Monday, January 5, 2009

Groin Strain

The most common acute injuries about the hip and pelvis from athletic competition are muscle strains. The musculature of the groin most often affected includes the adductor group (gracilis, pectineus, adductor brevis, adductor longus, and adductor magnus). The rectus abdominus, rectus femoris, and iliopsoas are also common muscles that can be affected. The mechanism of injury can be overuse causing microtears or a sudden forceful movement. A position of external rotation and eccentric forces often cause flexor / adductor strains, and the injury most typically occurs at the myotendonous junction or the tendonous insertion.

Signs and Symptoms
A strain can be felt as a sudden sensation of tearing or twinge while playing or may not be noticed until after the activity. Symptoms include pain and swelling. Focal areas of tenderness and swelling are often detected. With more severe injuries, a defect may be palpable. The history of injury, localized tenderness, and pain with resistance are the most notable measures for diagnosis.

Differential Diagnosis
Avulsions should be ruled out with an AP pelvis radiograph. Differential diagnosis also includes hernia, internal derangement of the hip (e.g. labral tears and chondral injuries), nerve entrapments, osteitis pubis, fractures and stress fractures.

Strains should be treated with RICE and analgesics as needed for a minimum of 2 to 3 days. Range of motion exercises should be initiated early. As pain resolves, gentle isometric exercise progressing to more dynamic resisted exercise can be performed using pain as a guide. The athlete can gradually return to play when pain-free. A protective spica bandage may assist in the early phase of return to sport for flexor / adductor strains. The most common complication is recurring symptoms and in chronic cases, surgery may be indicated but is rare.

Training programs should be specific for the level of athlete, timing during the season, and goals of the athlete. It is important to focus on general conditioning, specifically strength, endurance, and flexibility. Programs should include warm-ups and cool downs for training and matches.


Anonymous said...

Dr. Carreira,

You mention that strains should be treated with rice. Do you recommend white or brown? Should black beans be added as well?

Anonymous said...


Anonymous said...

Dr. Carreira,

My question isn't related to Groin Strains, but I didn't know where to post my question and figured this would be the easiest spot.

I'm a pretty good athlete and have dreams of playing in the NFL. I should get a chance to tryout in the next couple of months, but recently found out that I have the beginning stages of a stress fracture in my left foot that will require a screw to be surgically inserted to stabilize that area of the foot. The fracture was discovered during a bone scan conducted Friday during the NFL Combine in Indianapolis. The scan revealed a slight crack in the fifth metatarsal bone in my left foot.

Do you have any thoughts on how I can speed up my recovery time? Is this something the RICE method would help with? Thanks in advance for your help doctor.


Anonymous said...

Dr. Carreira,
Someone in my immediate family is encountering pain when they move in quick bursts or turns. I do not think it's groin pain because the pain is halfway down their leg. My question is, should we have Chinese for dinner or Mexican?