Groin Pull: Recovery?

author : AMSSM

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What is the normal recovery time and therapy for a groin pull injury?

Member Question

"Had a slight groin pull a couple of weeks ago. I have break in my race schedule and taking some time off from running to heal the muscle. This is the first time I have had this injury. Any tips from someone that recovered from this injury would be helpful. I am currently taking anti-inflammatory and doing some thigh stretches. So how many weeks is the norm for recovery? I love running so it is hard to take the time off but I know I need to do it."

Answer from Jeffrey B. Kreher, M.D., F.A.A.P.
Member AMSSM

“Groin pull” can include many possible causes. In short, what is often referred to as a groin pull is a strain of a muscle and/or tendon attachment in the front and middle of the thigh (the “adductor” group of muscles and most often the adductor longus). If one of the adductor muscles is the cause of your pain from the groin pull, you should have pain when you try to squeeze your knees together while someone resists. 

However, another common cause of groin pain could be “hip flexor” strain. A hip flexor strain would recreate your pain as you tried to raise your knee while someone resisted. (This is often engaged during the drive part of your running stride.) There are other potential etiologies (i.e. hip joint injuries, lumbar spine, stress fractures among others) so do not hesitate to get the appropriate diagnosis from a sports medicine professional.

The cause of adductor strains are often a sudden change in direction, overworking fatigued muscles, and shortening the muscle with a contraction while the muscle is being lengthened (eccentric contraction). The maximal pain may be anywhere from the middle of the thigh on the inside all the way up to near the “sits bones,” on the pelvis. When the pain is closer to the pelvis and not improving with conservative care, you should consider specialist opinion and examination for possible athletic pubalgia due to adductor tendinopathy.

Treatment for adductor muscle strain, or “groin pull,” should include ice 3-4 times daily x20 minutes, relative rest (avoiding all activities that make the pain worse while free to train in all pain free activities), and avoidance of stretching immediately after the injury.

The use of pain medications (anti-inflammatory or non-anti-inflammatory) is often debated. Pain should be minimized so recovery can begin, but often pain reduction can be accomplished with aggressive icing. Once there is pain free range of motion with actively moving the thighs in and out, then resistance can be gradually introduced followed by functional strengthening through full ranges of motion.

Functional strengthening with full range of motion is initiated usually in one plane of motion (i.e. swimming, biking and running). Finally, multi-plane motions can be introduced such as cutting sports.

If your pain has not improved with simple care listed above, you should enlist the help of a rehabilitation expert like Physical Therapist, or Physiotherapist, for focus on pelvic stabilization, additional manual work and modalities such as electric stimulation and/or therapeutic ultrasound. The natural history is variable.

Time to recovery tends to be shortest the further down the thigh your pain is located. Longer recovery times occur as you move from adductor strain in the muscle belly (mid thigh) to junction of primarily muscle to primarily tendon (upper thigh) to tendon (near pelvis bones).

The best form of prevention of muscle strains is through adductor strengthening. This is often with the same muscle length done against a fixed resistance (isometric contraction) or with change in muscle length with a machine (concentric contraction). Finally, time to recovery is longer with re-injury than after initial injury.

Jeffrey B. Kreher, MD, FAAP
Pediatric Musculoskeletal & Sports Medicine Specialist Assistant
Department of Orthopaedic Surgery, Division of Pediatrics Orthopaedics
Assistant Professor, Department of Pediatrics Massachusetts General Hospital for Children
Instructor, Harvard Medical School, Boston, Massachusetts
Team Physician: USA Triathlon, Boston Breakers, Boston Cannons, Boston Renegades, Lasell College

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date: October 29, 2015