Risk Factors for Groin Strains in Sports

DSC01635Groin strains and other injuries are very commonly observed in sports, and have been reported to cause up to 16% of injuries in sports like soccer.  For those that work with athletes and who have seen these injuries, you know that groin strains can be tricky and often times become a recurrent problem.  Thus, it is important to identify risk factors associated with groin injuries to assist in identifying those at risk for injury as well as serving as a potential criteria to return to play.

A recent study from the American Journal of Sports Medicine followed 508 soccer players over the course of one season in an attempt to identify potential factors correlating to groin injury.  The authors examined several functional tests (such as jumpy tests and a 40-m sprint) a several clinical examinations including strength, flexibility, and palpation of the hips and lower extremity muscles.

10% of players followed sustained a groin strain.  The authors demonstrated that the two most significant risk factors were:

  1. History of previous groin injury – those with a history of previous groin injuries were twice as likely to sustain another groin injury
  2. Weak adductor muscle – those with weak adductor muscle groups show a 4x greater chance of sustaining a groin injury.

 

Clinical Implications

Several studies in the past have shown similar results in regard to previous injuries and this is one of the main things I preach when developing and implementing injury prevention programs:

The #1 risk factor for muscle strain injuries is a previous muscle strain injury

Therefore, attempting to prevent injuries is key.  The second component of this study is a good step in that direction.  Adductor weakness had a very large contribution to groin injuries.  I think we could also extrapolate this information to other muscle groups as well, such as the quad or hamstring.  The way I think of it is that a healthy athlete with muscle weakness or imbalance is still going to perform at 100% intensity.  But if a specific muscle group was at, perhaps 80% strength, something has to give and a strain occurs.

This information really underscores three take home messages for me:

  1. Past injuries are going to lead to future injuries, often times there was a reason this person was injured the first time, right?
  2. We need to do our best to identify those at risk for injuries to prevent this future cycle of injury and reinjury – this includes screening for muscle weakness and imbalances
  3. We need to make sure that the athlete returns to activities when they have restored this weakness or imbalance.  I bet one of the reasons that these injuries continue to reoccur is because we far too often rely on pain as our criteria to return to play.  Just because the athlete is asymptomatic does not mean they are ready to compete.

What have you found to be helpful in reducing these reinjuries?  What do you do to screen for lower extremity imbalances?  Have you found them to be effective in preventing injuries?

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11 Responses to “Risk Factors for Groin Strains in Sports”

  1. Hi Mike,
    I have found an adduction squeeze test using a sphygmomanometer to be a useful screening test for groin injuries. Comparisons of preseason data and during season to look for loss of strength and thus increased risk. Currently the practice Im in doesnt see alot of groin strains but I learnt the above technique from a previous employer and they had good success with it.

  2. @ Luke, good idea. Do you remember any norms?

  3. Hey Mike. One thing I think may be important to consider is left vs right. Have you noticed a pattern? Any thoughts on the possibility that recurrent groin strains could be a result of femoral positioning in relationship to the acetabulum and FAI?

  4. Hi Mike,
    Good post. There is also some evidence from a study by Verrall et al – Journal of Science and Medicine in Sports 2007; 10: 463-466 – suggesting that lower hip ROM in abduction and combined rotation can predispose to developing chronic groin injury. This was a prospective study done on a group of Aussie rules footballers.

    Kevin Neeld reviewed this paper for us on Research Review Service FITNESS and wrote this in the 'Clinical Application & Conclusion' section of the review:
    "Clinicians and coaches can help minimize chronic groin injury risk of their athletes by assessing hip joint ROM and addressing deficiencies. Although subject to a wide range of variability depending on individual hip joint anatomy, in general athletes should have around 30-40° of internal rotation ROM and 40-60° of external rotation ROM. Range of motion deficiencies can be remedied by addressing local soft-tissue structures using a foam roller and/or lacrosse ball and by using a variety of stretches. Various manual therapy techniques could be employed if you work in a multi-disciplinary environment, and have access to a chiropractor or physiotherapist for your clients. To improve internal rotation ROM, athletes can perform a supine lying knee-to-knee stretch, a prone flexed knee internal rotation stretch, and supine knee to opposite shoulder stretch. To improve external rotation ROM, athletes can perform a seated “newspaper” stretch by sitting with their heel across their opposite knee and gently pressing on the knee of the raised leg."

    Cheers,

    Shawn

  5. @Shawn – good comments, thanks for sharing!

    @ Haim – very good points regarding FAI, and I would add sport hernias as well. Groin pain may be coming from elsewhere, no doubt. But a true groin strain is likely a groin strain. FAI and athletic pubalgia could look like groin "pain" but classic signs of a strain will not be there.

  6. Mike,

    I see this fairly often in professional soccer players.

    Adductor strains occur from kicking, change of direction or by stretching (reaching out to block ball or tackle opponent).

    We tend to see several muscle imbalances in our players including quad dominance from the demands of the game (kicking, deceleration) as well as a lack of ROM in the IR/ER of their hips. This can be different from plant leg versus dominant kicking leg as well.

    Soft tissue work can help balance these differences. Foam rollers work best on quads/hamstrings/adductors while foam/lacrosse/baseball/softball work best on the gluts to get into the spaces between SI joint and greater trochanter. Stretches as described in Dr Thistle's comment work well too.

    Strengthening of the gluts and abdominals is part of the adductor rehab as well (remember lower crossed syndrome).

    FAI and sports hernia are two entirely different issues that deserve their own posts.

    Thanks for the good post on lower body stuff!

    Theron Enns, ATC
    Houston Dynamo

  7. Sphygmomanometer is more indirect than testing muscle with a objective myoanalytics device such as TMG, Myoton, or thermography- something getting muscle readiness. I would look at gait analysis with pressure mapping and EMG as well, since those areas are likely a more effective way to make interventions than just muscle strength and previous injury. Look at what the Spanish League is doing, very impressive but like any soccer club lifting is still behind the Aussies and North American sports.

  8. Hey mike,
    What do you know about chronic groin strains and pelvic alignment? Where is a good place to look into and what might you expect to see?
    Thanks so much!

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