Pain in Groin Area
When someone presents in our clinic with groin pain we ask a number of questions.
- Where exactly is the Groin Pain?
- How did the pain in the groin start?
- What aggravates or eases the groin pain?
- How long have you had the groin pain?
- Have you ever had this pain before?
These questions along with a detailed assessment will enable us to diagnose the cause of the groin pain.
The groin pain may be at the front of the hip joint, or slightly above it, in the actual groin area between the legs, or at the pubic bone in front of the pelvis. The cause of each type of pain can be from a very different source and may not necessarily be from a strain or tear of the groin muscles.
Causes of Groin Pain
Our assessment will enable us to determine the cause some of which are outlined below
- A genuine groin muscle strain
- Overuse of groin muscles due to poor use of gluteal muscles because of poor core stability
- Referral of pain in to the groin area from a disc, joint or muscle injury in the back
- Referral of pain into the groin area from the Sacro-iliac joint
- Referral of pain from Myofascial trigger points in overworked muscles in the pelvic region or back area.
- Abdominal hernia
- Gilmore’s groin
- Osteitis Pubis
- Labral tear, CAM eformity or pincer lesion in the hip joint
The cause of the injury may be gradual onset for no apparent reason, sudden onset as a result of a twist, sudden jerk or injury.
The nature of the pain and what aggravates and eases it is of extreme relevance to us. For example if the pain has been there for several weeks, and hurts while sitting or driving, and came on for no apparent reason,then we can already tell by our subjective assessment that this is most likely not a groin muscle strain.
One of my favorite things is being called to a dressing room before a match because someone has “groin strain” on quick assessment I determine that this is referred pain and treatable so that the player can play after all.
What is groin strain ?
When an excessive load is applied to one of the adductor or medial rotator muscles in the groin area while it is contracting, or if these muscles over stretch as they lengthen the muscle may tear. As the adductor muscle pulls your leg in, or stabilises the hip while you weightbear on it, and the Medial rotator muscle turns the leg in or stabilises it while you pivot on it, injury to the muscle is most likely to occur while the leg is planted on the ground.
Grade 1 Groin Strain
When there is damage to a small number of muscle fibres – usually less than 5% of fibres this is a considered to be a mild groin strain.
In this case the pain may be sudden onset pain or just tightness in the groin area, the player might be able to play on, the area will become painful and tender later on, there will probably be no visible bruising or swelling, and the player will be able to walk around without limping.
This could take 2 to 3 weeks rest, however sometimes this is more like a micro-tear with minimal damage, and with good early management the player may return to sport after a week.
Grade 2 Groin Strain
When there is more extensive damage, with a large number of muscle fibres involved, but the muscle is still in tact it is known as a grade 2 groin strain or groin tear.
In this case there will be a sudden onset of pain usually while the player is pushing off from the side, changing direction or twisting on that leg. The player will be unable to play on, there will be a tender mass at the site of injury, there may be bruising which may not appear until the following day, and may be lower than the area of pain. There will be weakness in the muscle and the player may be limping.
The rest period required is usually between 3 and 6 weeks. Good physiotherapy treatment and early management will reduce the recovery period.
Grade 3 Groin Strain
When there is a complete rupture of a muscle it is referred to as a grade 3 groin tear. There will be a sudden severe onset of pain, and the player may not be able to walk off the pitch.
There will be severe pain in the muscle and severe pain and weakness on resistance. There may be a visible deformity in the muscle where the fibres have recoiled back into a lump. There will be swelling in the area and bruising will be extensive when it appears the following day.
In a sports person this may require surgery to repair the muscle if the fibres have severely recoiled. Even with good physiotherapy and management it may take 3 months to fully recover. This severity of injury in the groin muscles is rare.
All muscle strains should be rested and allowed to heal. If the patient continues to play, the condition will worsen. If ignored, a grade one strain has the potential to become a grade two strain or even a complete rupture.
How to treat a groin strain?
As with any acute injury the early management of a groin strain is extremely important to aid recovery and prevent further trauma to the area.
PRICE for Groin Injury treatment
- Protect the area
- Rest – relative rest is advocated, no running, but move within normal painfree limits
- Ice is extremely important. 20 minutes at a time every 2 hours, protect the skin to avoid ice burns
- Compression – use an elastic bandage or support to apply firm light pressure to the area to limit swelling
- Elevation – keeping the injured area higher than the hip aids swelling reabsorption
In our clinic we will use Laser therapy within the first 48 hours in conjunction with PRICE to accelerate the Inflammatory phase of healing. Then we will offer you manual therapy, electrotherapy, deep dry needling, strengthening, stretching and rehabilitation for return to sport.
Also we will address any underlying issues which may have been causative factors for your groin strain.
Why does it take so long for groin strain to heal?
There are four main stages of the healing process for the adductor or medial rotator tear in the groin.
- INFLAMATORY REACTION
The body has a natural healing process which must occur when a muscle is strained or torn.This begins with an inflammatory response which occurs over the first 48 hours. This is a really important time where the inflammatory reaction the body produces chemicals and cells which remove dead muscle fibres and start the repair process. This must be allowed to happen, and that is why you should not take anti-inflamatory medication in the first 48 hours after an injury. It is also why protection of the area, rest, ice, compression and elevation is important
- REGENERATION OF MUSCLE FIBRES
The damaged tissue must be replaced, so new muscle fibres grow from special cells within the muscle.
- FORMATION OF SCAR TISSUE
When an injury occurs there will be bleeding in the gap between the torn muscle ends, and this eventually lays down fibres called collagen which form a scar linking the 2 muscle fibre ends to help them heal.
- MATURATION OF THE SCAR TISSUE
As the scar develops the collagen fibres take on a permanent structure and physiotherapy is useful in this stage to help the new collagen fibres to be laid down inline with the original muscle fibres so improving the long term tensile strength and flexibility of the injured muscle enabling it to withstand more force.