Groin Strain

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What is Groin Strain?

Groin strain is a common sports injury. The injury comes from stretching or suddenly pulling the muscles, adductors of the leg. This causes a pain in the inner side of the thigh. The injury usually happens when a person jumps or runs, and stretches the legs too much.

From an outer position to inner position, and the pain worseThere are actually six adductor muscles in this area (pectineous, adductor brevis, adductor longus, gracilis and adductor magnus, obturator externus), and any of them may be injured, but in most cases adductor longus muscle is injured. These muscles, adductors, are responsible for moving the legns with these movements and with bringing the legs together.

Mechanism of injury

The injury may be in form of a sprain or a complete rupture of the muscle. The adductor longus muscle attaches to the pubic bone and on the other side on the inner side of the femur. That is why the symptoms are in the groin. The injury is in the tendon or in the muscle, and may vary from mild to severe.

With sudden or repetitive stretching of the tendons and muscles, the muscle fibres become damaged, because they extend over their limits. Inflammation progresses when the inflammatory cells and cytokines arrive at the site. They produce prostaglandins and bradykinin which are responsible for swelling and pain.

in the same process the cells that will help in healing arrive at site. The injuries may be in form of contusions, tearing, straining and rupture.

The injury can be repetitive which causes tendinitis or may be acute, with a sudden injury to the muscle. Usually, the injury happens when a sportiest doesn’t warm up the muscles or after a long while of not being active.

If a person already had some other musculoskeletal problems such as back pain or have been previously injured, there is a higher chance for straining these muscles because of improper movements of the back and legs.

Epidemiology

These injuries are more common in men, and 15% of all soccer injuries are groin strains. In some sports these injuries are more common: karate, soccer and athletics (running, jumping). ^{(1) (3)}

Signs & Symptoms

Immediately after the injury a person may feel a sudden sharp pain which may spread through the leg or to the abdomen.

There are three degrees of injury depending on the level of damage to the tendons and muscle and symptoms that a person experiences:

1^st degree – mild injury, minor damage to the muscle, but a person may still walk normally, feeling a slight discomfort. Damage is in less than 25% of muscle fibres.
2^nd degree moderate injury, strength is lost and there are difficulties with walking, with swelling and bruising. Damage is in between 25 and 90% of the muscle fibres.
3^rd degree is a partially or completely ruptured muscle with a complete loss of strength and severe pain. (2)

The pain is stabbing and sharp. The pain appears suddenly and is very intensive. Some swelling will be present because of the migration of the inflammatory cells and chemicals that promote healing. Because of the pain and muscle spasms, the movements are limited. There is also some tenderness on palpation and muscle spasms that both provoke pain.

Pain is provoked when :

Bringing legs together and
Bending and raising the knee,

which are the characteristic symptoms of groin pain and damage to one of the muscles from the adductor group. With rupture, a person begins to feel a popping or snapping sensation in the groin. The gait is also affected, and there are difficulties and pain with every movement. ⁽⁴⁾

Diagnosis

Clinical exam and history

The diagnosis is made after thorough history has been taken from the patient. Many illnesses and conditions may resemble to the groin strain.

In the same area are testicles or in women, there are possible edema or haematoma to the labia, or swelling of the lymph nodes with pain for various reasons, and damage to other surrounding musculoskeletal structures (hip labral tear and hip flexor injury resemble this injury the most).

After the received data about the injury, there is usually no dilemma. Clinical exam will indicate the type of injury and damage to the adductor muscles. A doctor will evaluate the range of motion that are still possible and painless.

It is important to do a bilateral adductor test, Thomas test (palpation test for tenderness in the inguinal region), and palpation and assessment of the abdominal pain.

Additional diagnostic procedures

Other diagnostic procedures that may be helpful in diagnosis are MRI and X-ray of the femur. It is important differentiating groin strain from other diseases and syndromes such as hernia, osteitis or testicular pain for example. Ultrasound of the groin is useful in exclusion of hernias and abdominal and scrotal conditions.⁽³⁾

Treatment

First line of treatment

In the first line of treatment it is important to reduce pain and swelling which is why application of ice, elevation of the leg and rest for 7 days are crucial. Ice is applied not directly on skin, but rather wrapped in a towel, for 3-4 times a day for 15 minutes. To reduce swelling, it is useful to use elastic bandage around the groin and upper leg. Taking some analgesics may be useful to relieve pain.

Usually, the analgesics that are used are from NSAIDs group. In treatment, it is wise to follow the principle : PRICE- protection, rest, ice, compression and elevation. These five will contribute to proper healing and regeneration of the muscle and prevent complications. ⁽⁵⁾

Exercises

After a period of time and acute pain, depending on the degree of injury, the athlete may begin with some mild exercises and rehabilitation. The exercises include :

Stretching
Strengthening
Specific sport exercises
Sports massage.

It is useful to wear the bandage and groin support while doing the exercise to protect the muscles while healing.

Prognosis

The healing, depending on the level of injury takes:

a week maximum for the mild injures, with proper treatment and rest
2-3 weeks for 2nd degree
2 months or more for the 3rd degree injuries. ⁽⁶⁾

References

2009. [Cited: 3 19, 2017.] http://www.coreperformance.com/knowledge/injury-pain/groin-strain.html.
Groin Strain. Sports Injury Clinic. [Online] [Cited: 3 19, 2017.] http://www.sportsinjuryclinic.net/sport-injuries/hip-groin-pain/groin-strain.
J, Miller. Groin Strain. Physioworks. [Online] [Cited: 3 19, 2017.] http://physioworks.com.au/injuries-conditions-1/groin-strain.
Groin strain. Physio-pedia. [Online] [Cited: 3 19, 2017.] http://www.physio-pedia.com/Groin_strain.
Groin pull. WebMED. [Online] [Cited: 3 19, 2017.] http://www.webmd.com/fitness-exercise/groin-pull#1.
The Treatment of Inguinal Pain. Richardson WS, Jones DG, Winters JC, McQueen MA. 2009, The Ochsner Journal.9(1), pp. 11-3.
J., Lewis. The Complete Guide to Groin Strains. Core Performance. [Online]