Groin Strain vs Groin Pain
All too often we see clients attend clinic with groin pain that was incorrectly diagnosed as a groin strain. It is important to distinguish between the two and worth reading groin pain to understand that distinction. It is imperative you understand why you have pain in the groin area and not start treatment as this could lead to a waste of money and time!
Assessment
At Kensington Physio & Sports Medicine we pride ourselves on our ability to confidently assess and diagnose groin strain. From your initial history taking, and physical assessment we are able to determine the causes of groin strain and establish the correct path for your recovery.
What causes a groin strain?
Pain in the groin caused by an acute, traumatic event will be a groin strain. The most common cause of this is an uncontrolled change of direction or slipping over and having the legs separate
What are the symptoms of a groin strain?
- It is not going to be a slow, build up of pain in the groin.
- It will be a sharp, instant occurrence and you will be VERY aware of a sharp, strong pain in the groin region.
- If you have torn one or more of the groin muscles then it is likely you will experience some bruising and swelling in the inner leg region.
- You are likely to limp
- You will have difficulty squeezing your legs together.
What is a groin strain?
A groin strain is an injury to the muscles on the inside of the leg. These muscles are called the adductors (brevis/longus/magnus), gracilis and pectineus.
A strain does not have to involve disruption/tearing of muscle. It can be a neurological (fatigue, spinal related, muscle related) strain or it can be a mechanical tear (minor partial, moderate partial, or total). The difference is quite important, as the recovery will be quite different from your “groin strain”. Below is an extensive table detailing the different classifications of strains and tears – this can be adapted to all areas of the body and not just groin pain or pain in the groin region.
| Comprehensive muscle injury classification: type-specific definitions and clinical presentations. Taken from Terminology and classification of muscle injuries in sport: The Munich consensus statement. Mueller-Wohlfahrt et al, 2013 British Journal of Sports Medicine | ||||||
| Type | Classification | Definition | Symptoms | Clinical signs | Location | Ultrasound/MRI |
| A | Fatigue-induced muscle disorder | Circumscribed longitudinal increase of muscle tone (muscle firmness) due to overexertion, change of playing surface or change in training patterns | Aching muscle firmness. Increasing with continued activity. Can provoke pain at rest. During or after activity | Dull, diffuse, tolerable pain in involved muscles, circumscribed increase of tone. Athlete reports of ‘muscle tightness’ | Focal involvement up to entire length of muscle | Negative |
| 1B | Delayed-onset muscle soreness (DOMS) | More generalised muscle pain following unaccustomed, eccentric deceleration movements. | Acute pain. Pain at rest. Hours after activity | Swelling, stiff muscles. Limited range of motion of adjacent joints. Pain on isometric contraction. Therapeutic stretching leads to relief | Mostly entire muscle or muscle group | Negative or oedema only |
| 2A | Spine-related neuromuscular muscle disorder | Circumscribed longitudinal increase of muscle tone (muscle firmness) due to functional or structural spinal/lumbopelvical disorder. | Aching muscle firmness. Increasing with continued activity. No pain at rest | Circumscribed longitudinal increase of muscle tone. Discrete oedema between muscle and fascia. Occasional skin sensitivity, defensive reaction on muscle stretching. Pressure pain Circumscribed (spindle-shaped) area of increased muscle tone, oedematous swelling. Therapeutic stretching leads to relief. Pressure pain | Muscle bundle or larger muscle group along entire length of muscle | Negative or oedema only |
| 2B | Muscle-related neuromuscular muscle disorder | Circumscribed (spindle-shaped) area of increased muscle tone (muscle firmness). May result from dysfunctional neuromuscular control such as reciprocal inhibition | Aching, gradually increasing muscle firmness and tension. Cramp-like pain | Well-defined localised pain. Probably palpable defect in fibre structure within a firm muscle band. Stretch-induced pain aggravation | Mostly along the entire length of the muscle belly | Negative or oedema only |
| 3A | Minor partial muscle tear | Tear with a maximum diameter of less than muscle fascicle/bundle. | Sharp, needle-like or stabbing pain at time of injury. Athlete often experiences a ‘snap’ followed by a sudden onset of localised pain Stabbing, sharp pain, often noticeable tearing at time of injury. Athlete often experiences a ‘snap’ followed by a sudden onset of localised pain. Possible fall of athlete | Well-defined localised pain. Palpable defect in muscle structure, often haematoma, fascial injury Stretch-induced pain aggravation | Primarily muscle–tendon junction | Positive for fibre disruption on high resolution MRI*. Intramuscular haematoma |
| 3B | Moderate partial muscle tear | Tear with a diameter of greater than a fascicle/ bundle | Dull pain at time of injury. Noticeable tearing. Athlete experiences a ‘snap’ followed by a sudden onset of localised pain. Often fall | Large defect in muscle, haematoma, palpable gap, haematoma, muscle retraction, pain with movement, loss of function, haematoma | Primarily muscle–tendon junction | Positive for significant fibre disruption, probably including some retraction. With fascial injury and intermuscular haematoma |
| 4 | (Sub)total muscle tear/tendinous avulsion | Tear involving the subtotal/ complete muscle diameter/ tendinous injury involving the bone–tendon junction | Dull pain at time of injury, possibly increasing due to increasing haematoma. Athlete often reports definite external mechanism | Dull, diffuse pain, haematoma, pain on movement, swelling, decreased range of motion, tenderness to palpation depending on the severity of impact. Athlete may be able to continue sport activity rather than in indirect structural injury | Primarily muscle–tendon junction or Bone–tendon junction | Subtotal/complete discontinuity of muscle/ tendon. Possible wavy tendon morphology and retraction. With fascial injury and intermuscular haematoma |
| Contusion | Direct injury | Direct muscle trauma, caused by blunt external force. Leading to diffuse or circumscribed haematoma within the muscle causing pain and loss of motion | Aching muscle firmness. Increasing with continued activity. Can provoke pain at rest. During or after activity | Dull, diffuse, tolerable pain in involved muscles, circumscribed increase of tone. Athlete reports of ‘muscle tightness’ | Any muscle, mostly vastus intermedius and rectus femoris | Diffuse or circumscribed haematoma in varying dimensions |
Treatment for Groin Strain
Once your groin strain source is identified a plan will be made to treat and most likely rehabilitate your injury back to performance.
Treatment can involve the following elements:
- Soft tissue release
- Active Tissue Release (ART)
- Instrumented Assisted Soft Tissue Massage
- Graston release
- Mobilization
- Manipulation
- Trigger point needling
- Dry Needling
- PNF stretching
- Stretching
- Movement re-education
- Proprioceptive training
- Plyometric training
- Running re-education
- Hypertrophy training
- Strength training
Information
For more information about groin pain or getting your groin reviewed to understand what the problem really is, please contact 02076030040 or info@kenphysio.com
