Many times throughout the school year, athletes will come in saying “I pulled my groin.” In most cases they have been running or doing some action that required the muscles in the groin area to be worked.
We are now getting into our spring sports seasons, and this has been more prevalent recently.
When you are working with a new sport or in the early season, you usually are not in the peak condition yet. You might not have warmed up properly and have muscle tightness. In early season you fatigue these muscles more quickly, and they are prone to a strain. A hard sprint or kick, a quick change of direction or slipping on the wet ground might be enough to cause a strain to the muscles in the groin area.
Typically, a groin strain is a muscle strain to either the hip flexor muscles or the hip abductor muscles. Looking at these muscles might help to understand what muscle group you have strained.
The hip flexor muscle consists of three to four muscles that work together to flex the hip or lift your leg upward. The Psoas and Iliopsoas are deep muscles that originate in the abdominal region and run to the femur, thigh bone. The Rectus Femoris originates from the very front of the hip bone and runs down the middle of your thigh, and the Sartorius originates from the hip bone also and crosses over the front of the thigh to the medial knee.
In most cases the Rectus Femoris is the hip flexor muscle that is involved with a hip flexor strain. It is superficial, and its tendon that attaches the muscle to the hip bone can be felt to touch just below the anterior hip bone.
Hip adductors bring the leg inward toward the midline of your body. These muscles also can be part of the groin area, as they originate from the pubic bone and are located in the upper, medial thigh.
To know whether you have strained the hip flexor or adductor can be determined by two things. Where the pain is and what actions cause the most pain. Hip flexor pain is in the front of the upper thigh where hip adductor pain is on the inner thigh area. Hip flexor pain will increase when lifting the leg upward, such as lifting to walk stairs. Hip adductor pain will increase when moving the leg inward, such as getting into bed and bringing your legs across the bed.
Symptoms of these strains can start with mild pain or pulling sensation in the area, cramping sensation or sharp pains, as the strain worsens swelling might be seen or even bruising.
We see many of these strains in the early season as the athletes are not yet conditioned and the muscles fatigue. These muscles are used when running, cutting and kicking. Therefore, as the practice continues and they are using these muscles over and over, they might fatigue and strain, which is small tearing to a large tear depending on the severity of the strain.
Once the muscle is strained, rest is the best treatment. Typically, a strain to these muscles will only get worse if you try to continue to play. Protecting the area with a compression wrap or brace to help reduce the motion might help. Immediately after the injury, ice can be applied to help reduce pain. Heat can be used two to three days after the initial injury.
To return to activity, we want to make sure flexibility is maintained or gained if you are very tight and inflexible. Strengthening these muscles also will help reduce the chances of reinjury. Prior to activity, stretching and a good active warmup is recommended to help reduce the stress on the muscles.
There is another injury that can occur in this area that you should be aware of. We mentioned that the Rectus Femoris and Sartorius originates from the front of the hip bone. In adolescents, if they have pain right on the tip of the hip bone, this could be an avulsion fracture. An X-ray will be needed to determine this. This occurs when the muscle pulls on the bone where it is attached and the bone pulls away at the growth plate. This injury takes slightly longer to recover from and may change the recovery process slightly.
As always, if the injury is slow to heal or is very painful, check with a health care provider for diagnosis and treatment.