Groin Muscle Strain / Groin Pull
Related terms: Gilmores Groin, GrOin Disruption, Inguinal Disruption, Sportsman's Hernia, Strained Groin, Adductor Pull, Adductor Injury, Osteitis Pubis, Sports Hernia
A pulled groin (also termed as "groin strain") is used to describe damage to the muscles on the inside of the upper thigh - near the pubic area. A groin strain/tear can be extremely painful and are nearly always sports related.
There are six muscles in the thigh - all of them working together to give you full movement of your leg and hip. One or more of these muscles may be strained or partially torn - if this is the case then you are experiencing a groin strain/tear. When we talk about a pulled groin or some other soft tissue injury to the groin, we are really dealing with a muscle, ligament and/or tendon injury of the hip.
As you may expect, the hip is quite a complicated joint. The pelvis sustains most of your body weight while also providing 2 joint sockets, enabling your upper legs to attach to the pelvis. Achieving such a substantial range of motion of the torso, back and upper legs require a significant number of muscles; further to this - all nerves and blood flow needed for your lower body flow through the hip. Due to this, the hip has a total of 17 muscles, 5 bones, numerous tendons, ligaments and bursae used to connect your leg bone (femur), pelvis and spine together.
There are two separate classifications of muscles in the hip - the hip adductor muscles & the hip flexor muscles and they are listed as follows...
Hip Adductor Muscles
The hip adductor muscles help to bring your legs together and rotate your hip inwards towards the midline of your body. There are two types of adductor muscles - long adductors and short adductors.
Short Hip Adductor Muscles
- pectineus muscle
- adductor brevis muscle
- adductor longus muscle
Groin strain most commonly occurs in the adductor longus muscle.
Long Hip Adductor Muscles
- adductor magnus muscle
- gracilis muscle
All of these muscles are located on the inside of your thigh. At the end of these muscles are tendons, which are tough, fibrous tissues that connect muscles to bone. Most of the hip adductor muscles and tendons attach your pubic bone (lower part of the pelvis) to your thigh bone (femur); however the gracilis muscle attaches to the lower leg bone (tibia) not the femur. These muscles and tendons start in the groin (creasing at the junction of the inner part of the thigh where it meets the body near the external genital area) and move down through the inner thigh to the inside of the knee.
The adductor magnus and adductor longus draw the leg toward the inside of the body.
Related Adductors: Hamstring Muscles
The hamstring muscles (semitendinosus, biceps femoris, semimembranosus) and gluteus maximus allow you to move your leg backward, behind your body from your hip (extension). The biceps femoris is the most commonly injured muscle in this muscle group, followed by the semitendinosus muscle. The occurrence of an injury to the semimembranosus muscle is rare. When it comes to groin injuries, I include the hamstring muscle group as there has been some evidence that injuries to both are related to hip and pelvis mechanics:
When individuals "lock down" their thoracic spine and rib cage (areas of mobility), they will compensate by moving through their lumbar spine and pelvis (areas of stability). Once the nervous system recognizes instability through the lumbar spine, there is reflexive up-regulation (increased activation) of the hamstrings and external hip rotators. This results in a subsequent loss of hip motion, leading to further movement dysfunction in the lumbar spine. Additionally, it leads to the femoral head being driven forward into the socket and the loss of internal hip rotation. Research has demonstrated that loss of internal hip rotation is a direct cause of anterior hip pain.
This is often complicated by weakness of the stabilizing structures of the femoral head in the acetabulum. Weakness of the gluteus maximus in hip extension and the iliacus/psoas complex in hip flexion has been shown to contribute to an increase in femoral head migration in the acetabulum and can therefore be considered a precursor to anterior groin injuries.
This change in pelvic alignment (posterior tilt and lumbar flexion) and femoral head position (anterior migration) then becomes a direct cause of hamstring injuries. The change in pelvis and hip alignment functionally inhibits the gluteus maximus, leading to synergist dominance of the hamstrings for hip extension. Because of their attachment to the ishcial tuberosity, the hamstring can not maintain an optimal axis of hip rotation. Along with the altered pelvic alignment, the hamstrings serve to drive the head of the femur further forward in the socket. Over time, the hamstrings fatigue from being overworked as hip extensors and become susceptible to tears and other overuse injuries.
Source: "Groin And Hamstring Injuries | Article | Ptonthenet". 2019. Ptonthenet.Com. Accessed February 22 2019. view source (opens in new page).
The long head of the biceps femoris extends the hip, as when beginning to walk; both short and long heads flex the knee and laterally (outwardly) rotate the lower leg when the knee is bent.
The distal semitendinosus tendon is one of the tendons that is often considered as a candidate in the reconstruction of the ACL (anterior cruciate ligament of the knee). In such a procedure, a piece of the tendon is removed and used to replace a damaged ACL.
Hip Flexor Muscles
The hip flexors are among the most powerful set of muscles and tendons in your body. Together hip flexor muscles and tendons help you lift your upper leg to your torso or flex your torso towards your thigh. The actions would be when sitting up from a lying down position. They externally rotate your spine and thigh bone, and also limit your hip extension when walking or running. They are made up of a deep set of muscles at the front of your hip (iliopsoas), outer hip muscles (tensor fasciae latae), and muscles that lie over the top of the iliopsoas muscles in your front, upper thigh area (rectus femoris and sartorius).
Flexor Group 1: The Iliopsoas
The Iliopsoas muscle is really a combination of 3 muscles - all of which lie deep within the hip: the psoas major, psoas minor, and iliacus. The psoas muscle lies at the front of your hip. It starts in your lower back, attaches to the base of your sacrum (triangular bone that forms the bottom of your spine and the back part of your pelvis) on the inner surface of your ilium (the upper and widest part of the pelvis/hip bone) and ends on the top of your femur (thigh bone). The iliacus starts from your hip bone/ilium, and attaches across to the inner surface of your lower spine and sacrum. It also ends at the top of your femur. Both of these muscles come together via the same tendon and attach to the bump on the inside of the shaft of your femur (the lesser trochanter) - this is where most injuries occur.
The iliopsoas muscle is the strongest flexor of the hip joint and is arguably the most important muscle group in the body. If you are doing a sit up, the iliopsoas muscle group is basically what allows you to straighten your upper body. Without it, walking is pretty much impossible.
Flexor Group 2: Quadriceps
The rectus femoris is the most prevalent of the four quadriceps muscles. The other quadriceps muscles are the vastus intermedius, vastus medialis and the vastus lateralis. All the quadriceps muscles attach to the quadriceps tendon which attaches to the knee cap (patella) - these muscles work together to bring the leg forward (hip flexion).
Rectus femoris strain
This is commonly referred to as hip flexor strain. Often this injury takes place at the tendon that attaches to the patella or in the muscle itself. Often the injury is a partial tear but it is not rare for a full tear to happen. The injury is caused by a forceful movement related to sprinting, jumping, or kicking and as such, is common in sports like football and soccer. The rectus femoris crosses both the knee and the hip and because of this, it is more prone to injury. Symptoms include a sudden sharp pain at the front of the hip or in the groin, swelling and bruising, and an inability to contract the rectus femoris with a full tear.
Flexor Group 3
In the adductor group, the adductor magnus and adductor longus draw the leg toward the inside of the body. Conversely, the gluteus medius, gluteus minimus and tensor fascia latae (attached to the IT band) are used to abduct your leg away from the body. The tensor fascia latae (TFL) also assists with rotating your hip inward and hip flexion.
This muscle group is basically responsible for stabilizing the hip, especially with weight bearing activities (ie. maintaining balance while carrying a child while walking or just standing).
Other deep muscles of the hip include the piriformis, the obturator internus, the obturator externus, the gemellus superior, the gemellus inferior and the quadratus femoris.
Common Symptoms of Groin Strain)
A sharp pain may be felt in your groin and inner thigh area if you are suffering from a groin / hip pull or strain. You will feel tightness, tenderness and/or muscle spasms when you try to move your groin muscles. Movements you previously took for granted throughout your day become painful and even impossible, such as getting into a car seat. Attempts to try and move your legs or extend / rotate your hip or leg inward can immediately trigger a lot of pain.
You may feel tenderness in the inside of your thigh, especially when you touch/prod the area. Pain may also radiate further down your inner thigh. If you have a chronic injury, you may feel more of a dull ache that lasts for long periods of time. This pain can happen in one area or multiple areas at one time.
You will likely experience stiffness and a decreased range of motion (ROM) in the area as a result of a pulled groin - this will make it difficult to bend and rotate your hip and knee. To test your stiffness and ROM, sit on the floor and put the soles of your feet together. If you have tightness, pain and/or tenderness while doing this, you are likely suffering from a damage to one or more of your hip flexor muscles. You may also feel tightness in your lower abdominal, spine, hip and thigh region. You may also feel pain if you lay down on your back and raise your heels just a slight 15 degrees off the ground.
- Swelling in your groin / hip muscle is a result of muscles and/or tendons becoming inflamed. This normally occurs with a more serious groin pull. Warmth and redness may accompany swelling in severe cases.
- Weakness of the groin muscles may also be experienced as a result of a groin pull. This will make it difficult for you to walk or run and can result in you walking with a limp.
- Occasionally, bruising (broken blood vessels) may appear a few days after your injury in one area of the groin - or or the bruise can span from your groin down to your knees
- A popping or snapping sensation in your hip can often be heard when your hip flexor or hip adductor muscles are tearing.
Three Grades of Groin Strain Severity
This can be classified into 3 grades of groin pull or strain severity:
Minor - Grade 1 Groin Pull
A grade 1 groin pull means you have slightly pulled muscles or very small tears in these muscles. You will generally feel mild cramping which will be a little tender or uncomfortable, but will involve little swelling or loss of strength.
Moderate - Grade 2 Groin Pull
Grade 2 pulls are more severe and painful than a grade 1 pull. This will involve a partial tearing of the groin fibers in your muscle, tendon, or where the tendon attaches to bone. You will generally experience pain, along with swelling, decreased range of motion and strength, as well as difficulty walking or running. Your groin muscles will often be painful when you touch them.
Severe - Grade 3 Groin Pull
Severe groin pulls involve a complete tear (rupture) of groin muscle fibers - usually where the muscle meets tendon or where the tendon attaches to bone. A grade 3 Strain/Pull is very painful and less frequent than the others. You will tend to experience a burning or stabbing pain, a lot of swelling and significant loss of strength. This may prevent you from walking without assistance and likely make it impossible for you to run. Bruising in the injured area is common a few days after the accident. This type of pull or strain will require a surgical repair as there is complete detachment.
Causes of a Strained Groin
Hip and groin pulls are among the most common of any injuries that occur in the hip and groin. When it comes to sports related injuries:
- People that participate in active sports such as hockey, basketball, soccer, football, rugby, tennis, track & field activities (running, hurdles, long jump) - activities that involve a lot of jumping, kicking, and changing direction at various speeds while running are more susceptible to hip strain.
- Groin strain is obviously more common in sport that places extra pressure on muscles in the groin. Such sports include skiing, skating, karate, weight lifting, gymnastics, ballet dancing and horse-back riding.
Those that participate in sports yet embody poor motion mechanics are more susceptible to muscle and tendon strain as a whole. Poor mechanics in running sports specifically would make a person more vulnerable to hip, leg, lower back, groin, knee, ankle and foot related strain/sprain injuries. Unless the mechanics are corrected, the injuries will most likely persist and become chronic (long term); eventually, the injury may affect gait (the way you walk) permanently.
Outside of sports,
- a hip flexor injury can be caused from a sudden fall or direct hit to the muscle itself.
- any activity that involves twisting or lifting heavy objects while bending can cause hip strain or a groin pull.
- any activity that involves running on a slippery or unstable surface (like grass) can cause hip strain or a groin pull.
- many groin strains occur when one is trying to pull their leg inwards (toward the torso) but something pushes the leg outward (away from the torso), such as kicking against resistance or jumping.
- overstretching, overloading and overuse of your hip flexor and groin muscles can cause hip and groin pulls.
- weakness or a strength imbalance in the hip and groin muscles can cause hip and groin pulls. If your muscles are tight or inflexible, this will make your situation worse.
- a strength imbalance in the lower back and torso can cause groin pulls. If your muscles are tight or inflexible, this will make your situation worse.
- alignment issues with your pelvis can cause hip and/or groin strain.
- overpronation, supination and/or leg length discrepancies can cause hip and/or groin strain.
- lack of exercise and changes in the intensity of your activity without proper preparation (common with weekend warriors), age-related weaknesses and/or degeneration, previous hip muscle injuries, and obesity will also influence your risk of experiencing groin pull.
Overstretching, Overloading & Overuse
This occurs often for "weekend warriors" or sometimes in athletes - especially when training competitively for the high risk sports (listed above), and/or in swimming when using a "swimming breaststroke" (whip kick) on a regular basis. The chances for injury are increased when the person has not warmed-up and/or stretched properfly beforehand. Without proper stretching and warm-up, muscles just aren't ready for the added stress. You are at further risk of a strain or pull if you are performing these activities in cold temperature or if are tired.
Diagnosing a Groin or Hip Strain
To help your doctor give you a diagnosis, he/she will begin with your medical history, current condition and symptoms. He/she will ask how much pain you are having, if you heard a popping noise when you first experienced your injury. The how long you have the type of symptoms and the limitations you are experiencing. Details about what brought about your problem, when it started, and whether or not you have ever had treatments for this or a similar condition in the past, will be very helpful in assessing your injury.
A physical examination done by your doctor will look and feel the muscles, bones and other soft tissue in and around your hip, torso and thigh to identify pain, tenderness and non-symmetric variance (ie. the inside of your left thigh is more swollen than the inside of the right thigh). This will help the physician discover abnormalities, such as mild or severe inflammation, fluid, bruising, bone or tissue deformity, and leg length discrepancies. He/she may ask you to complete a series of flexing and extending leg movements to see what motions cause pain, weakness, tightness, or instability. Your doctor will also likely test for the grade of muscle strain and try to identify any muscle imbalances. Generally with a strain you will experience resisted extension and pain, where as with a tear you will not be able to complete a specific request (such as raising your feet while lying on your back). They physician may also evaluate your feet and gait (the way you walk) to determine if you overpronate, or have other alignment issues.
Most Common Quadriceps Injury Diagnostic Tests:
Most grade 1 or 2 strains don't require diagnostic testing but the physician may opt for one anyway if they are finding the severity difficult to determine. This difficuly is due to swelling and bleeding that can occur deep within the muscle, and many muscles in this area are deep.
X-rays will provide a two-dimensional image of the overall structure of your upper leg (pelvis, femur and knee). They are helpful in pointing out instability, fractures, abnormal bone shapes (bone spurs, calcifications or cysts, joint degeneration), and/or other hip and groin problems.
MRIs (magnetic resonance imaging) will provide more detailed information and will help to see the soft tissues in and around your area of injury (muscles, tendons, ligaments, fascia, and other connective tissues). The accuracy of an MRI will most likely provide your doctor with plenty of information to determine the grade of your thigh muscle tear. The MRI will also determine if there is additional ligament or tendon damage, inflammation, tendinopathies and many other associated conditions.
Should you seek medical attention?
This is up to your discretion; however any continued discomfort in your thigh area should be investigated. If you continue to experience the thigh muscle related injury symptoms and have tried the suggested conservative treatments for 2 -3 weeks, it is recommended that you seek professional medical attention. It is recommended you seek immediate attention if you:
- hear a "loud pop" in your muscle when injured
- have immediate severe pain, swelling or discoloration in your quadriceps
- experience severe weakness in your hip/groin area and have difficulty walking
- have a temperature over 100.4 degrees F (38 degrees C)
- notice blue toe nails, numbness or coldness below your injury
Preventing Groin Strains
It is always better to prevent injuries rather than try to fix them after they happen, however that is not always the situation. A thigh muscle strain can be difficult to prevent as your major symptoms may start long after you've had the condition. In any case, there are a number of things you can do to keep yourself healthy and prevent further damage.
Maintain a strong and proper posture, and wear proper footwear and gear for your activity. This will ensure your body is properly aligned, and will prevent against slouching or bad form which will make you more prone to injury. Your equipment should be comfortable and provide enough padding (knee or thigh pads), and your shoes should provide sufficient sole stiffness and arch support.
Avoid doing too much to soon to give your body an opportunity to build up its endurance. This is especially important when participating in a new activity. Gradually increase your participation to prevent overstraining your muscles.
Always warm up your muscles (especially your leg muscles) before working them to prepare your body and to raise your body temperature (15-20 minutes is the recommended time). Recovery from your activity can be enhanced by doing a cool down to lower your body temperature and relax your muscles.
To stabilize your thigh muscles, and increase your range of motion, maintain and build your strength, stability and flexibility of your quadriceps as well as your hamstrings, IT band, lower leg, gluteal, pelvis, low back and core body muscles. Light weights, exercise bands and balls are very beneficial for strengthening your lower body. Core balance training and exercises to develop strength, speed and agility, such as jumping or bounding movements (plyometrics). Yoga, tai chi, or a daily stretching routine will help to keep your muscles and joints supple - avoid sudden twisting and turning motions.
A regular exercise program that focuses on total body fitness and includes low-impact aerobic activity at least 3 days per week, such as walking, swimming or biking will help to keep you healthy overall and will strengthen your body to prevent against further quadriceps injuries.
Proper food and fluid intake prior to and/or during activities will ensure you have enough energy and will help to prevent against fatigue. Ensure you avoid dehydration which can lead to muscle cramping. Weight loss and/or weight maintenance involves eating a balanced diet full of protein, complex carbohydrates, fats, vitamins, minerals, phytochemicals and antioxidants which will help support a healthy system. If you gain just 10 pounds, your joints must bear from 25 up to 100 pounds extra, which can add unnecessary stress to your body. Limiting your caffeine, alcohol and nicotine consumption will also improve your health.
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