We’ve been seeing a fair bit of groin issues in our clinic recently! Including one of our own receptionists (who is a soccer superstar) right now!
This may be because a lot of people are in the thick of pre-season training and matches! Running, kicking, change of direction and rapid stop-starting are considered contributing factors to the development of groin pain. So it’s something your physio is likely to ask you about if this is your area of complaint!
Whilst it’s not what we like to tell athletes, in the initial phase some rest from kicking and agility drills may be required! However that doesn’t mean we want you to stop completely! Your physio can work with you to figure out how to keep up your conditioning whilst you sort out this issue.
What muscles make up the groin?
Before getting into it – what area of the body are we actually dealing with?! What is the groin?
When people report groin pain, physiotherapists and other allied health professionals will often be looking to assess the adductor muscle group as a source. These muscles attach from the pelvis to the bones of the leg – both above and below the knee joint!
That said, our body is one system – pain in one area might be a result of an issue elsewhere! So we may also look to you hip joint, other surrounding muscles (i.e. glutes!) as well as trunk control. Our body segments are never truly working in isolation, so our mentality to assessment and rehabilitation shouldn’t work that way.
Introduction to Groin Rehab
Here I will discuss some commonly prescribed exercises and some progressions for people with groin pain! Do remember though that everyone is different and this article and others like it cannot substitute individual assessment and management! It’s important to have the history of your pain considered and your physical function assessed and monitored for optimal results. Everyone has different expectations and desires for what they want their body to do – so we need to work towards that specifically!
Isometric Adductor Squeeze
Iso-adding-what? Don’t stress – just think of it as ‘Knee hugs’
- Lie on your back
- Put a foam roller between your knees
- Give it a gentle squeeze for 10-15 seconds
- Relax for 5-10 seconds, and repeat!
By squeezing the roller you’re asking your inner thigh/groin muscles to do some work, without the muscle itself getting any shorter or longer. In the early days when pain is more of an issue, this may be an ideal starting point to calm things down a bit!
Bent Knee Opening
- Lie down
- Keep your pelvis still (use your hands to keep accountable here if necessary!)
- Let one thigh lower out with control
- Bring it back in!
The main thing here is we don’t want your low back rocking side to side, only the thigh is allowed to move!
Whilst it might look simple, some people have great difficulty distinguishing hip movement from their pelvis and lower back.
Soft Tissue Release Work
Have a painful, tight, stiff or otherwise gunky feeling area? Provide an input to change the output!
Working on a few soft tissue pieces may be beneficial in easing symptoms at rest or easing perceived stiffness or restriction through movement. There are many different options to try!
The Groin is near the hip, the Glutes are also near the hip…
Bit of love through the hip muscles can affect how movement feels for the better! Even without groin pain, jump up now and perform 12 steady squats. Self-assess how it feels – now spend a minute or two rolling around through each side gluteals! Find the yucky spots that make you want to pull a face and question why you’re doing this. Then jump back up, repeat your squats – how does it feel!?
Now whilst you may have quite happily tolerated the glute work, adductor work may be a different story! When in pain people can experience muscle guarding – cause movement to feel restricted or that the muscle to touch is sore compared to the opposite side. Gently working on that area can work to ease that guarding!
Easiest way to do this is lie comfortable on your side, foam roller between your legs above your knee joint. Gentle rotate your top leg to change the area of pressure through the muscles. You can gently squeeze the roller also in certain spots to change the feeling.
So you’ve been diligent about your deloading from sport and gym, done the appropriate release work AND started with some basic adductor exercises to get the ball rolling.
Pain has settled, your moving better and perhaps discussed reintroducing straight line running or other load you want to get back to. Now you’re ready for bigger and better things!
In this half of the blog I’ll speak to some harder groin related exercises. These may not specifically just need to be done as rehab, they can be done for ongoing maintenance of adductor strength and prevention of injury! ‘Prehab’ if you will.
Time to get strong, preferably stronger than you were before!
- Take a wide stance
- Chest up, butt back
- Squat to one side!
Here I’m keeping both feet down and using a reduced range (not squatting very low).
If your inner thigh/groin is on the mend, it is likely to appreciate this adjustment.
As pain subsides and as your mobility allows, you can squat lower, add some load (see dumbbell in the goblet position) or allow the foot of the straightened leg to point upwards.
Or if you prefer… “Sliding lateral lunge”
Direct relative of the cossack squat but a completely different movement experience (if you ask me)
If you’re fancy, use a slide board OR at home, use a towel/sock under your foot on hard flooring or tiles.
- Keep you weight over the stance leg and squat down, whilst you allow the other foot to slide out!
- Stand back up, bringing the sliding leg back underneath you. Smoothly though! Please exercise some control!
Adductor “Rock Back”
Bet you were surprised you weren’t stretching til now, huh! I’ve left it out on purpose!
If your groin muscles are unhappy and painful, there is a good chance just stretching out aggressively isn’t actually going to leave you feeling much better!
When you start looking to stretch please do it within a relatively comfortable range for you. I would also advocate for something which sees you continuously moving rather then just statically stretching (holding one position)
- 4 point kneeling (hands and knees)
- Put one leg straight out to the side. This foot may be slightly in-front of your hips
- Gently allow your pelvis to shift back, avoiding excessive change to low back position! Keep it neutral where possible.
- Try rocking back and forth, 10 times per side, twice through and see how you feel!
You’re getting less groin pain now and looking to get back into things? Delightful! Lets get you stronger.
The wide sumo stance puts your adductors in a lengthened position.
The deadlift puts your hamstrings in a lengthened position.
This combo is great for rehab as a massive portion of our adductors (Adductor Magnus) also works like a hamstring!
Building strength is also awesome generally, so please do it
Normal deadlift cues apply, neutral spine and drive the movement from your hip!
If your inner thigh, back, hip, whole-self doesn’t seem to gel with this movement pattern – get it checked out!
You, as a functioning human being, should be able to comfortably lift heavy things off the floor!
Copenhagen Adductor Exercise
Oh boy. The holy grail of adductor strengthening!
How much and how often?
To begin, 3-5 reps per side. 3 times per week
Work up to 12-15 reps (this has been done over an 8 week period)
For in-season sport/maintenance of strength, 12-15 reps was performed once per week
This is only a recommendation! The research looking at this protocol looked at semi-professional soccer players. So it really depends! This prescription may need to be altered! Chat to your physio about what exercise frequency is best for you if you’re coming back from injury or just have a niggle. There are variations and regressions on this exercise available!
What to remember
- If you have a niggly groin that isn’t getting any better, seek some guidance from your physiotherapist or other movement focused, allied health professional!
- Physiotherapy outcomes are about what you do! You could have the best program in the world written for you but if the work doesn’t get done, you don’t get better.
- Take de-loading seriously. Physios generally don’t enjoy telling someone they can’t play sport or participate in whatever thing it is that gives them joy! We are making this recommendation so you can get back to playing and feeling 100% as soon as possible. If you jump back in too quickly, the more likely the issue isn’t going to be resolved properly and it’s just going to raise its head again!
- If you are prescribed rehab and are receiving ongoing monitoring from a physiotherapist, see it through! When prescribed anti-biotics, you finish the whole course even if your symptoms have subsided. Physical therapy is much the same, just because your pain is gone – doesn’t mean the issue is resolved and won’t come back!