What is a Pulled Groin Muscle?
A pulled groin muscle is commonly seen in athletes competing in sports that require quick acceleration and change of direction in forward and lateral movements.
A pulled groin muscle is a muscle injury in the front hip region that involves the primary hip flexor muscles (iliopsoas, rectus femoris, tensor fascia latae, and sartorius) and/or the hip adductor muscle group (group of five muscles that contract to bring the leg in and across the body including the pectineus, gracilis, and adductor magnus, longus, and brevis).
A strain to a muscle is caused when the muscles are overstretched or overloaded. In this case, it can happen in a number of ways including a strong kick of a ball without warming up, a quick stretch during a lateral movement, a fall in sports or while skiing in which the bindings do not release and the leg is twisted at the hip.
Who gets pulled groin muscles?
Athletes susceptible to a pulled groin muscle are those in sports that require a quick change of direction as well as explosive movements. Back row volleyball players are at risk for groin injuries because of their requirement for quick dynamic side-to-side movements. While volleyball athletes may be injured going to the ball, some athletes are injured moving the ball.
Because the lower extremity kicking motion uses both adductor and hip flexor muscles, athletes competing in the sport of soccer are susceptible to pulled groin muscles especially when their hip muscles are not stretched and properly warmed up.
Dancers are also known for problems in their hips including “snapping hip” syndrome. Although there are several causes of snapping hip syndrome, one is caused by a deep hip flexor muscle/tendon (iliopsoas) popping over a bony prominence of the pelvis.
Hip flexor tightness can also be seen in dancers because of the amount of hip flexion and rotation required in their sport. The athletes will complain of pain and tightness deep in the front of the hip with palpation revealing a definitive tight band within the muscle.
Pulled groin symptoms
The classifications of a pulled groin muscle are dependent on the amount of tissue damaged. Pulled groin muscle or groin strains are classified as first, second, and third degree.
First degree groin strains are classified as mild and may be characterized by “tightness” in the muscle. A first degree strain would result from stretching or small tears of the muscle fibers within the muscle. The athlete would have pain on stretching the muscle and have some weakness when the adductor/hip flexor muscle group is manually tested. An athlete may be able to have a normal gait, but would have pain on any increase in the intensity or speed of movement (moving from a light jog to a sprint).
A second degree groin strain is classified as a moderate injury. Because there is a greater amount of tissue damage, a second degree strain will have a significant impact on the functional ability of the leg. An athlete may have localized discoloration, muscle spasm, point tenderness over the injury site, swelling, a painful gait, limited range of motion, and weakness in the muscle. The discoloration may initially show at the site of the tear, but may move distally due to the force of gravity.
Third degree groin strains or tears are full ruptures of the muscle either within the muscle belly or at the musculotendinous junction (where the muscle and tendon connect). A third degree tear is a significant injury with symptoms that may include a noticeable gap or deformity within the muscle, point tenderness over the injury site, muscle spasm, extensive swelling, extensive discoloration (may have bruising down the front or inside of the thigh), a painful gait, significant decrease in range of motion of the hip, and significant weakness when the muscle is manually tested.
Because a third degree tear will have an obvious deformity within the muscle and may impact the function of the muscle, these types of injuries need to be treated by an orthopedic surgeon who may need to surgically repair the muscle.
How is a pulled groin muscle diagnosed?
A sports medicine professional can diagnose a pulled groin muscle given a thorough medical history and comprehensive physical assessment. If a third degree groin strain is suspected, an MRI can be ordered to look specifically at the muscle tissue.
Pulled groin muscle or sports hernia?
What causes a pulled groin muscle?
A pulled groin muscle is caused by either overloading or overstretching the muscle. A common mechanism of injury for soccer athletes is a half-field kick to the goal prior to warming up. The force needed to put the ball into the goal is greater than the muscle can withstand especially if the muscle is not stretched and warmed up.
Tight adductor muscles are another cause of pulled groin muscle. Most athletes concentrate on stretching their quadriceps and hamstring muscle groups, but do not give the same attention to their adductor muscle group. These muscles tend to be tighter than other hip muscles hence placing an athlete at risk for injury.
What can I do to prevent a pulled groin muscle?
Prevention of pulled groin muscles should focus on flexibility and strengthening programs for both the hip adductors and hip flexors and a proper warm-up to adequately prepare the muscles for explosive movements.
Flexibility of the hip adductor/flexor muscle group can be improved through consistent daily stretching exercises specifically geared for these muscle groups. It is well known that muscles that are consistently and properly stretched will increase their tissue flexibility. However, it is also well known that muscles that are not stretched will get tighter and tighter over time.
Groin stretches can be performed in a variety of positions. The key to a successful stretch is to elongate the muscle to the point of discomfort, then back off slightly, and hold the position for 30 seconds. This stretch is then repeated two more times for a total of three times for each leg.
Effective hip adductor stretches include:
• Butterfly stretch – knees to the floor
• Butterfly stretch – chest to the floor
• Seated straddle position adductor stretch
Effective hip flexor stretches include:
• Single leg stance (unaffected leg), assisted knee flexion with posterior pelvic tilt to hip being stretched
• Lunge position with back knee on the ground, gradually lean into forward leg stretching hip flexors.
Strengthening of the groin muscle groups is another way to prevent injury. Care must be focused on ensuring that the adductor/flexor muscle group gets the same attention in the weight room as the quadriceps, hamstring and abductor muscle groups. Balancing out the number of exercises for each muscle group is one way to keep the muscle groups in balance.
One of the most important ways to prevent groin injuries is to effectively warm-up the muscle tissue prior to competing. The purposes of a warm-up are twofold. The first is to gradually increase the core temperature of the muscle tissue and the second is to prepare the muscles for dynamic activity.
Athletes should participate in 10-15 minutes of warm-up. One effective way to accomplish this is through a light jog. The athlete should continue jogging until he/she has broken into a light sweat. Any activity using the large muscle groups of the body can be effective as a warm-up.
One of the frequent mistakes made by coaches and athletes is to cut the preparatory warm-up too short. A quick lap around a field lasting less than five minutes is not an effective warm-up for the body.
After the body is warm, the athlete should participate in a progression of sport-specific skills that gradually increase in their intensity. The skills in the warm-up should include all of the major muscle groups that are used in the athlete’s sport.
To prevent injuries in the adductor/hip flexor muscle groups, athletes need to include functional warm-up activities in forward and lateral directions. These should start at a light jog and gradually increase in their intensity until the athlete reaches full speed. Movements in lateral directions may include side steps and grapevine steps.
Pulled groin treatment
Initial Treatment (1-3 days)
The initial treatment for a groin injury will depend on the severity of the injury. But in general, the athlete should be pulled from the activity and have an ice pack immediately applied to the area for twenty minutes.
If a second or third degree strain is suspected, the athlete should be fitted for crutches, provided crutch-walking instructions, and referred for further medical evaluation.
The athlete should continue with a cycle of twenty minutes of ice followed by a compression wrap for the first 48 – 72 hours. The individual should also limit their activity and rest the leg as much as possible in a position of elevation (leg above the heart level). Sports injury treatment using the P.R.I.C.E. principle – Protection, Rest, Icing, Compression, Elevation will help reduce the amount of swelling in the thigh.
Recovery Exercises (3 – 7 days)
When the swelling and pain begin to reduce, the athlete can then move into the next stage of rehabilitation with the focus on regaining range of motion, tissue mobility, and strength.
In this phase, the athlete can begin treatment with heat. The heat can either be moist heat (Jacuzzi, whirlpool) or dry heat (hot pack). The heat should be applied for 10 – 15 minutes for the purpose of increasing circulation to the tissue and increasing extensibility of the muscle fibers.
Immediately after the heat while the tissue is still warm and pliable, gentle massage can be given to the area. The purpose of the tissue massage is to keep the tissue mobile and decrease the possibility of adhesions and/or scar tissue from forming within and around the injured muscle tissue. The tissue should be massaged gently with care that pain is not induced.
Now that the tissue is warm and extensible, gentle stretching exercises can begin. Care must be taken to stretch the muscle tissue, but not to cause pain. Overaggressive stretching can damage the new tissue being laid down and elongate the healing and rehabilitation process. Gentle stretching exercises can be performed twice a day during this phase of recovery.
Once the muscle has been adequately stretched, strengthening exercises can be performed. The focus at this point is to provide mild resistance to the muscle, but to not perform any resistance exercise that causes pain or may re-injure the new tissue.
There are a number of strengthening exercises to isolate the hip adductor group. They include the following:
- Side lying position; flex the knee of the uninjured leg to move it out of the way. Perform isolated hip adductor repetitions using either ankle weights or manual resistance.
- Standing position with pulley wrapped around ankle. Move the leg through the full range of motion of adduction and then return to standing position.
- Butterfly position. Manually resist both knees and have athlete pull knees towards each other.
There are also exercises that isolate the hip flexors and they include the following:
- Sitting off the edge of a table, athlete lifts knee to chest using either ankle weights or manual resistance.
- Lying supine, athlete performs straight leg raises using either ankle weights or manual resistance.
(These can be adjusted depending on the equipment that your PTs have available)
All of these exercises can be performed with light resistance for three sets of ten repetitions.
Recovery Exercises (Week 2 – Week 3)
As the muscle heals, the athlete will be able to stretch farther without discomfort and will notice that walking is more comfortable. If full range of motion is still not achieved, the athlete needs to continue to focus on heating, tissue mobility, and stretching the tissue prior to adding more exercises. A strong muscle is irrelevant if the tissue remains tight.
Once full range of motion is achieved, the athlete can then advance to functional exercises for the hip. These types of exercises also load the muscles, but are done in a standing position.
- Wall squats
- Lateral step-ups/step downs
- Mountain climbers
Proprioceptive exercises can also be added during this phase to improve balance, agility, and coordination. Proprioceptive exercises are a series of balance exercises that improve the neuromuscular feedback system damaged when the muscle was injured. These exercises progress from simple to more difficult and from a stable surface to an unstable surface.
- Stork stand, eyes open
- Stork stand, eyes closed
- Stork stand, eyes open, unstable surface (wobble board, foam board, balance board)
- Stork stand, eyes closed, unstable surface
The goal of the athlete is to perform the task for a minimum of 30 seconds without losing balance beginning with the first level. Once the athlete has achieved this goal, the athlete can progress to the next level.
The last component in this phase of rehabilitation is the development of explosive power in the muscle. Once full strength has been regained (strength of the injured leg is equal to the uninjured leg), the athlete can progress to exercises that develop power in the muscle. There is probably no other muscle in which developing power is so important to the functioning of the muscle.
Power is the “speed” component of the exercise. Any “strength” exercise can be converted to a “power” exercise if the athlete performs the exercise “as fast” as they can.
Recovery – Getting back to Sport
The final component in any rehabilitation program is the addition of sport specific exercises. These are exercises specifically designed to put the athlete through the skills and demands of his/her sport in a progressive fashion so as to ensure that the muscle has completed healed and that the athlete has the confidence necessary to return to sport.
The athlete’s sport is analyzed for a breakdown of fundamental skills. The athlete is then asked to perform these skills beginning at 50% intensity. As the athlete continues through the list of basic skills, the intensity is gradually increased incrementally over time until the athlete performs the skills full out. Depending on the classification of the injury, this phase may take anywhere from several days to several weeks.
Groin Injury Recovery
When Can I Return to Play?
Once the athlete has full range of motion of the hip, full strength equal or greater than the uninjured leg, and can perform all of the fundamental skills of his/her sport pain free, the athlete is ready to return to sport.
Getting a Second Opinion
A second opinion should be considered when deciding on a high-risk procedure like surgery or you want another opinion on your treatment options. It will also provide you with peace of mind. Multiple studies make a case for getting additional medical opinions.
In 2017, a Mayo Clinic study showed that 21% of patients who sought a second opinion left with a completely new diagnosis, and 66% were deemed partly correct, but refined or redefined by the second doctor.
You can ask your primary care doctor for another doctor to consider for a second opinion or ask your family and friends for suggestions. Another option is to use a Telemedicine Second Opinion service from a local health center or a Virtual Care Service.
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- Levangie, P.K., & Norkin, C.C. (2001). Joint Structure and Function: A comprehensive Analysis. (3rd Ed.). F.A. Davis: Philadelphia, PA.
- Caine, D.J., Caine, C.G., & Lindner, K.J. (1996). Epidemiology of Sports Injuries. Human Kinetics: Champaign, IL