Groin Injuries

The groin is a complex area involving the soft tissues of the inner thigh, bottom of the abdomen, and the pelvis.

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Hip flexor (iliopsoas) Strain

What is a hip flexor strain?

Hip flexor groin injuries refer to a tear within the iliopsoas muscle, the main muscle which bends (flexes) the hip. This muscle runs from the upper end of the thigh bone through the front of the groin and backwards (deep) attaching to the spine at the upper end of the lumbar region.

What causes a hip flexor strain?

This is one of the most common groin injuries seen by physiotherapists. The injury typically occurs when the muscle is contracted in an explosive or forceful way e.g. sprinting or kicking. The iliopsoas is particularly vulnerable to tearing when it is working in a stretched position or when required to contract against a load (i.e. kicking a ball). The injury is seen in sports such as football, AFL, sprinting and hurdling.

How does a hip flexor strain feel?

Sudden pain in the front of the hip and groin. In minor tears you may be able to continue activity with minimal symptoms. As the muscle cools down following activity, the pain may gradually worsen as bleeding and swelling around the injured muscle takes place. There usually is progressive tightening and stiffening of the ilipsoas muscle. In more severe tears you will be unable to continue the activity due to muscle tightness, weakness and spasm.

Management of a hip flexor strain and how to fix it

As with most groin injuries, if the injury is painful, cease activity and begin initial treatment. Avoid activities which increase blood flow to the injures muscle, including hot showers, heat rubs, massage, the consumption of alcohol and excessive activity. These can prolong muscle bleeding and exaggerate swelling, resulting in further pain and extended recovery. Most iliopsoas muscle strains heal without complication within a matter of weeks.  A number of other associated structures around the muscle may also be injured. Injury to these structures may delay return to participation. Recovery can also be delayed if the tear is not appropriately managed. This may result in tightness and weakness which can reinjury with return to participation of activity. The assistance of a sports medicine professional is important in the treatment of a hip flexor muscle strain. Initially they can assist in determining the structures damaged and the extent of the damage. Treatment techniques to assist in reducing pain and swelling and enhance the recovery of the injured structures may include ice, gentle stretches and progression of exercises aimed at increasing your range of motion, strength and specific pre injury activities.

Adductor Muscle Strain

What is an adductor strain?

An adductor muscle strain refers to a tear of one of the muscles which run down the inside of the thigh. This group of muscles pulls the lower limb in towards the midline of the body. The adductors also play an important role in stabilization of the pelvis and limb in the dynamic setting. e.g running, turning and kicking.

What causes an adductor strain?

Typically occurs when the muscle is overstretched or forcibly contracted, or a combination of both. This commonly occurs during rapid changes in direction when running and also during kicking activities. Of the common groin injuries, adductor strains are frequently seen in sports such as football (soccer) and AFL.

How does an adductor strain feel?

Sudden pain felt either along the inside of the thigh or in the groin region. You may have a sensation of something tearing. In minor tears you may be able to continue participation with minimal hindrance. However, the muscle cools down following participation, pain may gradually worsen as bleeding and swelling around the injured muscle takes place. In more severe tears, these symptoms are so great that you are unable to continue following injury.

Management of an adductor strain and how to fix it

As with all groin injuries, it is advised you stop activity until assessed and begin initial treatment. The most important time in the treatment of an adductor muscle strain is the first 24-48 hours. To control the amount of bleeding and swelling and minimise the extent of inflammation and damage initiate the  RICE regime(rest, ice, Compression, Elevation). Rest involves ceasing to participate and limiting the amount of weight you put through the injured site. Ice should be applied to the injured site for 15-20 minutes every 1-2 hours. Compression involves the application of a firm elastic bandage around the injured site. Elevation involves lying with the injured site resting comfortably on a chair or pillows so that it is above the level of the heart. You should continue the RICE regime until you consult a sports medicine professional. The assistance of a sports medicine professional is important in the treatment of an adductor muscle strain as they can assist in determining the exact structures involved and directing you on the most appropriate rehabilitation.

Try to avoid activities that increase blood flow e.g. hot showers, heat rubs, massage, the consumption of alcohol and excessive activity. From many years experience in the management of football injuries, our patients are advised to avoid stretching of the adductor group in the early stages following injury.

Physiotherapy management following an adductor muscle strain aims to promote tissue healing, restore movement, improve pelvic stability, restore muscle balance, prevent further injury, and aid in the return to sport.  Massage is used to reduce muscles spasm associated with pain. Exercises to strengthen the adductor muscles are an important element of rehabilitation. Without sufficient strength and flexibility the muscles will be prone to re-injury. The adductor muscles tend to overwork in the presence of poor pelvic stability. As a result your physiotherapist may prescribe pelvic stability exercises to reduce the stresses placed of the adductor muscles.

Occasionally, surgeons will perform an adductor tenotomy (surgical release of the tendon) to assist in the recovery of this condition. The rehabilitation and return to sport may then be 6-8 weeks.

Osteitis pubis

What is osteitis pubis?

Inflammation of the pubic symphysis joint. This is the joint at the front of the pelvis between the two pubic bones. Amongst specialists in this area, there has been debate as to whether the condition is actually a defect or tear of an adductor tendon at its attachment to the pubic bone.

What causes osteitis pubis?

The exact cause of the osteitis pubis is not clear. It is commonly seen in sports that are dynamic and involve a lot of kicking and turning e.g. soccer and AFL. It is an overuse injury and is also associated with excessive abdominal muscle contraction e.g. repeated sit-ups. During these activities, the muscles that produce the movement attach close to the pubic symphysis joint. This pull on the joint may cause excessive movement of the joint, resulting in a inflammatory response and subsequent osteitis pubis.

How does osteitis pubis feel?

Dull aching pain in the groin region which is aggravated by activity, particularly turning, kicking and fast running.

Management of osteitis pubis and how to fix it

Consult your nearest sport medicine professional for assistance with this complex condition. Avoid aggravation of the condition by eliminating sporting activities, especially running in any non-lineal direction. The assistance of a sports medicine professional is important in the treatment of osteitis pubis, as they can assist in diagnosing the problem and its severity. This may require the use of imaging techniques such as X-ray, ultra sound or MRI. From this, the sports medicine professional will be able to determine an appropriate treatment plan. This may involve activity modification, the taking of anti-inflammatory medications, soft tissue treatment such as massage and stretching and the progression through a series of specific strengthening exercises. Unfortunately, the condition may take many months to recover from.

Inguinal Hernia

What is an inguinal hernia?

An inguinal hernia refers to when part of the abdominal contents bulge through a defect in the wall of the abdomen.

What causes an inguinal hernia?

Weakness in the lower abdominal wall and lower abdominal muscles. Coupled with an increase in intra-abdominal pressure, such as during lifting, pushing, coughing, or straining during urination or defecation, a portion of the abdominal contents may be pushed through the area of weakness

How does an inguinal hernia feel?

Commonly you feel a deep sensation and pain on one side of the lower abdomen just above the genitals. Aggravated by activities which increase intra-abdominal pressure (i.e. lifting, pushing and coughing). There may be a a visible swelling at the site of the pain.

Management of an inguinal hernia and how to fix it

You should consult your nearest sports medicine professional as soon as possible. An inguinal hernia represents a condition which does not get better by itself. Surgery is required to repair the defect in the abdominal wall and to return the abdominal contents back to their original position. Following surgery, recovery usually takes place in a matter of weeks and there are usually no long-term effects.

Other sources of pain in the groin area include lumbar spine, sacroiliac joint, hip joint and nerve pathology.

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