The Mystery of the Groin Injury

January 1, 2004

Over the past 24 years of assessing and treating groin injuries in soccer, I am still amazed at how little the average soccer player knows about this injury. I am amazed at how often this injury is ignored with the usual “well I thought it would just go away” approach for self treatment. I love the phrase “I’ve never had this before, how can this have happened to me?” Furthermore, professional athletes don’t seem to manage this condition any better than the amateurs despite their level of accomplishment in their soccer careers.

Most research would support the fact that there are numerous causes for injury to the groin. These would include: previous injury, poor conditioning, inadequate treatment or rehabilitation, environmental factors, overload during practice and games, amount and quality of training, playing surface conditions, and of course, being tackled during training or a game.

So what is a “Groin” injury anyway? Some call it a hip flexor muscle injury, a hernia, pubalgia, a hip joint injury, an osteitis pubis, a lower abdominal muscle injury, or an adductor muscle injury. It can be one of the above or a complex combination of two or more of these. In a recent study on the muscular origin of groin pain, it was suggested that the mechanism of injury is caused most often by a combination of abdominal hyperextension and thigh hyperabduction with the pivot point being the pubic symphysis. Oddly enough, females are not as susceptible to this injury as males are. The most common combination of the above muscular types of groin injury is the lower abdomen plus adductor muscle or hip flexor muscle pain.

The best treatment would be to immediately ice and stop playing or training. Don’t hope it will just go away, because it probably won’t. There is a common thought in soccer that stiff adductor muscles will predispose you to this injury. However, although this may be true for hamstring and quadriceps injuries, it does not appear to be the case with groin injuries. Stretching, although important as part of a good warm up and cool down, has not been shown to help prevent groin injuries. After proper diagnosis, which might include x-ray for bone chips, diagnostic ultrasound for identifying haematomas (blood clots in the muscle tissues) and muscle tears, a good rehabilitation program is essential. In the past, it was thought that treatment alone would cure this condition. However, we now know that identifying muscle strength weaknesses with computerized muscle testing devices such as Cybex is an essential part of the rehabilitation program. Not only do we look at overall strength, as in power, but also endurance of the injured muscle(s). Follow-up diagnostic ultrasound can be useful to assess the healing progress of a torn groin muscle(s) or to evaluate size of a haematoma as it shrinks during the healing process.

One of the biggest mistakes that soccer players make is going back to training and playing too early. Just because it feels good doesn’t mean that you are ready. So, my advice would be that the rehabilitation facility you choose should have the proper equipment to ensure that your recovery won’t be delayed unnecessarily due to inadequate testing and training equipment or due to accidental re-injury. Most minor groin strains without tearing recover over a 4 to 6 week period.

In summary, these are the essential tips for managing your groin injury of muscular origin:

* Avoid over-training and make sure that you have adequate rest time between sessions to recover from training and playing soccer.
* If it does happen to you, apply ice immediately and stop playing or training. Use a support or wrap to protect the area.
* See a qualified sports doctor and/or therapist who will perform the required tests to make an accurate diagnosis.
* Have an appropriate rehab program designed specifically for your type of groin injury with proper periodic evaluations to review your progress.
*Once you get back on the field, consider using compression shorts until you have trained and played pain-free for at least 4 weeks.


Finally, remember that previous groin injuries make you more susceptible to re-injury, so keep that area strong and follow a well-designed warm-up and cool-down program before and after training sessions and games.


Submitted by: Dr. Robert Gringmuth, DC, FCCSS(C), FCCCRS(C)
Chair, OSA Medical Committee
Sports Specialist to the Toronto Lynx Soccer Club, The OSA and The National Training Center Ontario