• Lionel Pannunzio PT / SCS

Groin Pain in Soccer Players: causes and solutions


Introduction


Groin pain in Soccer Players has always been very difficult to treat because it’s hard to assess where the pain can be coming from.

Until the recent Doha Agreement in 2016, there was no clear consensus on a classification and nomenclature of the various causes of groin pain. The picture below shows the Doha Classification with the correct name to use when talking about these injuries (first line) , where the pain is located (second line) and the “old terminology” (third line in brackets).

Knowing the cause of your pain is a key factor in the recovery process.

Types of Groin Pain




Acute muscle strains are a common cause of groin pain in athletes.


The tissues typically involved are the adductor longus (most common), and iliopsoas (second most common).


Also, Youth soccer players should be assessed for possible pubic apophysitis of Iliac Bone avulsions because these immature structures are the last part of the human skeleton to mature and can be injured with the strong demands of soccer on these tissues.

Other causes of Groin pain not included in this classification can be hip related (FAI - Femoroacetabular Impingement for example) or low back related.




Mechanism of Injury



Kicking , change of directions , stretching situations and sprinting are the most common mechanisms of injury for Groin Pain.


Knowing the cause of your pain is a key factor in the  recovery process.


At White Bay Physical Therapy we have been efficiently solving groin pain because we go to the root of your problem.


A typical rehabilitation program for Groin Injuries will include:

  • Mobility workouts to restore Hip and Spine Range of movement .

  • Strengthening exercises for the groin and core muscles .

  • A comprehensive return-to-play program where we simulate all the movement and skills necessary to go back to play.

Knowing the mechanism of injury of Groin muscles allow us to rehearse them over and over until you feel 100 % safe to return to play.





Shoulder I rest it to get better ? ... I don't think so ...


Rest alone will not help with your Groin pain , you have to progressively challenge these muscles in order for them to get better and stop hurting This Video shows a simple mobility drill for your Adductor muscles and inner thigh to help improve your hip movement and length of your inner tight muscles Just move as tolerated, feeling a mild stretch on the affected groin. As the muscle warms-up you will be able to go deeper in the movements If you repeat it daily that tightness and pain you feel will improve significantly so the next step is to make your inner thigh muscles stronger.






The usual suspects: Inner thigh and the Adductor Longus


Research shows that from all the Groin injuries, the Adductor Group ( inner thigh muscles) accounts for 40 % of them. The adductors are a group of 5 muscles: the adductor longus, adductor magnus, adductor brevis, Pectinus and Gracilis.


62 % of Adductor Tears occurs in the Adductor Longus, that thick vertical muscle in your inner thigh. For the purpose of this educational article we will differentiate 3 types of injuries to these muscles: a simple strain or small, a Medium tear and large tear.

1 Adductor Minor Strain or Small Tear The minor strain is just a very tiny dent in the muscle and very easy to recover from, Usually resting alone will be enough to return to Play . 2 Adductor Medium Tear The Medium tear is a different " animal" . There is structural damage of the muscle fiber and the body will repair the injured muscle with scar tissue. This type of injury, when not treated properly can become chronic , that’s why We advise Soccer Players to go through a comprehensive rehabilitation program before returning to Play.

3 Adductor Large Tear Large Tears are severe and very painful. There could be an avulsion (detachment of the muscle from the bone at its insertion site) or complete tear of the muscle. With this injury you will have to seek medical assistance and a good rehabilitation program is mandatory to return to Play.

How long will it take to heal ?

Again to simplify, because every case is different , we can say that Small Tears will heal in 4-6 weeks and Large Tears can take up to 10-12 weeks to heal.





Chronic Groin Pain





Chronic Groin Pain is when Soccer Players develop progressive Inner Thigh Pain, Lower Abdominal Pain or Pain in the front of the Hip Joint that last for + 6 Weeks.


At that point one of the main findings of the physical therapy exam, is Muscle Weakness in the Adductor Group.

But weak Adductors is not the only finding, this Pain is also associated to Weak Core Muscles and weak Hip Flexors.


With all these weak muscles, we can say that the Player loses the fine balance between the Thigh and Abdominal Musculature and the tissues surrounding the hip, groin and inguinal area become very irritated by any physical activity.

Therefore, to recover from this debilitating condition, one must first, help athletes to correct these muscle imbalances.  For example, during the rehabilitation process we teach our athletes to engage the core musculature before activating the powerful Adductors.

Groin Pain , do this exercise first


The first exercise I prescribe to people with groin pain is the Ball Squeeze for many reasons 1. Reproduces patients’ pain allowing them to regulate the amount of squeezing put into the exercise 2. Can be combined with a core activation first to reduce pain and increase pressure applied to the ball 3. Easy to implement 4. Can be used in the very early stage when other exercises are very painful to do .

Supine Hip Adduction - “Ball Squeeze “


Setup * Begin lying on your back with your legs bent, feet resting on the floor, and a soft ball positioned between your knees. Movement * Engage your core musculature by Bracing with your abdominal muscles * Squeeze your knees together into the ball, then release and repeat. Tip * Make sure to keep your back flat against the floor during the exercise.

Then repeat the same exercise with your knees straight following the same cues and sequence as before: core engagement, adductor contraction, adductor relaxation, core relaxation.









Groin and Core Strengthening : The Jackknife Exercise

Jackknife with soccer ball - Level 1

Setup * Begin lying on the floor with your legs straight. Movement * Position the soccer ball in between your knees and squeeze it as tolerated * Cross your fingers behind your neck, lift your Head and shoulder only to engage Core Muscles then lift your feet from the ground. Maintain this position for a second or two . As you familiarize with the exercise you can lift head and legs all together. Tip * Make sure to keep your back straight and your core muscles engaged during the exercise.


Jackknife with soccer ball - Level 2

Setup * Begin lying on the floor with your legs straight. Movement * Position the soccer ball in between your Ankles and squeeze it as tolerated * Cross your fingers behind your neck, lift your Head and shoulder to engage Core Muscles at the same time you lift your feet from the ground. Maintain this position for a second or two. Tip * Make sure to keep your back straight and your core muscles engaged during the exercise.





Late Stage Rehabilitation

Post-activation potentiation Technique for Adductors



This training technique refers to a short-term improvement in performance (e.g. cutting) as a result of using a conditioning exercise (e.g. side lunge). .

Many conditioning exercises, for example back squats, deadlifts, and even isometric contractions have all been shown to improve subsequent performances. In the case of this video the side lunge with weight “activates “ the Adductor Muscles and “potentiates” the lateral jumping and cutting.


This sequence will demand full use of your Adductor Muscles to produce force into the drill. . Recommended 5️ to 8 repetitions of Side Lunge with a dumbbell and 4-6 lateral High-Knees with cutting and quick change of Directions. It always good to work both sides and not only the affected extremity.

At present, there is no common agreement on what causes the muscles to experience this ‘potentiated’ state, though several neurophysiological mechanisms have been suggested – with some bearing more evidence than others.



Conclusion:


  • Groin Pain is a complex condition that requires a progressive approach to restore movement and strength in the Hip muscles in general and inner thigh muscles in particular.

  • Solving this condition requires a comprehensive approach to correct all deficits that can be causing the Groin pain .

  • Research shows that Physical Therapy and Strengthening exercises is the best approach for Acute and Chronic Groin Pain



Lionel Pannunzio is a Physical Therapist Certified in Sports Injuries. With more than 20 years of experience helping athletes return to their sports after an injury. He is the Owner of White Bay Sports Physical Therapy and Fitness, conveniently located  in the beautiful City of Weston, where he treats Soccer Player, Runners and Athletes of all ages

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Lionel Pannunzio

Physical Therapist

Board-Certified Sports Specialist

Owner of White Bay Physical Therapy

“Keeping Athletes in the game”

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