Adductor Tendinopathy

The hip adductor muscles help bring your legs together and rotate your hip inwards. The short adductors include the pectineus, adductor brevis, and adductor longus, and the long adductors include the adductor magnus and gracilis. These start at your pubic bone where the crease of your inner thigh meets your body and move down your thigh bone to the inside of your knee. At the end of these muscles are tendons, which are tough, fibrous tissues that connect muscles to bones.

Groin injuries comprise 2 - 5% of all sports injuries; adductor tendinitis and tendinopathy are among the most common causes of groin pain in athletes. The adductor longus is responsible for 62% of groin injuries, and tends to be the most prone to injury, followed by the gracilis muscle. This injury is problematic among athletes especially runners and professional dancers, as both activites stress the adductor tendon quite heavily.

The initial damage can range from overstretching or a slightly pulled muscle (grade 1 strain) to partial tearing (grade 2 strain), to complete rupturing of your adductor muscle or tendon fibers (grade 3 strain). If you do not allow your tissues to heal properly, your previous adductor injuries will build upon each other. The inability of your tendon to repair itself encourages microtears to accumulate faster than they can heal, increasing the breakdown of your tissue and reinforcing your pain and disability. The majority of adductor strains are grade 1 or 2 strains that involve partial tears, where your adductor tendon and muscle meet.

Causes and Diagnosing

The most common cause of tendon inflammation is overuse of your adductors. It results from repetitive stress placed on your adductor muscles and tendons during active sports (especially when running, kicking, twisting, or side-stepping), as a result of a sudden fall or direct hit, and/or overexerting yourself in everyday activities that involve twisting or lifting heavy objects while bending or running on an unstable surface (like grass or mud).

Alignment issues, leg length discrepancies, which affect the way you walk, or incorrect sport-specific motions, as well as strength differences in your muscles, lack of exercise and obesity, age-related weaknesses and/or degeneration, and genetics.

Your doctor will perform a medical history and physical examination, and may use some diagnostic tests (including X-Rays, MRIs, bone scans, CT scans, and diagnostic ultrasound) to determine your situation.

Prevention

Avoid doing too much too soon - decrease, modify and/or avoid any activities that cause pain and irritation.

Stabilize your groin, pelvis and hip area, build your core strength with light weights, exercise bands and balls, core balance training, and exercises to develop strength, speed and agility, such as jumping or bounding. Yoga, tai chi, or a daily stretching routine will also help keep your muscles and joints supple, and will increase your range of motion. Combine these with regular low-impact exercise and healthy diet.

Always warm up and cool down your muscles, learn the proper form and techniques to prevent injuries, and utilize any available mobility supports (braces, taping, orthotics, canes) to help alleviate undue stress and improve your function.

Treatment

Early diagnosis and proper treatment are important. Rest the adductor and hip, this is essential to prevent further injury. Apply ice or better yet a cold gel pack (because they mold to your body) for 10-20 minutes at a time for at least 3 times a day for the first day up to 3 days and compress the area with a compression short or brace; this will reduces initial inflammation and swelling.

Heat may be used after acute swelling has decreased, to circulate blood through the area and speed the healing process; a dual purpose hot/cold pack is a great option. Ultrasound is an excellent tool to reduce pain and inflammation when treating an injured adductor. The application of ultrasound over the affected inner thigh and hip area reduces swelling quickly, increases blood flow and minimizes scar tissue, helping the tendon heal more quickly. Do not use ultrasound over the genital or abdominal area. The American Academy of Physical Medicine and Rehabilitation have recommended that in chronic adductor strains (adductor tendinopathy), ultrasound is a useful modality.

Often people ice once or twice, rest a bit, then take some Advil or Tylenol and continue with their regular routine. If their strain was minor, their body may heal the soft tissues normally. Unfortunately, this is not the usual result. Because of the stress on the muscle and tendon, their body heals the injured fibers by binding them together with scar tissue. It is a normal protective response of their body trying to prevent further damage. The trick to any tendon injury is getting it to heal with minimal scar tissue formation - something Radiant Energy and Ultrasound are great at! Even with optimum healing there is always less elasticity in a previously injured tendon.

Recovery from adductor tendinitis can take between 2-12 weeks, and adductor tendinopathy can take up to 6 months. This is dependent on your type of injury and your commitment to proper rehabilitation. The more dedicated you are with your treatments, the faster you will see successful, long-lasting results. A good reference point for healing is once you've regained approximately 70% of your pre-injury strength, have full range of motion and are pain free, you can return to your normal activities.