{"id":25790,"date":"2025-08-30T10:00:00","date_gmt":"2025-08-30T08:00:00","guid":{"rendered":"https:\/\/www.physiotutors.com\/?p=25790"},"modified":"2025-08-29T17:37:18","modified_gmt":"2025-08-29T15:37:18","slug":"groin-pain-adductor-injuries","status":"publish","type":"post","link":"https:\/\/www.physiotutors.com\/groin-pain-adductor-injuries\/","title":{"rendered":"Navigating Groin Pain: Dealing with Adductor Injuries in Runners and Field Athletes"},"content":{"rendered":"\n

Groin pain is a common overload injury seen in multidirectional athletes such as football, rugby, and hockey players. Runners are also affected, though less frequently. The incidence ranges from 5% to 18%, with runners typically on the lower end.<\/p>\n\n\n\n

Managing groin pain is challenging due to the region\u2019s complex anatomy. This includes multiple structures and the possibility of various co-existing pathologies. Therefore, understanding this anatomy is essential for diagnosis and treatment.<\/p>\n\n\n\n

The pain source may originate from the lower abdomen, inguinal region, adductor muscles, hip joint, hip flexors, or perineum. Therefore, a good understanding of the anatomy of this region is crucial for both diagnosing and treating groin-related problems.<\/p>\n\n\n\n

\"Doha<\/figure>\n\n\n\n

The Doha Agreement<\/a>: A Clinical Framework<\/h2>\n\n\n\n

The Doha Consensus Statement categorizes groin pain into four primary clinical entities, based on location and symptoms:<\/p>\n\n\n\n

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  • Adductor-related groin pain:<\/strong> Inner thigh pain, with tenderness and discomfort during resisted hip adduction.
    <\/li>\n\n\n\n
  • Iliopsoas-related groin pain:<\/strong> Pain at the front of the hip. It worsens with resisted hip flexion or stretching of the hip flexors.
    <\/li>\n\n\n\n
  • Inguinal-related groin pain:<\/strong> Pain in the inguinal canal area. It increases with abdominal contraction or actions that increase intra-abdominal pressure like coughing.
    <\/li>\n\n\n\n
  • Pubic-related groin pain:<\/strong> Pain localized to the pubic symphysis, with tenderness over the bone.
    <\/li>\n<\/ul>\n\n\n\n

    For all types, pain is localized and worsens with physical activity. This classification supports accurate diagnosis and tailored treatment.<\/p>\n\n\n

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    In runners, the most common causes of groin pain stem from injuries in the adductor muscle group or the perineum area.<\/p>\n <\/div>\n

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    Key Risk Factors<\/h2>\n\n\n\n

    Several high-level studies identify the main contributors to groin injuries:<\/p>\n\n\n\n

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    • Previous injury:<\/strong> Unsurprisingly, a history of groin pain is a strong predictor of future occurrences. Hence the importance of thorough rehabilitation and addressing any residual issues after an initial injury.
      <\/li>\n\n\n\n
    • Higher level of play:<\/strong> Elite athletes are more prone due to training intensity and competitive load.
      <\/li>\n\n\n\n
    • Reduced hip adduction strength:<\/strong> Weakness in these muscles undermines pelvic stability, making injury more likely.
      <\/li>\n\n\n\n
    • Insufficient sport-specific training:<\/strong> A lack of tailored training and preparation for the physical demands of the sport raises injury risk.
      <\/li>\n\n\n\n
    • Male sex:<\/strong> Male athletes experience groin injuries more often than females.
      <\/li>\n<\/ul>\n\n\n\n

      Possible, though less significant, risk factors include:<\/p>\n\n\n\n

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      • Older age
        <\/li>\n\n\n\n
      • Taller or heavier body types
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      • Position played in multidirectional sports
        <\/li>\n\n\n\n
      • Reduced hip ROM: abduction, adduction, extension, flexion, internal rotation
        <\/li>\n\n\n\n
      • Lower hip flexor strength<\/li>\n<\/ul>\n\n\n\n

        Pathophysiology<\/h2>\n\n\n\n

        In runners, the most common causes of groin pain stem from problems with the adductor muscle group or the perineum area. In this article we will cover what the causes and symptoms are and how to assess and treat adductor related groin pain.<\/p>\n\n\n\n

        Anatomy of the Adductor Group<\/h2>\n\n\n\n

        The adductor group consists of five muscles:<\/p>\n\n\n\n

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        • Pectineus: <\/strong>Extends from the pubic bone to the femur, between the lesser trochanter and the proximal part of the linea aspera.
          <\/strong><\/li>\n\n\n\n
        • Adductor Brevis: <\/strong> Originating from the inferior pubic ramus and inserting into the proximal part of the  linea aspera of the femur.
          <\/strong><\/li>\n\n\n\n
        • Adductor Longus: <\/strong>Arising from the anterior aspect of the pubic bone inferior to the pubic tubercle, and also attaching to the middle portion of the linea aspera.
          <\/strong><\/li>\n\n\n\n
        • Adductor Magnus: <\/strong>The largest of the group, originating from both the inferior pubic ramus and the ischial tuberosity, and inserting into the linea aspera and the adductor tubercle of the femur.
          <\/strong><\/li>\n\n\n\n
        • Gracilis: <\/strong>Gracilis: it extends between the pubis and the ischial ramus to the pes anserinus of the tibia.<\/li>\n<\/ul>\n\n\n\n

          These muscles stabilize the pelvis and enable hip adduction. Larger ones also assist in hip flexion or extension depending on the position of the femur. They are innervated by the obturator and femoral nerves (L2\u2013L4).<\/p>\n\n\n\n

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