Member Case Study: Groin Pain

author : AMSSM

comments : 1

Groin pain in athletes has a long differential diagnosis. As a triathlete, and the area you are describing, you are more likely to have a strain of the iliopsoas, or hip flexor.

Question from bubba76819

I have this recurring groin strain. It's really high, actually in the crease of my leg between my hip and crotch, not the inner thigh that people normally think of as the groin.

I went to the doctor, who is actually the team physician for a local pro hockey team and he said it's a fairly common hockey injury and is best treated by continuing to move, and not to take it easy on it. But it comes and goes all the time.

Sometimes it's almost debilitating, meaning it's painful to move. It hurts when I sleep on my side, or sit at my desk with my legs splayed apart.  I've iced it regularly, taken anti-inflammatories, and continued to exercise. It does go away, but returns a month later.

Any long term solutions, and any known causes of such a strain?

Answer from Marjie Delo, MD

Member AMSSM
 

Groin pain in athletes has a long differential diagnosis. It sounds as though your physician was referring to an adductor strain, a strain of the inner muscles of the thigh that bring the legs together. That is a common injury in hockey and soccer athletes. Normally adductor strain causes pain with the skating movement or with kicking across the body. As a triathlete, and the area you are describing, you are more likely to have a strain of the iliopsoas, or hip flexor. A specific test for this muscle would be: sit on the very edge of a table, then lay back letting your legs hang over, have a friend flex the noninjured hip and knee up towards your chest, then try to resist flexion of the injured hip. If this reproduces your pain, chances are you have a iliopsoas strain.

Other possibilities for pain in that region include hip joint disease, such as arthritis, stress fractures, nerve compression, or a sports hernia. Occasionally, pain can be referred from the spine, abdomen, or genitoureteral systems. Below is a program for rehabilitating the iliopsoas, if you continue to have problems, you should be reevaluated to be sure there is not another source for your pain. Hip joint disease and stress fractures should have been ruled out by x-ray at your evaluation.

In 'Orthopaedic Sports Medicine: Principles and Practice', Dr. ML Gross outlines a 5-phase treatment protocol for muscle injury. The first phase is rest, ice, compression, and protection. The second phase is regaining range of motion. A good iliopsoas stretch is to place the knee and shin of the injured side on the floor behind your torso, balancing on the opposite foot. You should feel this stretch in the front of your hip. An alternate is to place the back leg on a chair or stool and shift the torso forward. Warrior Pose 1, from yoga, provides a great stretch of the iliopsoas.

Phase 3 is focused on strength and endurance. Begin with isometric exercises such as leg lifts, gentle squats, resisting flexion as above. The yoga pose Navasana (Boat Pose) is also a good iliopsoas strengthening exercise. Subsequently advance to sit-ups with raised legs and lunges.

Phase 4 and 5 include dynamic exercises (plyometrics), coordination, and balance. For these, I recommend a core strengthening program, which will incorporate the abdominals (important for functioning of the iliopsoas), gluteal muscles, multifodi (spinal stabilizers), hamstrings and quads. One home series I like is the 'Core Performance Essentials' with Mark Verstegen. These are actually available at WalMart.

Remember to increase your training slowly. Hill work will flare-up an iliopsoas strain, so add hills slowly back into your running routine.

I hope this helps, and I hope your injury improves. Iliopsoas strains can be slow healers, but with thorough, paced rehabilitation, you should be able to return to activity and racing.

Marjie Delo, MD
Mercy Sports Medicine and Rehabilitation Center
Walworth and Whitewater, WI

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date: June 11, 2007