Groin: Injury Overview of Pulls, Strains & Tears

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Groin pull, a groin strain, a groin tear, or just general pain in the groin area is very common among regular people, runners and all types athletes. Active runners, the occasional runner and weekend basketball player will eventually feel pain in the groin area when they do their routines. Since the groin is such a focal point of the body during athletic endeavors, it is a matter of time before you either pull, strain or possibly tear this muscle.

Groin injuries are like most athletic injuries  – added stress is placed on the muscle (or stretched too far) which forces the body to go into protection mode. According to researchers at Louisiana State University, groin injuries make up 2 to 5 percent of all sports related injuries.

Hopefully a better understanding of the issues surrounding the groin will help mitigate injuries that will inevitably take place the longer you run or work out.

Groin pulls make around 10% of all injuries in professional hockey players, but all athletes who play intense sports are at risk of developing some kind of groin injury.  Generally, groin pain is associated with some kind of an over-stretch of the muscles, but can also appear in cases of a hernia, intestinal or bladder disorders, nerve conditions, kidney infections, respiratory system, and kidney stones, appendicitis or pelvic disorder, menstruation, and sexually transmitted diseases.

 

Groin Pain Definition

A groin strain, pull or tear is a mechanic injury to the muscle fibers of one or more of the adductor muscles. Groin pulls often to be sports related injuries. However they are also common for those doing strenuous lifting in a professional setting.

There are five adductor muscles in the groin area which help in pulling the legs inward, towards the middle, a movement also called adduction. A further role of the groin muscles is to stabilize the legs and pelvis when performing physical activity.  

Overall, issues with groin pulls arise when there are strains or injury from the inner pelvis to the inner thigh bone region (femur).

Three short muscles:

  • adductor pectineus (located in the upper front area of the pubic bone; often used when performing a kicking movement).
  • adductor brevis (located in the thigh; often used when swimming).
  • adductor longus (most commonly injured; located in the thigh and connected to the hip; used to rotate the thigh).

Two long muscles:

  • adductor gracialis (flat and thin muscle located on medial side of the thigh; used to flex and rotate parts of the hip).
  • adductor magnus (originates in the pelvis area; generates muscle use in the thighs; can be irritated when legs are spread to far apart).

 

groin-injury-groin-pull-groin-tear-groin-anatomy

Symptoms

Since the adductor muscles are so commonly used for runners, swimmers, soccer players and generally active people, there will be aches and pains in the groin area during and after workouts. The key is to understand if the groin is just showing the effects of engagement or if there is a strain or pull or even worse, a tear. Runners in particular need to be aware and completely understand the symptoms of groin injuries.

Since groin injuries are usually sports related, the following symptoms might appear for those who are no in proper physical condition, have preexisting injuries in the area, and those not properly stretched or warmed up.

Signs and symptoms of groin injury include:

  • Sudden sharp pain and discomfort in the groin area, sometimes even in the belly or pelvic area. This pain will often force someone to stop running or participating in an athletic event. The area will all of a sudden become to tender to the touch.
  • Pain and discomfort when moving the legs in certain directions (especially a scissors or kicking movement). This will often be the case for soccer players, swimmers or runners. It might also be triggered for runners who break into a sudden sprint. Pain when raising the knee to hip level. Also there is pain when you bring the knees together.
  • Severe pain after a snapping or popping event during the injury. Often runners will feel pain in the groin area, but when the severe pain arises, it will cause immediate concern.
  • Groin inflammation, swelling, bruising, and edema accumulation. Perhaps you can work through the pain during a run, but these symptoms will appear later in the day.

Severity degrees

  • 1st degree indicates mild pain and little loss of strength or movement. Here is when an athlete complains of a tight groin. Less than 25% of the muscle fibers are damaged. In this minor case, the patient experiences discomfort when walking or running. Pain is experienced when the patient over-works or stretches the injured muscles which feel stiff and tender to the touch. Usually, the patient is unable to recall the exact moment of injury and every-day activity is not impaired.If you are an athlete and experience a groin injury, this is the best scenario you can hope for. It will be the shortest time off the track or field.
  • 2nd degree indicates moderate pain, mild to moderate strength loss, and some tissue damage. The tissue damage is between 25% to 90% of the muscle fibers. In this mild to severe injury case, the patient experiences both pain and discomfort whenever the injured muscles are used and daily activities may be impaired. This will limit the functionality of the leg. The patient may or may not be able to recall the exact moment of injury and the muscles may become bruised, weakened, and inflamed.In some cases of a 2nd degree injury, there will be swelling and discoloration in the groin and inner thigh areas.
  • 3rd degree indicates severe pain, severe loss of strength and function due to a partial (+90%) or a complete tear (100%) of the muscle. Due to the severe nature of the injury (it is a rupture of the muscle), the patient will almost always be able to recall the exact moment of the injury. Acute and even debilitating pain is present even when resting. The injured area will present some kind of deformity – bruising, swelling, and even gaps or lumps due to the severity of the tear. Being the most severe groin injury and one that requires medical attention and rehabilitation, this will take you away from sports and workouts for a considerable period of time.

To put these different groin injury degrees into perspective, look at a couple of recent Major League baseball players. In 2016, Miami Marlins superstar Giancarlo Stanton missed most of the 2016 season because of a 3rd degree groin injury. However, in 2017, Joc Pederson of the Los Angeles Dodgers needed only a stint on the 10-day disabled list to heal his 1st degree strain. Both outfielders injured their groins while running on the base paths.

Risk factors

Common risk factors include:

  • weightlifting or lifting heavy objects in general
  • running, sprinting, jumping, making quick cuts
  • playing sports such as football, basketball, soccer, rugby, hockey, ice skating, roller bladding, skateboarding, horse riding, beach volleyball, karate etc.
  • performing a sport such as skiing where quick falls are possible
  • increase athletic workload too quickly
  • dancers who use “snapping hips” in their movements
  • old age and decreased flexibility
  • muscular imbalances
  • not warming up
  • past injury to the groin area
  • past injury to the hip or pelvis
  • running on uneven ground or pavement that may cause slipping

Hemolytic-Anemia-from-Footstrikes-risk-factors-running-surfac

Complications

The overuse or overstrain of the groin muscles may cause adductor tendinopathy or chronic inflammation, both of which are long-term injuries, much harder to treat. Other complications may arrive from not regulating activity after a groin injury. Ask your doctor about planning a customized guided behavioral program for you to follow throughout the rehabilitation phase.

  • Gilmore groin, athletic pubalgia, groin disruption or misnomered as a hernia or a hockey hernia is a condition in which the pubic joint is affected and the inguinal canal ring is dilated because of certain lesions.  Symptoms include pain during movements, particularly hip extension, twisting, turning, coughing, sneezing, everything that increases the intra-abdominal pressure. Pain and discomfort might radiate towards the adductor muscle and testicles, often difficult to pinpoint. This falls under the general area of sports hernia injuries. 
  • Adductor tendinitis is an inflammation of the tendons in the adductor muscles which affects the pelvis and legs.  Symptoms include groin pain, especially upon touch, leg and pelvis movement, muscle stiffness, and muscle weakness. Pain and discomfort might be acute or moderate with visible inflammation and lumps.
  • Osteitis pubis is a condition refers to a noninfectious inflammation of the midline cartilaginous joint called pubis symphysis, pubic symphysis, symphysis pubis, or symphysis pubica.  Symptoms include various degrees of abdominal and pelvic pain, stiffness in the groin region, tenderness, and muscular weakness. This will cause in walking and even more so in running.

 

Muscle-Strain-hamstring-curl

Prevention

  • Warming up is very important and will safely reduce all-cause injury risk. It will also increase athletic performance. Make sure you warm up for at least 15 minutes before attempting strenuous physical activity. It’s recommended you do a dynamic stretching before sports and static stretching after physical activity. Dynamic stretching consists of light cardio, compound movements that will lubricate your joints, increase your body temperature, prepare your organs, and get’s you in the right mindset. Some doctors attribute the amount of groin injuries to people not addressing the area during warmups. Many runners will stretch the back, thighs and quads but bypass the groin. One of the reasons for people skipping over the groin stretches deal with the lack of interest in getting on the ground during warmups. Doing a lap around the field or track does not mean you warmed up properly.Warming up properly and stretching is important for older athletes as the muscles get stiffer, still it is very important for young ones as well. Younger athletes need to keep their muscles healthy and not prone to injuries as the years roll on. Very likely, if you sustain a groin injury, it will be an issue for the rest of your active years.
  • Stretches to focus on include ones that work the hip adductor. Specifically seated butterfly stretches and lunges.
    Seated butterfly stretch                                              LungeWith these stretches, the key is to reach the point of slight discomfort which means the muscle is being elongated. Due these stretches for at least 30 seconds and do multiple sets of repetition.The general adductor stretch is also a common groin stretch. Here the key is to stretch one leg out to the side, the other leg is then kept under your core. The leg that is outstretched must have a straight knee which brings the stretch feeling into the inner thigh.

Adductor stretch

Another important seating stretch is the cross legged stretch. For this, cross one leg over the other while sitting down. Bring your knee as close as
possible to your midsection. This will help open up the the thigh and hip.


Cross legged stretch

  • Cooling down is equally important and productive. After a training session, you should cool down with low-intensity exercises. Think about your blood vessels within your muscles as highways, the more traffic, the more blood replenishes the area. Don’t just stop with a workout and sit down. The same with ice, it can sometimes hurt the muscle recovery since it restricts blood flow.
  • Adequate footwear is also very important. Try to aim for a low heel-to-toe drop shoe or barefoot sneakers. These types of shoe are excellent for running, weightlifting, plyometrics, and much more. Barefoot shoes are characterized by a very low or zero drop from heel to toe, meaning they’ll act like protective “socks” with minimal cushioning, giving you a better ground feel and improved muscles and bones. Minimalist shoes are in-between traditional shoes and barefoot shoes, with a minimum heel height of circa 4–8 mm. Wear shoes that are designed for the specific activity you wish to undertake. There aren’t universal shoes, so select adequate footwear to decrease injury chances. Arch support will also give the feet better support and strength to all the muscles above. As a runner, it all starts from the bottom up.
  • Muscular imbalances generally appear because of a lacking comprehensive training program which seeks to work out the entire body. Groin injuries and tears may result from weakness elsewhere. If certain muscles are under or over developed, they may negatively influence other muscle groups, resulting in injury. So, always train every muscle group in your body in as many ways as possible to make sure the stress is equally distributed. Think about your daily activities you undertake and the muscles you overlook and train them accordingly. For example, very strong abdominals and weak groin muscles can result in a pelvis or groin injury. A certified professional sports trainer may prove helpful here as he might assess your training style and guide you towards improvement. Think about the same with general cardio activity. Make sure you are in proper cardio shape before over exerting yourself in a work out, surplus-holiday-calories-salad-fresh-food-diet
  • Diet and lifestyle contribute a lot to your general health. To have strong, flexible, and resistant muscles, reduce rehabilitation time, and most importantly, to decrease chances of re-injury, a plant-based diet is strongly advised. Better yet, a strict vegan diet is way better because you’ll keep inflammation to an absolute minimum, you’ll fuel your body with readily usable nutrients, and you’ll reduce all-cause mortality risks. A plant-based diet will also help you reach an ideal body weight. All of which will provide tangible improvements. On top of a plant-based diet, you’ll a proper sleep pattern and adequate hydration. Alongside a reduction of harmful vices such as smoking, drinking etc. You should also monitor your micro and macro nutrients to see if you’re meeting your needs.

Carbohydrates:

  • Fruits -especially citrus (oranges, lemons, limes, etc.)
  • Vegetables such as winter squash, sweet potatoes, whole corn, watercress, bok choy, okra, broccoli
  • Whole grains such as rice, buckwheat, whole wheat pasta, barley, bread

Proteins:

  • Veggies
  • Hemp and pumpkin seeds
  • Non-Dairy Milk (soy milk, almond, rice etc.)
  • Whey
  • Nut Butter
  • Quinoa
  • Tofu
  • Lentils
  • Beans
  • Tempeh
  • Sprouted-grain bread
  • Potato (baked is best way to serve)

Fats:

  • Nuts and seeds
  • Lowfat milk
  • Flaxseed
  • Vegetable oils
  • Avocado
  • Fake meats
  • Peanut, almond, and cashew butter
  • Coconut oil

Calcium
Men and premenopausal women should consume at least 1000 mg of calcium. Postmenopausal women should consume 1200 mg of calcium. Don’t take more than 2000mg of calcium a day, in total.

Vitamin D
Men and women should consume between 600 and 800 international units (IU) of vitamin D per day. Don’t take more than 800 IU of vitamin D a day as high doses can be toxic, especially after proceed periods of time.

B12 is especially important on both a vegan and non-vegan diet because it’s produced by certain bacteria and might lack in our modern foods.  So monitor your intake and eat B12-fortified foods.

B12 in micrograms (μg)
Age RDA                                  (μg)
0-6 months…………………..0.4
7-12 months…………………0.5
1-3 years………………………0.9
4-8 years………………………1.2
9-13 years…………………….1.8
14+ years……………………..2.4
pregnant women………….2.6
lactating women………….2.8

  • Sleep is also very important for your body to heal, so aim for 7-9 hours of sleep.
  • Adequate hydration is also very important because the majority of the body’s processes need water. For proper hydration, remember the 8×8 rule: drink 8 servings of 8 ounces of water a day (a total of 2L of water a day). Drinking more water during the day will not only provide your body will the healthy aspects of water, it will also limit your intake of sodas and processed drinks (teas, fruit punches). Sure there are positive aspects of sports drinks, but most likely, your body will be best served by another glass of straight water.
  • Sunlight Get at least 1 hour of sunlight, every day. Continue maintaining a physically active lifestyle to encourage calcium synthesis in the body. Exposure to sunlight also makes it more likely for you to stay active. Groin injuries can result from a lack of regular exercise.

Diagnosis

Louisiana State researchers state that diagnoses in groin injuries remain unclear in approximately 30 percent of cases since people can feel  strains and pains in other nearby areas of the body (core, hips, pelvis, upper thighs). These researchers concluded that “groin pain in athletes is complex and can be difficult to evaluate even by experienced physicians.”

Still, if you feel more than just some slight tenderness or tightness in the groin area, you will need to see a medical professional.

Firstly, the doctor will perform a number of physical exams to assess the type and severity of the injury. Recurrent or long-standing groin injuries are more difficult to assess and treat, requiring further imaging investigation such as X-rays and MRI scans.  A licensed doctor or professional therapist will perform some resistance physical examinations.

 

 

  • Range of motion physical exam is a test in which the hip joint is inspected and the suspected injured muscles are stretched in hopes of reproducing the symptoms to analyze them in relation to certain movements and stretches. This will provide information about the injury and help set a correct diagnosis. The test includes moving the legs out to the sides, commonly known as an abduction which stretches the groin muscles and assesses the level of flexibility. This exam will also help doctors determine if the injury is in the core, a sports hernia, hip or thigh. No matter where the injury is located, it will be painful but the doctor needs to identify the source area to determine rehabilitation methods.
  • Resisted muscle tests involve adding resistance to certain movements in hopes of reproducing the symptoms. This gives vital feedback to the doctor in assessing the injury regarding the strength, flexibility, and range of motion of the muscle, needed for a correct diagnosis.  Apart from a standard physical exam, a more thorough imaging investigation may be needed for a correct diagnosis.
  • X-rays: An electromagnetic wave of high energy and very short wavelength passes through different tissues and forms a photographic or digital image of the internal composition of the examined body part.
  • CT scan: A Computed Tomography or Computer Assisted Tomography combines many X-ray images from different angles to form a cross-sectional (tomographic) image, allowing the viewer to see inside the object. This diagnostic tool is used when a 3rd degree injury or tear is suspected.
  • Magnetic resonance imaging (MRI): An MRI is an imaging technique which uses radio waves, strong magnetic fields, and field gradients to create detailed anatomic pictures. The procedure can pinpoint blood clots with high accuracy. As with a CT scan, this used when there are concerns of a groin tear.

 

Treatment

Infections, illnesses, and disorders may be treated with antibiotics and other drugs, whereas strains or mechanical injuries to the groin area may be treated with (P.)R.I.C.E. method and conservative treatment. Severe cases may require reconstructive surgery.

P.R.I.C.E.

resting-face-up-groin-injury

Protection means keeping the groin area free from further stress and damage. This means the patient has to keep the physical activity low, and if necessary, use helpful orthopedic devices such as crutches, mobility aids walkers, casts, canes, and such.

Rest means you’ll refrain from sports or intense physical activity for at least a couple of days after the injury. Sometimes, several weeks are needed for a complete rehabilitation, and most severe cases may require several months.

Crutches can be used to alleviate the weight used below the mid section. Crutches will also help those with severe groin injuries to be more ambulatory than they otherwise would be because of the pain.

Ice decreases inflammation and relieves symptoms. Apply ice in the area (usually in the inner thigh) for 20 to 30 minutes every couple of hours. Wrap the ice in a towel or similar to avoid ice burns.

ice-for-groin-injury-groin-pull

Compression means the patient must apply uniform pressure around the groin, tight, and/or pelvic area using an elastic bandage, tape, strapping, or similar. whatever gives the best results in relieving some of the pain, discomfort, and swellings. Always allow adequate blood flow! Compression or bike shorts can help the process but there also needs to be compression bandages.

The best recommendation for most people would be a 7 to 10 cm (3 to 4 inches) elastic or elastic cohesive tape, followed by a 2,5 cm (1 inch) nonstretch zinc oxide band to top it off and keep everything in place. The band encircles around the tight, covering the injury area, and wraps around the waist, slightly over the opposite hip to support the upper part of the leg by creating a tension.

Many retailers now offer groin or hip wraps. These neoprene wraps are adjustable and can provide greater compression and support to people of all sizes. The key is to find one you feel is the most lightweight and won’t interfere with your clothing. Most will wick away moisture and also support the thighs and quads. Don’t spend more than $30 for a compression wrap.

Once you are back to action, you can use these during workouts.

Hot tubs or whirlpools will help bring some heat and stimulation to the injured area. Sitting in a hot tub will also help increase blood circulation to the groin. After experiencing the heat of the hot tub and stepping out of it, some very light stretching can be performed. Some light tissue massage will also help with the healing process.

Elevation may be somewhat meaningless in the case of a groin injury, keeping in mind the particular nature of this injury location. Nonetheless, pain, swelling, and discomfort can be relieved by laying in bed or in a similar horizontal position facing up, so that the groin area is relieved from the bodyweight.

Chiropractors can help with the healing process of a groin injury. They can conduct adjustments to the back, hips and legs to increase the synchronicity of movements. After the initial adjustments are made, a weekly visit can help you get back to regular activity. Make sure you find a chiropractor you feel most comfortable with in terms of his or her vision for your continued health.

 

Sports massage

Sports massage can help in treating the injury by stimulating blood flow and flushing away waste products. It’s recommended you ask your doctor about such messages as it ca be contra-productive if done too early or incorrectly. Allow a minimum of 48 hours after the injury before attempting to massage the area. Severe groin injuries may require more than a week before sports massage.

Some sort of a lubricant is needed. It can be a medicine, like a heat rub gel or such, or just an organic oil like olive oil. Vaseline or baby oil are also valid alternatives. The patient must lie on a flat, hard surface in order to apply the needed pressure. Furthermore, use just enough lubricant to ensure a controlled, stable movement of the hands. Proceed to apply pressure while sliding the hands on the muscles to relieve tension. Worm your way towards the affected area and see how it feels. Use the pain as a guide and keep it in a tolerable threshold.

1. Effleurage technique: The athlete will lay on his back with his knee bent and facing outward with his tight on display. The Effleurage technique is meant to warm up the area. Start by stroking lightly but firmly the tight area all around towards the heart because that’s the direction of the blood flow. Stroking the other way poses the risk of vein damage, so avoid putting pressure on the way down. So, up and down strokes, putting pressure when going up and releasing pressure when going down the tight. Aim for 5-10 minutes while gradually increasing the pressure on the upwards strokes.

2. Petrissage technique: This technique involves a sort of kneading movement in which a hand lightly pulls half of a muscle and the other hand pushes the other half of the same muscle. Do this for a couple of times a muscle then switch hands on the same muscle and repeat the kneading movement. Perform the Petrissage technique for around 5 minutes. In between muscles you can apply the Effleurage technique a couple of times on the whole tight to avoid cramping and excess stimulation.

3. Stripping technique: This technique is a deep tissue massage method in which the thumb presses on the full length of the muscle while applying deep sustained pressure. Apply a slow, deep, upward pressure on the muscle while trying to “feel” the muscle fibers. Repeat the technique 3 to 5 times per muscle and alternate with the other two aforementioned techniques in-between. The stripping technique is to be done for no more than 10 minutes. Some people, especially those with a higher degree of injury, may find this technique to be painful.

4. Circular frictions technique: If there are any lumps, bumps, and similar scar tissue left in the injury area, usually at the point of strain or rupture, then circular friction motions are to be applied directly to the sore spot to help the natural remodeling process. Don’t over do it, avoid pain and extreme discomfort. Avoid this last technique if you’re unsure of your injury.  Finish off with the Effleurage technique and then “shake” up your tight to help dissipate the inner fluids for a couple of minutes. Massage therapy can be done every day or every other day in cases of post-massage soreness caused by the deeper techniques.

Surgery

Acute or chronic groin tears and injuries may not heal correctly with non-invasive treatment, in which case, surgery is needed. A lengthy period will be needed after surgery to restore range of motion and strength but it might be the best treatment in some particular circumstances. While groin surgeries are not that common, when conducted they can be done either with open and laparoscopic techniques. The open technique will have the doctor implant a mesh into the damaged muscle area. This will help heal and bring the muscles back together.

By no means is the mesh a fool proof way to heal a groin injury as there are many patient cases where it has broken away.

Alternative therapy

  • Ultrasound and shockwave therapies:  Ultrasound therapy penetrates the tissues and transmits heat deep into the tissues, increasing local metabolism, blood circulation, and enhancing the flexibility of connective tissues. It also accelerates tissue regeneration, potentially reducing pain and stiffness.  Shockwave therapy transmits low-frequency vibrations (10, 50, 100, or 250 Hz) into the tissues, causing oscillatory pressure to decrease pain.
  • Transcutaneous electrical nerve stimulation (TENS): In this therapy, an electrical current stimulates the muscles, and it’s generally believed to trigger the release of endorphins which are the body’s natural painkillers. It also reduces muscle spasms.
  • Cryotherapy: A local or general use of low temperatures which are proven to be effective against benign and malignant tissue damage, also known as lesions.
  • Acupuncture and acupressure: Use eastern healing techniques to focus on what is causing interruptions within the body’s energy flow.  Acupuncture uses small pinpointed needles to address the energy flow. Acupressure uses the same idea but a therapist uses his or her body to apply pressure and no needles are present.

Medication

drugs-groin-injury-medication

Growth Hormone (GH):  also known as somatotropin or as human growth hormone, is a peptide hormone that stimulates tissue growth, cell reproduction and regeneration in humans and other animals. Studies with lab rats have shown that GH can significantly aid in reconstruction and tensile strengthening of bones. Ask your doctor about GH therapy and consider running a short cycle while and after recuperation.

S.A.R.M: Selective androgen receptor modulators (SARMs), also known as partial androgens, are a novel class of androgen receptor ligands. The terminology is currently used for similar molecules targeting the estrogen receptor, such as tamoxifen. SARM drugs are designed to simulate the effects of androgenic substances such as anabolic steroids but without certain unwanted side effects such as virilization or any kind of influence on the testes, liver, prostate, cholesterol levels etc. Their use is more targeted than that of steroids which may prove a valid alternative for your situation. Ask your doctor about them.

For men with normal levels of testosterone and testicular function but in need of a therapy for bone related issues such as osteopenia or osteoporosis, SARMs is a better alternative to most steroids or hormone replacement therapies: in this case, SARMs molecules are effectively targeting bone and muscle tissue but with less influence on the testes or prostate.

For women, SARMs molecules are a better alternative to standard steroids and growth factors, as SARMs successfully repairs bone and muscle tissue without undesirable side-effects such as virilization (development of male characteristics), increased cholesterol, liver dysfunction etc.

TB-500: is a peptide drug with strong anti-inflammatory proprieties which regulates the cell-building protein called Actin. This synthetic molecule contains a fraction of the human protein called thymosin beta-4 of 43 amino acids and encoded by the TMSB4X gene. The drug contributes to tissue regeneration of muscles, heart, skin, cornea, and drastically lowers inflammation. Due to its very low molecular weight, it can be injected anywhere, both subcutaneously, intramuscularly, and intravenously because it doesn’t bind to the extracellular matrix.

Anti-inflammatory drugs (NSAIDs):  Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs) seem to be the best choice for temporary symptom relief such as:

Spondylolisthesis-medication-treatment-nsaid-ibuprofen-naproxen

Ibuprofen: This medication should be taken after a fiber-rich meal as to avoid rare side-effects such as gastrointestinal bleeding. Also, carefully inspect the package insert and refrain if you’re suffering from asthma or conditions to the heart, kidney or liver. Also sold as Nurofen, Advil, Brufen, Motrin etc.

Naproxen: This medication should also be taken after a fiber-rich meal as to reduce the rare side-effects of stomach ulcers. A proton-pump inhibitor drug is prescribed alongside Naproxen for patients with past health conditions that could put them at risk. Inspect the package insert carefully and avoid if you had a duodenal ulcer, gastric ulcer or similar conditions. Also sold as Naprelan, Aleve, Naprosyn, Anaprox etc.

Methyl salicylate-based analgesic heat rub gels: aka. oil of wintergreen or wintergreen oil is organic ester which is naturally produced by many species of plants, particularly wintergreens. It’s usually synthetically produced and the gel is intended for topic use. It’s toxic when ingested. Carefully read the package insert and apply a moderate quantity. Other names include salicylic acid methyl ester, Betula oil or methyl 2-hydroxybenzoate.

Selective COX-2 inhibitors:  are a type of non-steroidal anti-inflammatory drug (NSAID) that directly targets cyclooxygenase-2 enzyme responsible for inflammation and pain. It also reduces the risk of peptic ulceration. The medicine has the generic name of Celecoxib. Carefully read the package insert as the drugs present an increased risk for patients with heart problems or under treatment for cancer!

Muscle relaxants: More precisely, spasmolytics which are also centrally-acting acting muscle relaxants can be used to alleviate musculoskeletal pain and spasticity by decreasing the muscle tone. Carefully read the package insert as overdosing is a serious problem which might lead to heart failure and paralysis! Always check with your doctor before considering them. Brand names include Lioresal, Amrix, Flexeril, Dantrium, Dantrium IV, Valium etc.

Narcotic painkillers (can cause severe addiction!):  Consider administering painkillers only in extreme cases wherever the pain is acute and debilitating. These drugs should only be used if the pain is just too much to handle, as these drugs are extremely powerful and addictive! This should be one of the last options to treat a groin injury based on the risk of addiction.

Physical therapy

Patellar-tendinitis-check-up-physical-therapy

The patient can return to the level of activity before the injury only when he’s asymptomatic and has regained full strength, mobility, and flexibility. Both legs should feel equally strong. Pain and discomfort must be absent when walking, jogging, running, jumping, and even sprinting. The ability to return back to fill action could be as soon as two weeks or as long as months. Since the groin is such a tender area, you must be in full health before working the muscles at their full capacity.

Stretching and strengthening: After the injury has healed, stretching and muscle strengthening are necessary to both fully heal the injury and avoid future relapse. You can train almost immediately after treatment is done in cases of a light groin pull. A severe groin injury may require additional resting time after conservative or invasive treatment is done. Generally, you should wait 1 week after the injury before attempting a training regiment.

Always remember the 10% rule:
Do not increase the intensity, frequency, or duration of your training routine more than 10 percent each week post-injury.

So, you’ll be increasing your physical activity each week by no more than 10%. Meaning you’re going to gradually increase both work volume and intensity as to avoid re-injury and give your body enough time to adjust itself to increasing sports activity. For example, if you ran 1km last week, you’ll run 1,1km this current week, and the next one you’ll run a little bit more, and so on. Also, it would be wise to avoid hard plyometrics, high-impact cardio, or heavy weight training in the first few weeks. Try to switch to swimming, shadowboxing, static bike, light weightlifting, and other low-impact activities.

Stretching exercises: After a minimum of 72 hours after injury, start with static stretching sessions and avoid pain. Gradually progress to dynamic stretching sessions and then to more sports specific stretching. Focus on all muscle groups and don’t overlook the short and long adductor muscles.

Short adductor stretch

Baddha-konasana-butterfly-position-for-groin-injury-strech

Assume the baddha konasana or butterfly position on the floor while grabbing your ankles with opposite hands. Your soles should be touching. Gently push your knees with your elbows and bend forward just a bit. Hold the inner tight stretch for a couple of seconds and avoid pain. Do a couple of sets each day for two or three times a day.

Long adductor stretch  Sit on your buttocks as you would attempt a straddle split or side split and bend forward with your torso while extending your hands forward to the ground. This stretch can also me attempted while standing up to target the inner adductor muscles. Let pain be your guide and stop when experiencing it. Hold for a couple of seconds and do a couple sets each day.

Hip flexors stretch This stretch requires you to assume the lunge position. Assume a wide stance with your front leg firmly planted forming a 90-degree angle and then push the opposite knee downward. Hold for a couple of seconds per repetition and change sides. Do a couple of sets a day to get a good stretch and blood flow.

Foam rolling

groin-injury-foam-roll-stretch

This particular adductor stretch requires a foam roll. You can purchase one or make one yourself by improvising a fairly large pipe from PVC or similar and wrap it with some soft cushioning. By rolling your groin area on top of the foam roll you’ll be able to deep tissue massage (self-myofascial release) while perfectly controlling the amount of applied force. Start by laying face down on the floor and place the foam roll on your tight almost perpendicularly. While sustaining your weight with your hands and opposite knee, as if you’d attempt a push-up, slide your tight up and down the foam roll and hold the points of tension for a couple of seconds.

Dynamic stretching This type of stretching involves repetitive complex movements that will lubricate the joint, stimulate blood flow, increase your heart rate, and work the muscles. Dynamic stretching should only be performed when static stretching doesn’t cause pain or discomfort and before sports or strenuous activity. Aim for 15 minutes of drills, light upper and lower body cardio, and so on. Grapevines before and after a run will help with the core and groin.

Strengthening exercises (isometric, compound, sports)  Start with isometric exercises, gradually progress towards compound weight lifting exercises, and then towards sports and plyometrics. Start by using just your bodyweight and then slowly progress to resistance bands, weights, and similar. Make sure your injured muscles can handle the training to avoid re-injury. Make kettle bells part of your work out routine. Kettle bells range in weight so it is easy for anybody to find the best one for them. In particular kettle bell swings and dead lifts can help strengthen the groin.

Isometric or static exercises Such exercises allow muscle contraction without elongation. These types of exercises are the safest and are done to stimulate muscle growth and hormonal release after a period of inactivity and probably some muscle atrophy. Focus on the squeeze, establish a mind-muscle connection and twitch every fiber in the muscle groups. You can also alternate the intensity in sets. Many gyms now offer workout classes that provide isometric training. If you can, take advantage of any instructor who provides guidance with isometrics.  Pilates are also a successful way to work the groin, hip, thigh and quad muscles.

For the adductors, place a medicinal ball between the ankles and squeeze while lying on your back. Also, for the short adductors place the ball between the knees and squeeze. For the abductors, the same principle must be applied, search for an immovable object and proceed to push it away laterally by using you the bottom of your outer foot. Also, for the short abductors, push with your outer part of the knee.

Advanced isometrics

Straight leg raise By pushing your leg straight against resistance, the quadriceps muscles are worked, mainly. The abdominals and both adductor and abductors muscle groups will help stabilize this movement. Some variations may apply to this exercise but it’s advised you start with the just the force of gravity by lying on the floor, face up, and lifting the leg towards the ceiling, then alternating leg. Doing a couple of dozen reps for each leg will help prepare the muscles for harder exercises.

Hip extension exercises By pushing the leg backward against resistance, the hamstrings, glutes, and some back muscles are being worked. There are many variations of this exercises but it’s recommended that you gradually increase the difficulty of this exercise by first using only your bodyweight. Lie flat on your stomach and raise your heel towards the ceiling as much as possible, contracting the muscles. Do a couple of dozen repetition per leg until you feel the burn and then alternate leg. Variations include elastic bands, machinery, even free weights, both vertically and horizontally, proceed with caution towards the next variations.

Hip adduction

hip-adduction-for-groin-injury

By pushing your leg inward, towards your other leg, the groin muscles are being worked. Variations include machinery that allows you to squeeze your legs together while sitting, elastic bands or weight cables. Although the aforementioned are safe if used with moderate resistance, it’s recommended you start with just your bodyweight.

Lie sideways on the ground. Cross your legs by putting the top one over the bottom leg, in such a manner that the top leg is resting on the floor just in front of the other leg’s knee. Proceed to raise the bottom leg, the one you’re lying on, towards the ceiling as high as you can, while sitting on your side glutes and pelvis. Keep the bottom leg straight, do a couple of repetition until you feel some muscle fatigue and then switch legs. If you can handle the body weight variant without any pain, then proceed to other variations including devices or free weights.

Hip abduction

hip-abduction-for-groin-injury

By pushing your leg laterally against resistance, the abductor muscles are being worked. Variations of this exercise include using bands, machinery or free weights but for the sake of safety, bodyweight is recommended in the beginning of the rehabilitation phase.

Lie on your side comfortably and lift your leg towards the ceiling as high as you can and then slowly bring it back on top of the other one which is naturally sitting on the floor to maintain balance. Perform a couple of reps for each leg and then alternate legs.

Hip thrusts on bench

hip-thrust-for-groin-injury-strengthening

By thrusting the hip towards the ceiling, hamstrings, glutes, and nearly all frontal groin muscles are being worked. Variations include different positioning, weight positioning, devices, and machinery but the safest way is to execute the movement on a bench and using only the body weight.

Rest your upper back on a bench, perpendicularly. Firmly plant your feet on the ground and aim for a 90-degree knee angle. Lower your lower torso area and get close to the ground, then thrust yourself upward in the bridge position while resting on the bench. Execute a couple of reps for each set. Do a couple a day when you feel you’re almost healed.

Plyometrics and sports

plyometrics-sports-for-groin-injury

Such dynamic exercises should be performed only if the recuperation is complete and if the injured muscles are good as new because these functional exercises can put you at risk. High-impact and high-intensity drills should never provoke pain or discomfort, maintain a conscious mindset and pay attention to your body as it guides you through the levels of training. Before getting back into competitive sports or extreme sports and such, be sure to focus on lateral movement drills, balance drills etc. If you’re going to get back into weightlifting, pay attention to the linear progression, give your body enough time to adapt.

Swimming, tennis or basketball might seem like good ways to workout once you get a little older but they can easily aggravate your groin. Don’t think you can do these sports without proper preparation.

Conclusion

Groin injuries are very common due to their anatomic position. Upon injury realization, stop all activity, assess the severity of the injury and go to the ER, call an ambulance or set an appointment with your doctor, by case. In the meantime, deploy the P.R.I.C.E. first aid guide and consider taking symptoms relievers if necessary. Ask your doctor about the rehabilitation process, treatments, orthopedic devices, and so on. Furthermore, revise your future plans as the injury requires certain resources that might disrupt some activities. Inform yourself constantly as to avoid committing mistakes that could prolong or even complicate your recovery.

This article provides creditable referenced material for informational and discussion purposes only. It does not give advice, please consult your health care provider for diagnosis, treatment, and follow-up. The goal of the article was to increase your knowledge of groin injuries in order to prevent them and bring you back to action as soon as possible. Make sure to keep stretching the groin before and after your workout.

Remember if your goal is to stay running, keep thinking of ways to make the groin a stronger and more productive muscles.

See you out on the road!

Co-written by Aaron Moore

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