Groin Pull Therapy & Treatment
What is a groin strain?
A groin strain is in an injury of the muscles in the groin area. The location of the groin is area where the upper abdomen area meets the top of the thigh, and where the inner thigh muscles meet the pubic bone of the hip. Groin pulls tend to happen more to athletes and usually happen through forceful movements of the thigh – usually through running, jumping, and kicking. 10% of all hockey injuries are groin strains and 5% of all soccer injuries are groin strains. Non-athletic injuries include lifting heavy items, slipping while walking, or climbing high objects.
The biggest defense and remedy of groin strains is physical therapy – not only do we provide manual therapy for healing of soft tissues strains, but also proper exercises to promote better form and avoid further re-injury.
In a groin pull, muscles of the inner thigh and the front of the hip get overstretched during activity and there is is some muscle fiber and tendon micro tears as a result. Groin strains can make walking difficult as the patient lifts the knee for ambulation. Moving the leg away and to the side can also be either painful or difficult.
Muscle strains can generally be graded according to the severity of muscle damage:
– Grade 1: The damage or tear on the muscle fibers are mild and partial. The muscle will be painful and tender to the touch but can maintain its normal strength. The patient may report impaired use of the leg, but walking gait is more or less normal.
– Grade 2: The tear is moderate as there is more muscle fiber torn. There is more tenderness and pain and loss of strength. Occasionally there will be bruising from torn capillaries as result of the injury. Use of the leg will definitely be impaired and the patient will limp when he/she is walking.
– Grade 3: The tear in the groin muscle or tendon is severe, or may be complete. The patient may report a “popping” sound during the injury. Bruising is present, as is a divet in the muscle can be felt underneath the skin. Moving the leg will be very difficult and weight bearing can also be very painful.
A groin strain feels usually feels sharp in nature, especially when trying to walk or move the leg – either in lifting it up, or in bringing the knees together. The pain can be intermittent, or it can be constant and persistent depending on severity and inflammation, which can feel like throbbing. The groin muscles can feel weak or tight and may cause the muscles to spasm further.
How Is A Groin Strain Diagnosed?
A groin strain can be easily diagnosed by a physical therapist, and need not further imaging if the patient is able to walk and weight bear. During your initial evaluation, your groin pull physical therapist will conduct a thorough subjective evaluation and ask you about the nature of the pain you have experienced. These are some things he/she would want to know:
- Injury specifics – what activity and what motions you were doing.
- The location of the groin pain, and if a pop was heard during injury.
- If any swelling as formed after the first 2-3 hours after the injury.
- What movements are impaired and what can’t you do as a result of the strain.
Your groin injury physical therapist will then perform an objective exam to test the strength and range of your muscles. A palpation exam would also allow him/her to see the severity and location of the potential muscle/tendon tear and feel for any active inflammation. Additionally, your PT may also conduct further tests to see how involved are other areas including your hip or lower back.
If the groin injury is less severe, or if the injury is verging on chronic (>4 weeks old), your physical therapist may ask that you gently repeat the movements and motions that injured you in the first place. This is a movement analysis and will allow your PT to see whether range and strength can be gained in other parts of your body, so you prevent from straining your groin muscle again.
If the strain is severe, your PT may choose to refer you to an orthopedist or physician to conduct further tests such as an X-Ray or MRI to confirm a more severe or full tear. A groin strain can sometimes feel very much like an abdominal hernia so this needs to be ruled out by a physician as well.
A Typical Groin Pull Physical Therapy Treatment Plan
There are several goals that a physical therapist establishes for your plan. In the beginning of treatment, pain modulation and range of motion is more important as it respects the healing phase. Exercises and manual therapy may get more intense as pain diminishes and the patient is re-integrated into sports or physical activities. Your PT will likely prescribe home exercises – these are crucial for proper healing and will definitely speed up the process.
The First 1-2 days after injury:
It is important to immediately rest the limb and avoid prolonged walking or any activities or motions that illicit the pain. Cold therapy is very useful in controlling inflammation, so apply as needed for 10-15 minutes at a time. Consult with a physician if you think you need pain medication or if you feel that you might have a severe tear.
PT Goal: Reduce Groin Pain
Your physical therapist will use several different tools to help modulate the pain. Cold therapy, heat therapy (if injury is chronic in nature), TENS electric stimulation, taping to help support the tissues, or hands-on manual therapy to ease tissue tension and spasm can all help to modulate the pain after a groin strain.
PT Goal: Improve Range of Motion
Your physical therapist will construct and exercise and stretching plan for you that will aim to improve hip mechanics and range of motion. Initially, if the region is painful, these maneuvers will be passive where the PT will move the leg for you. As pain diminishes, active stretching and exercises will be progressed.
PT Goal: Improve Strength
Because deconditioning and atrophy of muscles always occur after an injury, it is important to re-strengthen these muscles so that you can return to your sport or activity. As the muscle heals, exercises need to be progressed gradually so that the muscle can take the load of being forcefully pushed again during sports. The PT may use resistive weights, machines, cardio machines or functional calisthenics to achieve this goal.
PT Goal: Return to Activities
Your physical therapist will be closely collaborating with you on your return to sport and other activities. As mentioned before, practicing the motions that hurt or injure can give the PT more insight as to how the injury occurred. For e.g. if kicking a soccer ball was the injury, then the PT might want to look at your frontal plane dynamics and how your balance affects how muscles move and recover from the motion. When balance or strength is gained in other parts of your body like your abdomen and your glutes, the use of groin muscles can be reduced and therefore prevent further re-injury down the road.
If Surgery Is Necessary
Surgery is rarely needed in the healing of a groin strain, but will be necessary if there is a full thickness muscle or tendon tear. Your physical therapist can help you recover and heal from surgery, taking the above goals into consideration and with more respect to surgical repair healing times.
Can Groin Strains Be Prevented?
The following tips may help you avoid having them in the first place:
- Increase the intensity and frequency of the activity gradually. Pushing yourself too hard and too fast too soon will put excess strain on soft tissues that have not been given time to adapt and grow in strength.
- Warming up before playing a sport is helpful in getting blood flow to muscles pre-game.
- When performing sports, do not ignore sports conditioning. It may be boring and cumbersome, but following a consistent strength and conditioning program in adjunct to your sport will allow for a stronger body and better your biomechanics when you’re on the field.
- Make sure your footwear has adequate tread in them. When shoes wear out tread, the tendency to slip and strain your groin increased.
- Use proper posture and lifting techniques when lifting heavy weights. When in doubt, ask a physical therapist!
For the best groin pull treatment please visit one of our Portland clinics today!