I always feel a little sick to my stomach when one of my kids texts me from their various sporting activities and it says, “Mom, I hurt my (fill in the blank)”. In my profession, I have seen some crazy injuries over the years and unfortunately, I am a worry wart by nature. Bad combo! So earlier this week, I got a text from Bailey towards the end of the competitive cheer practice, “Mom, I hurt my leg” and, of course, my mind went to the worst case scenario like ACL tear or fracture. When I asked what happened she replied, “I don’t know. I was doing jumps and then I pulled something where my thigh meets my pubic bone.” Of course she didn’t say “pubic bone”, so after I laughed out loud, I sighed in relief that it sounded like a groin strain and nothing more.
Muscle strains are the number one injury in athletes, accounting for up to 31% of doctor visits. A groin strain, which is a strain to the adductor muscle group, is common, especially among soccer and hockey players. Other sports where we might see them include football, basketball, tennis, figure skating, baseball, horseback riding, karate, softball, and yes, cheerleading. Suddenly accelerating while sprinting is the most common cause of a groin strain, but sudden changes in direction while running also put exaggerated strain on the tendon. Finally, jumping and overstretching the adductor tendon is less common, but can occur as well, as was the case with Bailey.
The adductor muscle complex includes three adductor muscles: longus, magnus, and brevis. When the leg is off the ground, the adductors bring the leg towards midline. They also have secondary roles in flexion, extension, and rotation. When the foot is planted, the adductors help stabilize the pelvis and leg during the stance phase of gait. Three other muscles assist with adduction, including the gracilis, obturator externus, and pectineus.
Most adductor tendon strains occur while the muscle is being forcibly stretched while trying to contract and shorten. This is called eccentric tension. The greatest eccentric tension is placed on the groin when the leg is externally rotated and abducted, as when an athlete pushes off in the opposite direction. The adductor longus is the most commonly injured of the adductor muscles, as it adducts and internally rotates the leg. It accounts for 62-90% of all groin strain cases. The adductor longus also has a low tendon to muscle ratio at its origin on the pubic ramus, which increases the likelihood of injury. Most injuries occur at the musculotendinous junction, although strains can occur anywhere along the muscle. The adductor tendons have a small insertion zone with a poor blood, yet rich nerve supply, making the perceived pain greater with these injuries.
Most people who sustain a groin injury will describe a sudden onset of pain as opposed to a more gradual one. The pain is often severe and in the groin or medial thigh. Activity increases the pain. There may be bruising or swelling in moderate to severe strains. Typically, there is localized tenderness and pain with resisted hip adduction or passive stretching. Strength may be decreased depending on the severity of the injury. Acute injuries can take days or weeks to recover, whereas chronic strains may take many months. Bailey had no bruising or swelling and felt fine the next day, indicating a very mild strain.
As you would expect, there is an increased risk of groin strain if a person has injured the groin or the hip before. Other risk factors include age, weak adductors, muscle fatigue, and inadequate flexibility of the adductor muscles. Biomechanical issues such as increased pronation of the foot/ankle or issues at the pelvis can also contribute. We all know where to find the best prehab out there for the hip and pelvis…LYT Daily! 🙂 Maintaining proper mechanics, strength, and flexibility are key components to avoiding injury. In fact, click the link below for Lara’s class called “The Groin Dilemma”, where she helps you strengthen and mobilize this area to keep it more supple!
Until then, I’ll see you on the mat!