sports-related groin pain.

This attests to the importance of exposing tissues to similar stresses than those they will encounter in the sports environment.  

High-speed contractions should be included to replicate the demands of sports and integrate the requirement for a strong eccentric contraction for deceleration.

Here, the choice should be dynamic integration exercises that allow us to overload that hip extension, abduction and external rotation pattern similar to reaching and changing direction.

For example, a simple medball toss can be modified to a single-leg version to replicate that reaching pattern:

MAKE SURE TO WATCH THE MAIN VIDEO OF THIS ARTICLE FOR MORE ON THIS EXERCISE!

Sports-related groin pain can be a real pain in the…well, groin.  And while glutes are an important powerhouse for the hips, so are the adductors.

Plus, strong adductors may play a role in preventing groin injuries and managing chronic sports-related groin pain. 

And remember, hip range of motion is important but don’t stop there.  It is also important to strengthen the adductors using progressions that lend themselves to how they function in throwing, kicking, reaching and changing directions.

Using loaded and dynamic exercises that train the adductors directly, train rotation of the pelvis-hips complex and train deceleration are all key components to an efficient prevention strategy.

REFERENCES

(1) Tak, I., Glasgow, P., Langhout, R., Weir, A., Kerkhoffs, G., & Agricola, R. (2016). Hip Range of Motion Is Lower in Professional Soccer Players With Hip and Groin Symptoms or Previous Injuries, Independent of Cam Deformities. The American journal of sports medicine, 44(3), 682–688. 

(2) Sedaghati, P., Alizadeh, M. H., Shirzad, E., & Ardjmand, A. (2013). Review of sport-induced groin injuries. Trauma monthly, 18(3), 107–112. https://doi.org/10.5812/traumamon.12666

(3)Tyler, T. F., Nicholas, S. J., Campbell, R. J., & McHugh, M. P. (2001). The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. The American journal of sports medicine, 29(2), 124–128. https://doi.org/10.1177/03635465010290020301

(4) Whittaker, J. L., Small, C., Maffey, L., & Emery, C. A. (2015). Risk factors for groin injury in sport: an updated systematic review. British journal of sports medicine, 49(12), 803–809. https://doi.org/10.1136/bjsports-2014-094287

Mai-Linh Dovan M.SC., CAT(C)
Certified Athletic Therapist
Founder of Rehab-U