Adductor Related Groin Pain

Adductor InjuryThe main symptom is pain in the adductors region.  In the early stages of adductor related groin pain, symptoms may reduce after a warm-up, increase after prolonged activity or flare up after the activity. This may be later that evening or wakening up the next morning. As symptoms progress and worsen, there is a reduction in performance. The location of pain may depend on the onset of injury. Insidious onset will present at the proximal insertion site whereas an acute onset may present at the insertion or myotendinous junction (site of connection between tendon and muscle).

With all field-based sports, the main aggravating factors include sprinting, change of direction and kicking. The acceleration and deceleration elements of sprinting tend to aggravate the adductors, whereas slow jogging should not. Cutting and turning at speed tends to work the adductors hard. Known risk factors for adductor related groin pain include a history of injury or weakness.

If experiencing adductor related groin pain, the hip joint itself should be considered as a differential diagnosis. The hip may be a source of pain. Hip pain often presents with a deep anterior pain that can also be felt in the adductor region. Another important consideration is genitofemoral nerve entrapment with groin pain. The genital branch of the genitofemoral nerve runs in the inguinal canal and can cause pain into the adductor region. However this has a different character of pain – the patient usually reports burning pain or pain into the perineum or scrotum.

I am often asked to explain the main difference in adductor related groin pain and pubic related groin pain. The patient will always report pain in the adductor region, it is recognised on palpation and with pain on resisted testing. Pubic related groin pain is less common, but it is pain on the pubic symphysis reproduced on palpation. It is important to clear if this is the same pain that is specific to the pain felt during/after activity.

If you are a female and reporting groin pain, an important differential diagnosis to clear is a stress fracture. This is incredibly common in middle-aged female distance runners. If there is a potential stress fracture you need to stop running immediately. A neck of femur fracture may present with a deep anterior pain which is reproduced with examination of the hip. A pubic rami stress fracture will present as deep adductor pain that can be reproduced on palpation of the inferior ramus. Pain may be worse on the first steps of running specifically during heel strike as this transfers load up the leg but also may be prominent following no warm up period. Pain will increase with increasing activity and may lead to limping. An MRI is required to confirm this diagnosis due to its high-sensitivity. Yes an x-ray may confirm the diagnosis if chronic, but alone cannot be used to exclude the diagnosis of a stress fracture.

If you experiencing adductor related groin pain or experiencing any symptoms discussed please do not hesitate to contact and book an appointment at JT Physiotherapy today.

 

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Cathal Ellis

 

 

 

 

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