Groin Injury & Exercises

Groin Injuries: Types, Causes, and Symptoms

Groin injuries are common, particularly among athletes who participate in sports that require rapid changes in direction, side-stepping, or kicking, such as football, rugby, and hockey. The most frequent type of groin injury is a groin strain, which is a tear or overstretching of the muscles or tendons in the region-most often the adductor muscles.

Factors Contributing to Groin Injuries: Sudden side-stepping or twisting Overstretching in sports or exercise Poor running technique General wear and tear, especially with age Weak surrounding muscle weakness, predisposing to injury

Understanding the Groin: Anatomy and Function

The groin is a complex anatomical region where the lower abdomen meets the inner thigh. This area is composed of several key structures, including muscles, ligaments, tendons, and fascia, all of which attach to the pubic bone. The main muscles involved are the adductor group-adductor magnus, adductor brevis, adductor longus, gracilis, and pectineus-which run from the pubic bone to the inner thigh and knee. These muscles are primarily responsible for bringing the leg toward the body's midline (adduction), stabilizing the pelvis, and assisting with movements like walking, running, and changing direction.

Central to the groin's anatomy is the inguinal ligament, which marks the lower edge of the abdominal wall. The inguinal ligament, lacunar ligament, rectus muscle insertion, pectineal fascia, and adductor tendon origins are common sources of groin pain, especially in athletes. The pectineus muscle, covered by thick fascia, connects the femur to the superior pubic ramus, and tension in any of these structures can result in discomfort or injury.

The most common causes of groin injuries include:

1.Muscle, tendon, or ligament strains

The primary cause of groin injuries, especially in athletes, involves overstretching or tearing the adductor muscles (e.g., adductor longus) during activities requiring sudden directional changes, kicking, or sprinting. Sports like soccer, hockey, and football are high-risk due to frequent twisting, pivoting, and explosive movements.

2. Overuse and repetitive microtrauma

Cumulative stress from repetitive motions (e.g., running, kicking) can lead to chronic groin pain, tendinitis, or stress fractures. Distance runners and athletes in jumping sports are particularly susceptible.

3. Acute trauma

Direct blows, falls, or abnormal leg positioning (e.g., forced hip rotation) may cause muscle tears, hematomas, or avulsion fractures (where tendons/ligaments pull bone fragments away).

4. Inguinal hernias

Soft tissue (e.g., intestine) protruding through weakened abdominal muscles, often requiring surgical intervention if symptomatic.

5. Athletic pubalgia ("sports hernia")

A non-hernia condition involving pelvic muscle/tendon strains, common in athletes performing repetitive twisting motions.

6. Osteitis pubis

Chronic stress-induced inflammation of the pubic symphysis, seen in runners and soccer players.

Less common but serious causes include femoral neck stress fractures (rare, linked to endurance running) and referred pain from hip pathologies (e.g., arthritis) or kidney stones. Immediate medical attention is required for sudden scrotal pain/swelling (testicular torsion).

Gender-specific differences exist: males report higher groin injury rates in sports like football, while females may experience referred pain from hip issues

Symptoms of Groin Injuries:

• Sudden, sharp pain in the inner thigh or groin, often followed by a dull ache
• Bruising, swelling, and tenderness in the affected area
• Pain that worsens with movement, coughing, or sneezing (if abdominal muscles are involved)
• Weakness or persistent discomfort if the injury becomes chronic

Severity of Groin Strains:

• Grade I: Mild overstretching or microtears, slight discomfort but minimal loss of function
• Grade II: Partial tear, moderate pain, swelling, and reduced strength
• Grade III: Severe or complete tear, significant pain, swelling, bruising, and loss of function

Management and Rehabilitation of Groin Injuries

Immediate Care

In the first 48–72 hours after a groin injury:

• Rest: Avoid activities that aggravate pain.
• Ice: Apply ice packs to reduce inflammation and pain (10 minutes, twice daily).
• Compression and Elevation: May help reduce swelling.
• After this period, gentle exercises can begin, provided they do not cause excessive pain.

Rehabilitation Phases

Phase 1: Acute Rehabilitation

Focus: Pain control, swelling reduction, gentle stretching, and restoring range of motion.

Interventions:

• Gentle manual therapy and stretching (e.g., trunk rotations, figure-4 stretch, hip flexor stretch)
• Isometric adductor contractions (e.g., ball squeeze)
• Gentle hip and lumbar mobilizations
• Cardiovascular activity (walking, cycling, pool treadmill) as tolerated

Phase 2: Subacute Rehabilitation

Focus: Progressive strengthening, core stability, and functional movement.

Interventions:

• Progressive resistive exercises (PRE) for hip and core
• Eccentric strengthening (e.g., Copenhagen adduction)
• Functional exercises (squats, lunges, step-ups)
• Proprioceptive training (single-leg balance, Airex pad)

Phase 3: Return to Sport

Focus: Advanced strengthening, plyometrics, sport-specific drills, and gradual return to full activity.

Groin Strengthening Exercises

Targeted strengthening of the groin muscles is crucial for both rehabilitation and prevention of future injuries. Here are evidence-based exercises:

1. Isometric Adductor Squeeze

Lie on your back with knees bent, place a ball or pillow between your knees, and squeeze for 30 seconds. Rest and repeat 10 times.

2. Side-Lying Hip Adduction

Lie on your side with the top leg bent and resting in front. Lift the bottom leg upward, hold for 5 seconds, and repeat 10–12 times.

3. Standing Resistance Band Hip Adduction

Attach a resistance band to a fixed object and loop it around your ankle. Pull your leg toward the midline, then return slowly. Repeat 10–12 times.

4. Copenhagen Adductor Plank

Rest on your side, with the top leg supported on a chair or bench. Lift your pelvis and bottom leg, hold for 20 seconds, and repeat three times.

5. Multi-Directional Band Strengthening

With a resistance band around your ankle, move your leg in various directions (forward, side, diagonal) to challenge groin and hip muscles.

6. Magic Circle/Pilates Ring Squeeze

Lying on your back with knees bent, squeeze a Pilates ring between your thighs for 10 reps, three times.

7. Bridge with Adductor Squeeze

Perform a glute bridge while squeezing a ball between your knees, holding at the top for 10 seconds.

Groin Stretching Exercises

Stretching improves flexibility, reduces muscle tension, and aids recovery. Both dynamic and static stretches are beneficial:

Dynamic Stretches (Pre-activity):

• Leg Swings: Stand and swing one leg forward/backward and side-to-side, 20 reps per leg.
• Gate Stretches: Lift the knee, rotate it outward, and open the hip (“open the gate”), then return (“close the gate”).

Static Stretches (Post-activity or Rehab):

• Butterfly Stretch: Sit with feet together, knees out, and gently press knees toward the floor. Hold for 30 seconds.
• Lunge Stretch: Take a wide stance, lunge to one side to stretch the inner thigh of the opposite leg. Hold for 30 seconds.
• Wide Squat Stretch: Stand with feet wider than shoulder-width, squat down, and press knees outward to stretch the groin.
• Kneeling Hip Stretch: In a deep lunge, with one knee on the floor and the other bent, lean forward to stretch the hip flexor and groin.

Preventing Groin Injuries

Key strategies include:

1. Regular strengthening and stretching of the groin and hip muscles
2. Proper warm-up with dynamic stretches before activity
3. Gradual progression of exercise intensity
4. Addressing muscle imbalances and core weakness
5. Ensuring correct technique in sports and exercise

When to Seek Medical Advice

Persistent pain, inability to walk, or symptoms not improving within a week warrant medical assessment. Severe injuries (e.g., complete tears, large hematomas, or suspected hernias) require prompt evaluation.

An example of  Groin Rehabilitation Routine

Early Phase (Days 3–7):

• Isometric adductor squeeze (ball or pillow)
• Gentle side-lying leg lifts
• Gentle walking as tolerated

Mid Phase (Weeks 2–4):

• Standing resistance band hip adduction
• Bridge with adductor squeeze
• Multi-directional band strengthening
• Dynamic leg swings

Late Phase (Weeks 4+):

• Copenhagen adductor plank
• Wide squat stretch
• Sport-specific drills
• Gradual return to running, cutting, and pivoting movements

Concluding Thoughts on Groin Injury & Exercises

The groin is a structurally intricate region essential for lower body movement and stability. Groin injuries, particularly strains of the adductor muscles, are common in sports and can range from mild to severe. Effective management includes early rest, gradual rehabilitation, and a structured program of strengthening and stretching exercises. Prevention hinges on maintaining strong, flexible groin and hip muscles, proper warm-up, and attention to technique. Persistent or severe symptoms require medical evaluation to rule out more serious conditions and to optimise recovery for you.