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Article

Groin pain

Have you ever felt a "catch" in your groin after a shot or a feint? Perhaps you feel a "nagging" groin pain that creeps up on you after a match? Groin pain can either occur acutely or develop gradually. Acute groin injuries are often called "groin strains" and come on suddenly as a result of a specific event.

Groin pain

Overuse injuries in the groin region can also begin acutely, but it is usually harder to link such injuries to a specific event.

Muscles in the groin

A great many muscles attach in and around the groin, and several of these muscles have different functions. This means that groin pain can have several different causes. The muscles that flex the hip and the muscles that bring the leg in towards the body attach in the groin. In addition, abdominal muscles attach in the same area. It is therefore important to have a thorough examination to find out which muscles are injured. It can be decisive for further treatment and rehabilitation. You should also be aware that groin pain can come from the hip joint itself, but this article focuses on muscle injuries.

What is the most common injury?

In most cases, an injury to one of the "hip adductors" is the origin of groin pain. "Hip adductors" is a collective term for several muscles whose main function is to bring the leg in towards the body's midline. In general, these muscles originate from the front of the pelvis (pubis) and attach to the inside of the lower thigh. In football, it is most often the "adductor longus" muscle that is injured, especially on the dominant foot (the kicking foot).

Strain or overload?

An acute groin injury (groin strain) occurs when the muscles or tendon concerned are subjected to more force than they can tolerate. This happens particularly when the muscles have to produce a lot of force while being lengthened. The situation in which this occurs can vary. It can result from a tackle, but most often happens during feints, shots or jumps.

What is even more common, however, is that the injury is load-related. This means that the muscles and tendons in the groin have been exposed to slightly more load than they can tolerate over several weeks or months. Over time, it can thus become an "overload". Sometimes you may feel discomfort in the groin during a particular training session and think it is an acute injury. However, it is often the case that the problem has developed gradually over time, and that the pain has only now reached a pain threshold where it is clearly noticeable. Overload of the adductors' tendon tissue is called "adductor tendinopathy", and is an example of such a load-related injury that causes pain in the groin.

Groin pain in young people

In adolescents who are still growing, not all parts of the skeleton have fused yet. There is then an apophysis (growth zone) in the bone. Before this growth zone has "closed", it is somewhat more prone to injury. Some growth zones do not close until the early 20s, that is, long after you think you have stopped growing.

In the upper part of the groin we have an area of the pelvis called the pubis, where there is such an apophysis. Among other things, the tendon of adductor longus is attached to the pubis. Pull from the adductor muscles will thus load the apophysis of the pubis. If the load is too high over time, an apophyseal injury can develop that causes pain and discomfort in the groin. This is important to be aware of, as it will require a different treatment approach than, for example, adductor tendinopathy. With apophyseal problems, a period of relief from load is very important, whereas tendinopathy responds better to strength training and loading. It is therefore important to have a thorough examination to ensure the correct diagnosis and obtain optimal treatment and rehabilitation.

Injury prevention

It is important to take both acute and load-related injuries seriously and to go through a thorough rehabilitation process. The biggest risk factor for getting an injury is having had the injury before. This means it is absolutely essential to do a thorough job in rehabilitation so that it does not become a recurring problem. The "Copenhagen Adductor" exercise has shown very good results. It has been shown to be able to prevent groin injuries in football players by up to 41%.

Our practitioners have good experience with both diagnosing and rehabilitating groin injuries.

References

  • Harøy, J., Clarsen, B., Wiger, E. G., Øyen, M. G., Serner, A., Thorborg, K., Hölmich, P., Andersen, T. E., & Bahr, R. (2019). The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. British journal of sports medicine, 53 (3), 150–157. https://doi.org/10.1136/bjsports-2017-098937
  • Hölmich, P., Thorborg, K., Dehlendorff, C., Krogsgaard, K., & Gluud, C. (2014). Incidence and clinical presentation of groin injuries in sub-elite male soccer. British journal of sports medicine, 48 (16), 1245–1250. https://doi.org/10.1136/bjsports-2013-092627
  • Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine 2015; 49: 768-774.
  • Serner A, Mosler AB, Tol JL, et al. Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis. British Journal of Sports Medicine 2019; 53: 158-164. Olympiatoppen. Stressreaksjoner og apofyseskader i bekkenet. https://olympiatoppen.no/fagomrader/helse/fagstoff/stressreaksjoner-og-apofyseskader-i-bekkenet/