Healing a groin strain takes consistent effort and work.
We see a wide range of athletes with adductor muscle strains and associated pain. They include football and soccer players, walkers, joggers, and runners.
A strain becomes noticeable in their daily routine. Initially, a more severe strain can be felt with each step. This eventually progresses to only being present with lateral or rotational movements.
In this case study, you’ll see the process of one athlete who is healing a groin strain.
The Adductor Muscle Strain
At the initial evaluation, Zeeshan reports “I was working out with my personal trainer. In the workout, I was doing some lateral jumping, and during the activity I felt a strong pull in my groin”. Zeeshan reports, initially, he visited a chiropractor. The chiro provided results briefly, but did not have a lasting effect for him. Zeeshan primarily reported pain when walking, turning or changing directions. Also, he felt pain when getting into and out of bed or crossing his legs in bed.
Beginning Recovery
On his first day of physical therapy, Zeeshan said “I have pain with nearly all movements of my left leg, primarily lifting my left leg and when I cross my legs. It specifically hurts if I try to run or workout. I also have pain when lifting my left leg into bed. My goal was to heal the muscle fully, return to my normal workouts and be able to play basketball casually”.
Healing a Groin Strain
Zeeshan came to therapy nearly 2 months after his initial injury. Some lower level exercises were not challenging enough. He did not exhibit any discoloration or swelling. Zeeshan felt sore and tender to palpation through the adductor muscle group.
Our first goal (0-3 weeks of therapy) meant building strength in the hips, quadriceps and hamstrings in weight-bearing positions. This limits further irritation of the adductor muscles. We wanted to improve the range of motion (ROM) deficits he exhibited in hip flexion, internal rotation and abduction. With stretching and light strengthening, Zeeshan continued to be sore after his treatment. On the second visit, we included modalities and manual therapy. This allows appropriate tissue healing and reformation while decreasing soreness and trigger points through affected muscles.
Strengthening Adductor Muscles
As Zeeshan progressed and reported less pain, we built his strengthening program (3-5 weeks) to include single-leg balance activities. Also, we added more dynamic strengthening and stability exercises for the adductor muscle group. This included side lying planks with the affected leg on a high-low table, the slideboard, and deadlifts.
Introduction to Dynamic Activities
Zeeshan reported minor pain in the proximal (upper) portion of his adductor muscles (6-9 weeks). He expressed interest in testing his tolerance to more dynamic exercises.
Due to the pain in explosive activities, we made sure to begin with “parabolic” activities.
Zeeshan began working up to a higher speed and backing down to prevent excess eccentric strain.
When pushing off his left leg, Zeeshan tolerated straight line jogging and lateral shuffling with only minor pain.
We then included running at higher speeds, running with turns, bounding, hopping, box jumps and skipping. Each of these caused only minor discomfort, and didn’t increase soreness the following day.
Finally, we included “unplanned” movements to best prepare Zeeshan for reacting to his environment on runs or when he returns to playing basketball.
Measuring The Athlete’s Progress Through Rehab
Upon the initial evaluation, we measured Zeeshan’s strength and motion measurements. He began with 7 degrees of internal rotation, 28 degrees of abduction and 106 degrees of hip flexion.
After therapy completion, Zeeshan improved to 23 degrees of internal rotation, 41 degrees of abduction and 123 degrees of hip flexion. Zeeshan’s hip adductor strength improved from a 4- to a 5/5, and his hip flexors improved from a 4 to a 5/5.
Post Physical Therapy
Zeeshan discontinued physical therapy due to his progress. He demonstrated a lack of pain during and after running along with other dynamic tasks.
He plans on returning to his trainer and resume his normal workout routine. Zeeshan hopes of returning to soccer, basketball and general athletic activities soon.
Pleased with his treatment and care at our River Oaks location, Zeeshan says:
“Every member of the staff gives their clients undivided attention and reassurance during the whole rehabilitation process. The physical therapists are proactive when clients seem to plateau in their rehabilitation. New methods of strengthening and treatment are always suggested and practiced at the appropriate level. Also, I have never left a session while feeling discomfort. The staff always makes sure you feel much better than how you came in, which ties back in with their high level of reassurance…”
To minimize risk of an adductor strain, athletes should build hip strength to prevent any adverse knee movements.
Also, focus on eccentric strengthening, as the commonly strained adductors and hamstrings have a large component of eccentric control in sport.
As evidenced in this case, the lateral jumping activity created lengthening at the adductor that was not capable of meeting the demand placed on the muscle.
Athletes need to work in diagonal and lateral patterns, and practice unplanned reactions before being cleared for a full return to sport.
Prior to running, proper stretching minimizes your strain risks.
Are you suffering from a groin strain?
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