Groin Strain

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The groin area is located at the same place in men and women, which is at the junction where the upper body or abdomen meets the thigh. It is an area of the hip and is comprised of five muscles that work together to move your leg. The groin area can become very painful and cause great discomfort because of physical activities and sports. One of the most common injuries is a groin strain.

A groin strain (or ‘groin pull’) is an injury directly to the groin. Usually, groin strains occur in the muscles of the upper inner thigh near the pubic bone or in the front of the hip. This injury tends to be more common in athletes and men; however, certain activities can increase the risk for anyone to experience a groin strain. Groin strains can occur during sprinting or any type of activity requiring forceful movement of the leg, such as jumping, kicking the leg up or changing directions while running.

Groin strain injury often occurs when the muscles are either too forcefully contracted or too forcefully overstretched. Groin strains are graded according to the amount of muscle damage that happens, such as the following:

  • Grade 1 groin strain – Grade 1 includes mild or partial stretch or a tear of a few muscle fibers. The muscle is tender and painful but maintains its regular strength. The use of the leg isn’t impaired, and walking is normal.
  • Grade 2 groin strain – A moderate stretch or tearing of a greater percentage of the muscle fibers. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. The use of the leg is noticeably impaired and limping when walking is common.
  • Grade 3 groin strain – Severe tear of the muscle fibers, sometimes a complete muscle tear. A popping sound may be heard or felt when the injury occurs. Bruising may be visible, and sometimes a dent in the muscle may be seen under the skin at the site of the tear. The use of the leg is very difficult and putting weight on the leg is extremely painful.

Causes & Symptoms

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A groin strain is most common among both recreational and professional athletes. A common cause of a groin pull is when an athlete strains their adductor muscle while kicking (usually in their dominant leg). Other things may cause this injury such as turning quickly while running, jumping, or skating. A groin strain is a high possibility when you perform movements requiring your muscle to both contract and lengthen simultaneously because it stresses your muscle, leading it to tearing or overstretching.

While the most common cause of a pulled groin is sports, it can also occur from the following:

  • Falling
  • Certain exercises like resistance training
  • Overusing a muscle leading to a long-term strain
  • Lifting heavy objects

There are many indicators that a groin injury has occurred, most notably pain in the upper thigh and / or lower abdominal area. However, groin pain isn’t the only symptom, and sometimes pain in the groin area is referred from an injury in another nearby part of the body. Therefore, here are some of the most common symptoms of a groin strain injury:

  • Abdominal pain – Pain in the lower abdomen may be indicative of a groin injury. Some groin strains that may cause either direct or referred abdominal pain include osteitis pubis and inguinal hernia. Coughing, sneezing, or straining during a bowel movement may worsen abdominal pain.
  • Groin pain – Pain in the groin may appear suddenly, such as when a muscle, ligament, tendon, or labrum is torn during sports. It may also develop over time due to overuse of either soft tissues or bones in the groin and hip area.
  • Tenderness – Some other types of groin injuries only cause pain and / or tenderness when the skin over the affected tissues is touched or pressed. Other times pain only appears when the athlete does certain types of exercises that place strain on the deep pelvic floor muscles, such as half sit-ups (abdominal crunches).
  • Swelling, stiffness, or discoloration – Swelling may develop in the groin, upper leg, or hip, depending on which tissue is affected. The skin over the injury site can become red, bluish, or black due to the tearing of musculoskeletal tissue and surrounding blood vessels. Patients may have difficulty moving the hip or leg.
  • Joint disruption – Hip joint dislocations or subluxations are a rare but severe traumatic injury that occurs when the hip ball comes out of the hip socket. The hips or upper legs may be visibly misaligned or shorter, and / or walking may be impossible. This injury requires immediate further medical attention.
  • Fever or nausea – Some groin strain injuries cause other symptoms such as joint or bone infections. Some of these infections can be life-threatening, so anyone experiencing groin pain along with fever, nausea, or vomiting is strongly advised to seek immediate medical attention.
  • Pain in the genitals – Some types of musculoskeletal groin injuries can also affect one or more components of the reproductive system, especially in males. Pain in the scrotum is especially associated with inguinal hernia.

Who gets a Groin Strain?

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Certain risk factors that can lead to groin strains include the following below:

  • Sports – Athletes, soccer, ice hockey, and football players have the highest risk for a groin strain. Rapid starts and stops while running and jumping are the primary causes when performing any of the sports activities mentioned above. In addition, some other sports and activities that commonly contribute to groin pain include gymnastics, basketball, rugby, wrestling, and figure skating.
  • Lack of rest – If an athlete plays through the pain rather than taking an appropriate break from the sport that contributed to the groin problem, an acute groin injury can become chronic.
  • Military training – Military recruits undergoing basic training and athletes increasing the number and intensity of their training sessions frequently experience stress fractures.
  • Gender – Men are at greater risk of hernia, especially inguinal hernia.

How Does it Affect You? How Serious is it?

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Most complications associated with a groin strain can be progressive and vary depending on the underlying cause. Because groin pain can be due to a serious disease, not seeking treatment may result in complications and permanent damage. Once the underlying cause is diagnosed, following the treatment plan outlined by your doctor can lower your risk of potential complications of groin pain or its underlying cause including:

  • Disability.
  • Fertility problems.
  • Testicle removal.
  • Spread of cancer.
  • Spread of infection.

Recommended Treatment & Rehabilitation

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Generally, it is advisable to consult a doctor with a specialization in sports medicine for diagnosing groin pain. Doctors usually use a multi-tiered approach to diagnosing the main causes of a groin strain, such as:

  • Medical history – The first and most important part of the diagnostic process is a complete medical history so a treatment plan can be precisely customized to meet the needs for you. This typically consists of a patient interview to determine exactly how, when, and where the symptoms began.
  • Physical exam – Your doctor will tailor the physical exam around the findings from your medical history. You may be asked to sit, stand, lie prone, and walk during the exam, so your doctor can evaluate their gait, balance, hip flexion and range of motion, strength, and other factors such as pelvic alignment.
  • Imaging tests – X-ray or ultrasound are typically used initially, based on your doctor’s suspected diagnosis. Magnetic resonance imaging (MRI) is frequently necessary to help diagnose soft tissue groin injuries and some stress fractures.

 

After a diagnosis has been done, physiotherapy may be advised to further recovery your groin strain. A physiotherapist will design a specific treatment program for you based on your condition and goals. Your plan may include treatments to:

  • Reduce your pain – Your physiotherapist may use different types of treatments and technologies to manage and reduce your pain, including ice, heat, ultrasound, electrical stimulation (TENS), taping, exercises, and hands-on therapy, such as massage. These treatments can lessen the need for pain medication, including opioids.
  • Improve your strength – Certain exercises will benefit healing at each stage of recovery; your physiotherapist will choose and teach you the most appropriate exercises to steadily restore your strength and agility. These may include using cuff weights, resistance bands, and cardio exercise equipment.
  • Improve your motion – Your therapist will decide which specific activities and treatments can help restore regular movement in the leg and hip. These might start with passive motions that your physiotherapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you perform yourself.
  • Boost your recovery – Your physiotherapist is trained and experienced in choosing the correct treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you’re likely to do on your own.
  • Return to your activities – Your physiotherapist will work with you to decide on your recovery goals, including your return to work or sport, and will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your therapist will also apply hands-on therapy, such as massage, and teach you exercises and work retraining activities. Your physiotherapist may also teach you sport-specific techniques and drills to help you achieve and sport-specific goals.
  • Prevent re-injury – Your therapist may recommend a home-exercise program to strengthen and stretch the muscles around your hip, upper leg, and abdomen to help prevent re-injury of your groin. These may include strength and flexibility exercises for the leg, hip, and core muscles.

After your groin pain has subsided, you can begin to perform exercises to heal your groin injury. Typically, you can start these exercises within a few days of your initial injury, but it depends on the severity of your strain. Therefore, here are some exercise examples you can try on your own time:

 

Hamstring stretch

Position yourself on your back near a doorway. Then, extend your unaffected leg in front of you on the floor of the doorway. Place your affected leg along the wall next to the doorframe. Hold this position for up to 30 seconds before repeating 3 times a day.

Hip adductor stretch

Lie on your back with bent knees. Next, press your feet into the floor while allowing your knees to drop open to the sides. Press the soles of your feet together. Hold this position for up to 30 seconds. Return to your knees to the starting position before repeating 3 times.

Resisted hip flexion

Stand with your back to a door. Make a loop and place the resistance band around the ankle of your affected leg. Place the other end of the resistance band around an anchor point. Engage the front of your thigh and keep your leg straight as you extend your leg forward. Slowly go back to the starting position before repeating 2 times a day.

Alternative & Homeopathic Treatments

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Homeopathic treatments for groin strains will vary depending on the severity. Therefore, the following are possible treatment plans for athletic groin injuries:

  • Rest – Many mild to moderate groin injuries will resolve with rest. This is the most commonly prescribed activity reduction, but some injuries will require crutches or otherwise reduced weight-bearing.
  • Ice application – In addition to rest, athletes are advised to ice the affected area using a cloth-wrapped ice pack. Ice can be applied for 20-30 minutes every 2-4 hours until the pain and swelling subside.
  • Compression – To provide compression, you can wrap your thighs and / or groin with elastic bandages or use athletic tape to help reduce swelling and stabilize the injury.
  • Elevation – Elevating the groin area above the level of the chest by reclining over a pillow or bolster for a few hours each day can help reduce swelling and boost your recovery process.