Adductor related groin pain (ARGP) refers to discomfort or pain experienced in the groin area that is primarily attributed to dysfunction or injury of the adductor muscles, particularly the adductor longus muscle. This condition is commonly encountered, especially among athletes involved in sports that require repetitive movements such as kicking, sprinting, or rapid changes in direction. ARGP can result from various factors including overuse, muscle imbalances, inadequate conditioning, or traumatic injury.
Prevalence and Risk Factors
Groin pain poses a common challenge, particularly in the realm of athletic medicine. The task of distinguishing adductor related groin pain (ARGP) from other potential diagnoses is compounded by the presence of multiple anatomical structures surrounding the anterior pelvis. Clinical indicators of ARGP include tenderness upon palpation of the adductor tendons, symptom reproduction upon adductor contraction, and discomfort during passive stretching. Prevalence statistics reveal a rate of approximately 13% in men and 7% in women, notably elevated in individuals with strength deficits and prior injuries, rendering recurrence prevention strategies paramount.
Considerations for Rehabilitation
Effective rehabilitation necessitates a progressive approach exposing the musculature to sport-specific stressors, acknowledging the multifaceted functions of the adductors in hip movement and stability. Notably, adductor longus vulnerability is accentuated by mechanical disadvantage, limited insertion size, and compromised vascularity, thus warranting cautious rehabilitation following microtrauma.
Training Consideration
Regarding training considerations, a linear periodization model is typically favored during initial to intermediate stages of injury rehabilitation to accommodate the limited capacity of the musculotendinous unit. Periodized programming is advocated for its facilitation of neuromuscular overload, fatigue management, and prevention of training plateaus, fostering greater muscular strength and hypertrophy adaptations. Post-acute injury management emphasizes progressive loading of the adductors and surrounding musculature to address strength asymmetries, crucial for mitigating the heightened risk of groin injury associated with a low ADD/ABD strength ratio. Emerging rehabilitation paradigms, emphasizing intersegmental control, linear running mechanics, multidirectional movements, and high-speed sprinting, have demonstrated expedited return to play timelines, averaging 9-10 weeks.
Notable Exercises
Isometric exercises constitute a cornerstone of rehabilitation programs, exhibiting efficacy in ARGP treatment, particularly relevant in field sports where adductor isometric contractions stabilize the pelvis during kicking. Notable exercises, eliciting strength gains with electromyography (EMG) values exceeding 60%, include isometric hip adduction with a ball between the knees or ankles and Copenhagen's. Addressing abdominal strength is imperative, as diminished eccentric abdominal strength compromises pelvic stability, potentially increasing injury risk through increased load on the pubic symphysis and adductor musculature. Following symptom resolution and sagittal loading, integration of frontal plane exercises is advocated, recognizing the prevalence of injuries during eccentric loading of the adductors within this plane. Examples encompass lateral step-ups, step-downs, lunges, and open-chain adduction exercises utilizing resistance bands or cable-pulley systems.
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