DIAGNOSIS

ADDUCTOR MUSCLE INJURIES PART 2

By Seonaid Airth, MSc, MCSP, SRP

The most common groin injury reported in the literature is adduc- tor muscle strain. Definitions range from ‘adductor pull’ to "groin strain" but much of the literature does agree there may be sever- al diagnostic signs which indicate possible adductor muscle injury.

An adductor muscle injury may be acute, for example a strain of the musculotendinous junction or muscle belly, or it may be long stand- ing with tenderness over the adductor origin at the pubic bone (22).

ACUTE ADDUCTOR STRAIN An acute strain of one of the adductor muscles usually occurs in the muscle belly or in the distal musculotenidinous junction (22).

Subjective history ■ The patient often remembers an exact incident, for example a tackle

■ The patient often reports feeling a ‘pull’ in the muscle with sudden pain

■ The athlete could no longer continue the activity (22) ■ Activities involving hip abduction are painful as well as stairs

Clinical findings ■ Pain on palpation of the adductor muscles – often in the mus- cle belly

■ Pain is local ■ Little or no referred pain ■ Pain reproduced by passive abduction of the hip ■ Resisted adduction reproduces the patients pain (22) ■ Bruising ■ Swelling

The adductor longus muscle is the most com- monly injured muscle in the adductor group. Adductor longus and gra- cilis are particularly exposed to traumatic

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to injury if there is an opposing force such as heavy wet ground or an opponent’s leg.

Further investigations In an acute adductor strain with an obvious history and clinical findings to support the subjective history further investigations such as ultrasound imaging and MRI are not usually required to make a diagnosis.

MANAGEMENT OF ACUTE ADDUCTOR STRAIN Initial management ■ Application of ice ■ Compression of the injured area ■ Non-weight bearing as pain dictates ■ Avoid painful activity ■ Electrotherapy

As pain resolves the athlete can commence early isometric exer- cises. As there may be a loss of core stability, low load exercise is essential to reduce overload on the adductor group and enhance force closure. This should be started as soon after injury as possible.

Regaining full, pain-free hip range of movement must be an early objective in the management of this patient. For an optimal return to sport and prevention of recurrence of groin injury, strengthening of the adductor group is dependent on full hip range of movement being present.

When palpating the adductors it is useful initially to posi- tion the patient in side lying with their painful side down. Ask the patient to flex the knee of the uninjured leg up to their chest. The patient tends to relax better and a towel placed over their buttock and inner thigh means that everything is neatly tucked out of the way (figure 1)!

Figure 1: Palpation of the adductors www.sportex.net

strain when maximum extension of the knee is combined with flexion, abduction and external rotation of the hip (3). This sudden powerful over- stretching of the leg is observed in a soccer tack- le. The adductor muscles are particularly vulnerable

When it has been determined that bleeding has stopped in the mus- cle and there is no risk of haematoma, calcification and myositis ossificans, the following treatment modalities could be introduced ■ Hydrotherapy and sling suspension - to regain hip range of movement and early muscle conditioning

■ Manual techniques such as gentle soft tissue release techniques

■ Hip mobilisation techniques ■ Hold/relax techniques ■ Early neural mobilisation ■ Isometric and concentric, eccentric exercises

■ Early proprioceptive activity ■ Cardiovascular activity if possible.

Strengthening Muscle strengthening regimes vary among therapists. The pro- gression of the strengthening exercises for adductor muscle injury follows the same principle as any muscle rehabilitation.

Rehabilitation tips The following exercises are only suggestions which may be includ- ed in the rehabilitation programme. Bridging is an excellent exer-

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