Groin pain and strains
Article by Doug James (intraining physiotherapist and podiatrist)
Groin injuries – What you need to know
Groin injuries are an increasingly common injury in distance runners. Previously it was predominantly footballers that would develop these injuries due to the forceful nature of the kicking movement, however, runners are now reporting more injuries in this region. Despite being a ‘personal’ area of the body, assessment and treatment of these injuries should occur promptly to reduce the likelihood of it developing into a more severe and chronic injuries.
There are a large number of injuries that can cause groin pain. While the pain can be due to injuries to tendons, muscles or ligaments in the groin itself, groin pain may in fact be referred from an injury elsewhere which makes diagnosis more difficult.
Acute groin injuries
Acute groin injuries are those that start suddenly and are usually due to muscle strains in the adductor muscles on the inner thigh. Adductors attach to the central part of the pelvis and pain can be felt anywhere from the knee to the groin. These injuries often feel like a tightness, however, attempts to stretch the injury can exacerbate a mild muscle tear into a more serious injury. Continued bouts of stretching an adductor tear may induce adductor tendinitis which can cause long-term discomfort that is difficult to settle.
Adjacent to the adductor tendon insertions is the pubic symphysis which is where the two halves of the pelvic girdle are joined together with cartilage. This cartilage can become irritated from adductor tendinitis – an injury known as Pubic Symphysitis – and can also be triggered by running on hard surfaces with poor shock absorption. If poorly treated, a more severe version of this injury, Osteitis Pubis, may emerge where part of the pubic bone is eroded, and a much longer recovery time is needed (including up to a year off running).
Osteitis Pubis is not the only groin injury that involves damage to the pelvic bone. Pelvic stress fractures are a dangerous injury, and shouldn’t be ignored. These often start as dull, non-specific groin pain that will become sharper with running and exercise. A stress fracture can develop and requires a substantial amount of time to settle.
Imaging can be useful to help accurately diagnose groin injuries.
- Ultrasound can identify soft tissue injuries such as adductor strains and tendinitis
- MRI is often more effective to detect any damage to the bone.
Referred pain that is felt in the groin can originate from many sources including the hip joint (in the form of cartilage tears or joint inflammation), abdomen (abdominal muscle strain), and lower back (tightness and/or disc injuries). Due to the magnitude of potential areas of concern, a thorough examination is necessary with a podiatrist or physiotherapist.
Most groin injuries respond well to resting from activities that cause pain. Care needs to be taken with cross-training as even non-weight-bearing exercises such as swimming can exacerbate the injury. There is often a link between weak core and glute muscles and groin injuries. Improving core and lateral glute strength is useful as both a prevention and (at a suitable time) rehabilitation of the injury.
Be proactive in seeking help. Early diagnosis and management may avoid prolonged time out of training. If you have lingering groin pain, make an appointment and start moving towards pain-free running again.