Groin Pain

• Pain and discomfort in and around the groin.
• Pain can range from a dull ache to severe.
• Pain and tenderness on palpation.
• Swelling around the area.
• Bruising.
• Pain on movement, lifting the leg, moving the legs together.
• Pain and discomfort will be experienced on walking or twisting.

Here are an ATLPhysio list of possible causes of groin pain

• Groin Strain
• Osteoarthritis
• Bursitis
• Hip Fracture
• Adductor Strain
• Tendonitis
• Abdominal Strain
• Paget’s Disease
• Labrum Tear
• Avascular Necrosis
• Inguinal Hernia

Groin and Adductor Strains

 Very often these two conditions are frequently linked together. A groin strain happens in the area of the body where the stomach meets the thigh or the upper leg. Most groin/adductor strains I have treated over the years and my own groin/adductor strain, the pain and discomfort were lower down the inner leg and not high up into the groin area.

I am glad to say my experience of a grade I groin/adductor strain was successfully treated, and I was able to return to sporting activity within 3 weeks.

Gilmore’s Groin

This was first identified by Mr Jerry Gilmore consultant and surgeon a world expert on groin pain and its surgical repair. His technique of surgical repair became known as Gilmore’s Groin.

Gilmore’s Groin is a musculotendinous injury of the lower abdomen which involves tear in the external oblique, torn conjoint tendon and a large number of sportsmen have tears in the adductor muscle on its attachment near the pubic bone and rectus abdominus muscle.

Groin injuries are common in sport and their management is based on accurate diagnosis. Patients that have to have surgery will already have lengthy periods of conservative treatment and management. All these patients will have complained of chronic groin pain made worse by quick explosive movements.

Grade 1 Groin Strain

A grade one groin strain is referred to when only a few muscle or tendon fibres get torn, strained or damaged. Mild pain in the groin is experienced but does not significantly affect a person’s functional ability like everyday living activities like walking and stairs, but stretching, running, jumping and kicking will be painful. A grade I groin strain may require 2 to 3 weeks rest.

Grade 2 Groin Strain

A grade two groin strain is referred to when a significant number of muscle or tendon fibres get torn or damaged. The groin pain is a little more than mild and may require pain medication and this will be associated with moderate disruption of everyday living activities like discomfort in walking going up or down stairs even sitting for a prolong length of time or bringing the knees together. Most groin strains are grade one or grade two type strains. A grade II groin strain will require a longer rest period of 3 to 6 weeks.

Grade 3 Groin Strain

A grade three groin strain is a complete tear or rupture of muscle, tendon fibres or both with acute severe pain and gross disruption and loss of function. If a complete rupture is diagnosed, then this usually requires surgery and a rehabilitation phase of 3 to 6 months.

This happens frequently in sports men and women. Normally it is sudden explosive movements that bring on an acute groin strain, such as side stepping, sudden change in direction, kicking, running or jumping.

The pain can be and is commonly sharp, severe and debilitating causing the person to stop playing sport or the activity immediately. It can also be chronic building up over time maybe several weeks or months. Continuing sport or activities normally results in increasing pain and discomfort.

Self-treatment and a conservative approach should be the first method before the need for prescribed medication or more invasive treatment. The treatment of groin pain also depends on the diagnosis although in active and sports people overuse strains are by far the most common.

R.I.C.E

R.I.C.E is ATLphysio first recommendation. The aim is to reduce bleeding within the muscle tissue in the first instance then to start the rehabilitation phases involving gradual stretching of muscle and scar tissue and then progress the exercises to increase muscle strength and resume to the persons chosen sport or activity.

Rest

Try to reduce pressure or weight through the affected hip and try not to over stretch in the first three days. Reduce or stop activities like jogging, running, cycling or even long walks anything that aggravates the hip in the early days. Do not do the “no pain no gain” idea which I hear too frequently! This idea can lead to more damage, worsen the symptoms and delay your recovery.

Ice

Ice is a tried and tested formula for reducing pain and swelling. Apply an ice pack a quick and inexpensive form of ice pack is a bag of frozen peas wrapped in a thin cloth. This makes a great inexpensive ice pack because it moulds around the contours of the body.

The recommended timings for ice applications is 20 to 25 minutes there are slight variations on timings for ice applications some would recommend slightly longer up to 30 minutes and some authorities may suggest a 15 to 20 minutes application. Allow 3 hours between ice applications if planning to repeat the process. Ice therapy helps cool the tissue and relieves inflammation, relieving the inflammatory process assists in pain relief.

Compression

This can be done by wrapping a support bandage around the hip to help reduce tissue swelling. Do not tie any strapping too tight as this may limit blood flow around the hip and leg. Wearing compression shorts may help.

Elevation

If you can then raise and support your foot higher than your heart. The reason for this is that it aids what is termed venous return this means it assists blood flow and helps in reducing the swelling. The easiest way of elevating the foot is to lay on the floor and place your foot on a soft covered chair and if you can keep it elevated for 20 minutes at a time.

If you can do this then repeat this every few hours and certainly at the end of the day. If you have difficulty in raising your foot this high, then rest the leg slightly higher than your waist and keep it supported.

These stages depend on the severity of the hip strain and the discomfort experienced by the individual. The compression and the elevation stages might not be necessary. Just resting in the early stages might be all that is required. One if not the most important thing in the early stages of assisting recovery is the ice treatment as this helps prevent swelling and acts like a mild analgesia thus reducing the pain. I would recommend you avoid any heat application like hot packs in the first 48 to 60 hours.

Medication

Over the counter medications to relieve pain these can be:

• Paracetamol
• Ibuprofen
• Deep relief Anti-inflammatory gels
• Deep freeze pain relief gels
• Co-Codamol
• Naproxen

It is recommended that over the counter medications should not be taken for longer periods of 7 to 10 days. If needed always seek your GP Doctor or pharmacist’s advice.

Warning Signs

The following signs and symptoms are very rare but if any of these develop you should consult your GP or Doctor immediately:

• Sciatic Pain and pain down both legs
• Low Back Pain that is hot and burning
• Numbness, pins and needles in both legs
• Muscle weakness in the legs
• Constant pain day and night
• Pain that is getting worse
• Abdominal or pelvic pain
• Lump in the groin
• Numbness around the saddle area
• Feeling unsteady on your feet
• General feeling of being unwell
• Night sweats and high temperature
• Nausea or vomiting
• Blood in the urine
• Difficulty in passing urine
• Under the age of 16

Phase 1

Back lying knees bent and feet and knees together

Slowly lower the affected side outwards as far as discomfort allows,

Slowly bring the knee upwards so the knees are together.

Repeat the exercise 10 times.

Back lying knee bent knees and feet hip width apart

Slowly lift your hip and buttocks off the floor as high as comfortable.

Slowly lower your hips and buttocks to the floor.

Repeat the exercise 10 times.

Back lying both legs out straight and together

Keeping the affected side leg straight slowly take the leg outwards as far as comfortable.

Slowly return the affected side.

Repeat the exercise 10 times.

In a sitting position on the floor knees and feet together

Slowly lower the knee on the affected side outwards as far as comfortable.

Slowly return the lowered knee upwards to bring the knees together.

Repeat the exercise 10 times.

Phase 2

Back lying on the floor knees bent

Place a ball between the knee and gently squeeze the ball with the knees and release.

Repeat the exercise 10 to 15 times.

Back lying on the floor knees bent

Place a ball between the knees and slowly bring the knees to the chest.

Slowly lower the feet down to the floor.

Repeat the exercise 10 times.

Side lying with the affected side on the floor with both legs out straight

Take the upper leg backwards behind the affected leg.

Slowly raise and lower the lower leg.

Repeat the exercise 10 times.

Phase 3

In standing feet slightly more than hip width apart feel facing forward

Slowly bend the knee of the opposite side until you feel a stretch on the affected side.

Then slowly return to the upright position.

Repeat the exercise 10 times.

In standing feet stride distance apart feet facing forwards

Affected leg to the rear.

Slowly bend the front knee until you feel a stretch on the rear front thigh.

Return to the upright position.

Repeat the exercise 10 times.

Standing holding onto a works surface or chair

Cross the affected leg over to the opposite side.

Swing the leg outwards and upwards.

Repeat the exercise 10 times.

Phase 4

Phase 4 is the beginning of resisted band exercises.

In standing with the resisted band around the ankle on the affected side

Step sideways with the opposite leg so the feet are astride.

Slowly bring the affected leg together to the other leg.

Relax and the resisted band will return your affected leg back to the start position.

Repeat the exercise 10 times.

Standing with the resisted band around the ankle of the affected side

Stand in a stride position with the affected leg behind, unaffected led in front.

Slowly bring the rear affected leg forwards to the front leg so they are both together.

Relax and the resisted band will return your affected leg back to the start position.

Repeat the exercise 10 times.

Side stepping

Side-step to the left for ten steps followed by ten steps to the right.

Repeat the exercise 5 times.

• Start slow jogging with increased speed in progression.
• Fast and slow running.
• Forward running with side stepping
• Going or returning to the gym
• Swimming
• Pilates
• Yoga
• Tia chi