Transcript Adductor-Related-Groin-Pain-Handoutx

Adductor Related Groin Pain
Normal Anatomy
• Adductors are a group of 6 muscles on the inner
thigh
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Pectineus
Adductor longus
Adductor brevis
Adductor magnus
Gracilis
Obturator externus
• All originate from the inguinal region at the pubis
at various points
• Attach onto linea aspera of femur
• Adduct the thigh
• Also have roles in flexion/extension depending on
amount of hip flexion
• Also have stabilisation roles on pelvis
• Direction of pull is opposite to rectus abdominus
Pathology
• Pain in the adductor region most
commonly onto the insertion
into the bone
• Takes into consideration muscle
strains, ruptures, tendinopathies
• Term “Adductor Related Groin
Pain” used following Doha
Agreement
Mechanism of Injury
• Traumatic
• Acute pull in the muscle
• Over stretching or a tackle
• Insidious
• Load placed on tissue greater than
tissue capacity
Subjective Examination
• History indicates overstretching trauma or periods of increased load
• Pain in the adductor region which increases with exercise
Objective Examination
• Pain on palpation of the
adductor region
• Pain in the adductors on resisted
adduction
Objective Examination
• Pain on palpation of the
adductor region
• Pain in the adductors on resisted
adduction
Objective Examination
• Pain on palpation of the
adductor region
• Pain in the adductors on resisted
adduction
Further Investigation
• MRI
Management
• Similar approach to treating tendinopathy
• Active exercises strongly proven within the literature
• Interventions should be targeted at the adductors AND the rest of the
kinetic chain
Conservative
• Reduce Pain
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Remove the abuse load
Isometrics
Soft Tissue Massage
Joint Mobilisation
Joint Manipulation
Ice
NSAID’s
• Restore Normal Range of Movement
• Lumbar spine, hip and knee
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Stretching
Soft Tissue Massage
Joint Mobilisation
Joint Manipulation
Conservative
• Restore Normal Muscle
Activation and Strength
• Adductors, lumbar spine and
entire kinetic chain
• Isotonic and Isometric Exercise
• Core work with abducted hips
• Restore Dynamic Stability
• Proprioceptive Exercise
• Report to Sport Specific Training
• Gradual increase of sport specific
drills
Conservative
• Restore Normal Muscle
Activation and Strength
• Adductors, lumbar spine and
entire kinetic chain
• Isotonic and Isometric Exercise
• Core work with abducted hips
• Restore Dynamic Stability
• Proprioceptive Exercise
• Report to Sport Specific Training
• Gradual increase of sport specific
drills
Plan B
• Surgical Intervention depends on imaging and arthroscopic findings
References
• Branci, S., K. Thorborg, M. B. Nielsen and P. Holmich (2013). "Radiological findings in symphyseal and adductor-related groin pain
in athletes: a critical review of the literature." Br J Sports Med 47(10): 611-619.
• de SA, D., P. Hölmich, M. Phillips, S. Heaven, N. Simunovic, M. J. Philippon and O. R. Ayeni (2016). "Athletic groin pain: a systematic
review of surgical diagnoses, investigations and treatment." British Journal of Sports Medicine.
• Holmich, P. (2015). "Groin injuries in athletes--development of clinical entities, treatment, and prevention." Dan Med J 62(12):
B5184.
• Holmich, P., P. Uhrskou, L. Ulnits, I. L. Kanstrup, M. B. Nielsen, A. M. Bjerg and K. Krogsgaard (1999). "Effectiveness of active physical
training as treatment for long-standing adductor-related groin pain in athletes: randomised trial." Lancet 353(9151): 439-443.
• Ibrahim, A., G. A. Murrell and P. Knapman (2007). "Adductor strain and hip range of movement in male professional soccer
players." J Orthop Surg (Hong Kong) 15(1): 46-49.
• Nicholas, S. J. and T. F. Tyler (2002). "Adductor muscle strains in sport." Sports Med 32(5): 339-344.
• Tyler, T. F., S. J. Nicholas, R. J. Campbell and M. P. McHugh (2001). "The association of hip strength and flexibility with the incidence
of adductor muscle strains in professional ice hockey players." Am J Sports Med 29(2): 124-128.
• Valent, A., A. Frizziero, S. Bressan, E. Zanella, E. Giannotti and S. Masiero (2012). "Insertional tendinopathy of the adductors and
rectus abdominis in athletes: a review." Muscles Ligaments Tendons J 2(2): 142-148.
• Weir, A., P. Brukner, E. Delahunt, J. Ekstrand, D. Griffin, K. M. Khan, G. Lovell, W. C. Meyers, U. Muschaweck, J. Orchard, H.
Paajanen, M. Philippon, G. Reboul, P. Robinson, A. G. Schache, E. Schilders, A. Serner, H. Silvers, K. Thorborg, T. Tyler, G. Verrall, R. J.
de Vos, Z. Vuckovic and P. Holmich (2015). "Doha agreement meeting on terminology and definitions in groin pain in athletes." Br J
Sports Med 49(12): 768-774.
• Weir, A., J. A. Jansen, I. G. van de Port, H. B. Van de Sande, J. L. Tol and F. J. Backx (2011). "Manual or exercise therapy for longstanding adductor-related groin pain: a randomised controlled clinical trial." Man Ther 16(2): 148-154.