Groin Pain - More than what it seems

Definition:  A groin strain which is also called a “pulled groin” is an injury to the muscles at the front of your hip and pelvis region.  This can include abdominal muscles, hip flexor muscle group but most often refers to the muscles in the inner thigh called the adductor muscle group.  Symptoms can range from mild discomfort to severe pain.  Pain can be located at the inner thigh and include some swelling and bruising depending on the extent of the muscle tear. 

Mechanism of Injury:  Causes of this injury can include sports or higher intensity activities that include sudden change in direction or kicking or sprinting.  Groin Strain can also be from overuse and repetitive motions or overtraining.  Sudden movements such as a fall or trauma can contribute to a groin injury as well.  

1.      Direct blunt trauma which will often cause a muscle hematoma or significant bruising.

2.     Forceful contraction of the adductor muscle group such as with a quick change in direction and kicking such as with soccer. 

3.     Repeated microtrauma due to cumulative overuse. 

Clinical Presentation:  The main presentation is intense pain in the groin region.  With a muscle strain, there is damage localized at the muscle tendon junction.  There will be tenderness at the inner thigh along with bruising and swelling. 

Grade 1:  there is no loss of function or strength.  There can be bruising and swelling. 

Grade 2: severe pain with some weakness noted.  This is considered a partial tear.  There will be more bruising and swelling. 

Grade 3:  complete muscle tear with complete functional loss.  This tends to happen at the lower insertion of the muscle down on the thigh bone which is the femur. 

Differential Diagnosis:  If you are having pain in the groin area, sometimes it is straightforward and you know the mechanism of injury.  But it is important to look at what else might be causing this pain to rule out other diagnoses.  Other sources of pain in the groin can be related to referred pain from the lumbar spine, nerve entrapment or a hernia. 

            Generally the diagnosis is made in a clinical examination if there is tenderness at the inner thigh, swelling of the adductor muscle group region and decreased strength when one activates the adductor muscle group by bringing the leg toward the midline of the body and against resistance.

What can you do about this? 

• RICE:  rest, ice, compression and elevation are very helpful early on / immediately after the injury or trauma.

• Pain Relievers:  OTC pain relievers including anti-inflammatory medications can be helpful

• Physical Therapy:

  • Exercises for flexibility

  • Strengthening for the muscles in the area

  • Manual therapy

  • Functional exercises including sports or activities specific exercises

  • Surgery is rare and only considered in very severe cases

How can you prevent injury to the groin?

• Warming up properly especially before exercises, training, repeated motions

• Strengthening and stretching program

• With work outs, it will be important to gradually increase the intensity and duration to avoid injury and avoid overexertion

• If you start to feel pain in the groin with an activity, listen to your body.  Maybe you just need a short rest break and some stretches or a longer break.                             

Recovery time:

Mild strains can take a few weeks to heal.  More severe injuries will require more time as you have to wait for the edema and bruising to subside before you start the rehab process. 

It is very important to fully heal before returning to your prior level of function.   Physical Therapy can play a very important role in return to sport assessment and testing.   

We can treat this issue here at Physical Therapy Specialty Center.  Call us at 970-241-5856 to learn more or to schedule an evaluation.