Chronic groin pain is a common injury in sports, especially in games such as soccer and hockey. The groin is a complex area involving the soft tissues of the inner thigh, bottom of the abdomen, and the pelvis. As a consequence diagnosis of groin injuries can be difficult. One type of groin injury that has some consensus among the research is ‘Adductor-Related Groin Pain’ (ARGP). ARGP is defined as pain at palpation of the adductor tendons at insertion of the pubic bone combined with pain at adduction against resistance. This new study from Per Holmich (International SportsMed Journal, 1(1), 2000) investigates the efficacy of a rehabilitation exercise programme for adductor related groin pain.
Sixty-eight males athletes with long-term groin pain injuries were split randomly into two groups. One group received only physiotherapy treatment on the injury, while the other received physio as well as performed a specially designed exercise programme. The results of this study were very positive. Four months after beginning the treatment, 74 per cent of the physio-plus-exercise group were participating in sports with no pain.This compared to just 14 per cent of those in the physio-only group.
The exercise programme was split into two phases. Phase one lasted two weeks and involved simple static and dynamic exercise, mainly aimed at re-educating the adductors to be active – one of the consequences of chronic adductor related groin pain is, of course, reduced adductor activity. The second phase, averaging 10 weeks, involved more advanced strengthening exercises as well as balance and coordinating exercises for the groin and pelvis area. The aim of this phase was also to include functional exercises in the programme.
Groin pain injuries Exercise programme, phase 1 (weeks 1-2)
1. Static adductors.
a. Lying supine, legs straight, with soccer ball between feet. Squeeze the ball using adductors. Hold for 30 seconds and repeat 10 times.
b. Lying supine, knees bent with soccer ball between knees. Squeeze the ball using adductors. Hold for 30 seconds and repeat 10 times. Force applied should be just below pain threshold.
2. Ab curls, 3 x 10-20.
3. Reverse curls. Ball between knees, crunch shoulders and knees together from stomach. 3 x 10-20.
4. Wobble board. Five minutes of balance work.
5. Slideboard. Gentle movements side to side on slideboard, keeping feet fully on the ground.
Perform this routine three times per week.
Groin pain injuries Exercise programme, phase 2 (weeks 3-12)
Perform five sets of 10 reps of each of these exercises.
1. Side-lying adduction. Lying on side, top
leg bent, bottom leg straight. Lift bottom heel upwards.
2. Side-lying abduction. Lying on side, top leg straight, bottom leg bent. Lift top
3. Gluteal leg raise. Stand with hips touching physio couch. Lean forward so upper body is supported by couch, hips flexed to 90 deg. Lift legs off the floor until hips are fully extended.
4. Standing adduction with leg pulley.
Attach cable pulley to ankle, perform adduction movement standing next to
5. Single leg squats.
6. Fitter. Five minutes balance work on the Fitter machine.
7. Slideboard skating. Five sets of one minute simulated skating on the slideboard.
Perform this routine three times a week.