At Walker and Hall we know through personal experience how groin pain can have an enormous effect on every aspect of your life e.g., standing and dressing, walking, sitting, getting in and out of a car, driving and working and sports and leisure activities.
It is an area that people frequently have problems with and the most common types of groin pain we treat are
Adductor Strain (Adductor Tendonitis)
Pelvic Stress Fractures
If your condition is not listed above please contact us
We have extensive experience in treating these conditions and managing your recovery.
To see how Walker and Hall can help you please click on the links below:
Adductor Strain (Tendonitis) (also known as Adductor Tendinopathy, Adductor Tendinitis, Adductor Tendinosis, Groin Tendonitis, Groin Tendinopathy, Groin Tendinitis, Groin Tendinosis)
An Adductor Strain (tendonitis) is a condition characterized by tissue damage and occasional swelling to the adductor tendon at its insertion to the pelvis which often results in groin pain.
It is the most common hip/groin injury we treat at Walker and Hall and we know through experience that it responds well to the appropriate physiotherapy management.
The muscles at the inner aspect of your thigh are known as the adductor muscles (groin). They attach to the pelvis and insert into the inner aspect of the thigh bone (femur) and lower leg bone (tibia). They are responsible for stabilising the pelvis and moving the leg towards the midline of the body (adduction), and are particularly active during running – especially when changing direction, and kicking.
During contraction of the groin muscles, tension is placed through the adductor tendon at its attachment to the pelvis. If this tension is excessive due to too much repetition or too high a force, damage to the adductor tendon may occur. Adductor tendonitis is a condition whereby there is damage to the adductor tendon with subsequent degeneration and sometimes swelling.
Causes of Adductor Tendonitis
- Overuse – adductor tendonitis is usually the result of an overuse injury, often due to repetitive or prolonged activities placing strain on the adductor tendon. This typically occurs due to repetitive running, kicking or change of direction activities.
- Forceful muscular contraction – should this occur when the adductor muscles are in a position of stretch such as rapid acceleration whilst running e.g., in rugby, a sudden change in direction or when kicking a long ball during football, strain to the adductor muscles can occur.
Adductor tendonitis is commonly seen in running sports such as football, hockey and athletics – especially sprinters, hurdlers and long jumpers, as well as in skiing, horse riding and gymnastics.
There are a number of factors which can predispose you to developing adductor tendonitis. A few of these are
- muscle tightness (particularly of the adductors, gluteals, hip flexors and hamstrings)
- muscle weakness (especially of the groin, gluteals or core stabilisers)
- inadequate rehabilitation following a previous adductor injury
- inappropriate or excessive training or activity
- inadequate recovery periods from sport or activity
- change in training conditions or surfaces
- poor posture
- poor foot posture e.g., flat feet
- inappropriate footwear
- inappropriate running technique
- inadequate fitness
- inadequate warm up
- joint stiffness (particularly the lower back, hip and knee)
- poor pelvic and core stability
- neural tightness
- muscle imbalances
- being overweight
Signs and symptoms of Adductor Tendonitis
- Pain – a gradual onset of groin pain over a period of time. You may also experience pain on firmly touching the adductor tendon at its attachment to the pelvis. It may also increase when squeezing the legs together or when moving the affected leg away from the midline of the body (abduction). In less severe cases you may only experience an ache or stiffness in the groin that increases with rest following activities requiring strong or repetitive contraction of the adductor muscles. These activities typically include running, kicking and change of direction activities. It may also warm up with activity in the initial stages of the condition.
As the condition progresses you may experience pain during the activity and it may begin to affect your performance. In severe cases of adductor tendonitis the patient may be unable to continue the activity and may limp as a result of pain.
How Walker and Hall can help you
A thorough musculoskeletal examination is required to determine the extent of the adductor tendonitis. This is essential if the optimum recovery is to be achieved.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for adductor tendonitis include
- Ice or heat treatment (providing this is comfortable)
- Pain relieving techniques e.g., gentle joint mobilising techniques, electrical therapy e.g., ultrasound and interferential therapy and soft tissue massage to reduce pain and muscle spasm
- Joint mobilising techniques – to the hip joint, lumbar spine and sacroiliac joints e.g., gentle stretching and muscle release techniques.
- Home exercise programme – a graduated strength, core stability, pelvic stability, flexibility and balance programme to ensure an optimal outcome
- Anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Pelvic Stress Fracture (also known as Stress Fracture of the Pelvis, Pubic Ramus Stress Fracture, Pubic Bone Stress Fracture, Ischial Stress Fracture)
A pelvic stress fracture is a condition characterized by an incomplete crack in one of the pelvic bones.
Each half of the pelvis is made from the fusing together of 3 bones known as the ischium, ilium and pubis. Before puberty (ages 10 to 12), these bones are separated by cartilage but by the age of 20 to 23 they fuse together to form one complete bone. The two halves of the pelvis are called hemi pelvises and join together to form the pelvis as a whole.
Many muscles of the hip, knee, lower back and abdomen attach to the pelvis. When these muscles contract, a pulling force is exerted on the bone. In addition, weight bearing activity places compressive forces on the pelvis via the hip joint. When these forces are excessive or too repetitive, and beyond what the bone can stand, bony damage can gradually occur. This may initially result in a bony stress reaction, but with continued damage it may progress to a pelvic stress fracture. The pubic ramus and ischium are the two most commonly affected regions of the pelvis for a stress fracture. When these occur they are called ‘Pubic Ramus Stress Fracture’ and ‘Ischial Stress Fracture’ respectively.
Cause of a pelvic stress fracture
A pelvic stress fracture typically occurs over time and may be caused by:
- Excessive weight bearing – activities such as running, sprinting, jumping or dancing. These often occur following a recent increase in activity or change in training conditions – such as surface, footwear or technique changes etc. and are particularly common in long distance runners
- Repetitive kicking in sports – such as rugby and football
- Following pregnancy – returning to excessive weight bearing activities without adequate pelvic and core stability preparation can cause a pelvic stress fracture
There are several factors which may contribute to the development of a pelvic stress fracture, some of these include:
- muscle weakness (particularly of the gluteals, pelvic stabilisers and core stabilisers)
- pelvic instability (often following pregnancy)
- poor flexibility (particularly of the gluteals, hip flexors, abdominals, adductors, hamstrings or quadriceps)
- joint stiffness (particularly of the hip, lumbar spine, knee or ankle)
- poor balance
- inappropriate footwear
- poor foot posture (especially flat feet or high arches)
- leg length discrepancies
- inappropriate or excessive training (particularly on hard or uneven surfaces)
- poor running technique
- lack of fitness or conditioning
- body weight
Signs and symptoms of a pelvic stress fracture
- Pain – localized pain in the pelvic region that increases with impact activity (such as running, jumping, sprinting and hopping, often causing you to limp). It may decrease with rest. It may be severe enough that it causes you to stop the aggravating activity.
Depending on the location of the pelvic stress fracture, pain may be felt in the buttock, groin, hip or lower back and sometimes may radiate to the thigh or knee. In severe cases, walking and standing may be enough to aggravate symptoms. Other symptoms may include night ache, pain when resting or pain on firmly touching the affected region of the bone.
How can Walker and Hall help you?
A thorough musculoskeletal examination is required to determine the extent and location of the stress fracture. This is essential if the optimum recovery is to be achieved and to reduce the likelihood of recurrence.
Following the diagnosis a treatment plan is devised and discussed with you.
The types of physiotherapy treatment used at Walker and Hall for a pelvis stress fracture include:
- joint mobilization techniques to improve the range of movements
- soft tissue massage to reduce pain and muscle spasm
- electrotherapy (e.g. Ultrasound and Interferential Therapy) to reduce pain and muscle spasm
- the use of an appropriate pillow for sleeping
- a home exercise programme to improve strength, fitness, balance, flexibility and core stability
- activity modification advice
- anti-inflammatory advice. Anti-inflammatory medication may also significantly hasten the healing process by reducing the pain and swelling associated with inflammation. To check whether you are able to tolerate non-steroidal anti-inflammatory medication (NSAID) contact your General Practitioner or local pharmacist
Not all pain experienced in the groin is necessarily coming from the groin. Occasionally pain felt in the groin can be referred or caused by a problem in another area of the body such as the back or spine. This is called referred pain.
What is Referred Pain?
Referred pain occurs when pain is experienced in an area away from the actual injury or problem. This is not uncommon, an example being sciatica, where pain is felt down the leg whilst the problem is in the back, or a heart attack, where the pain is felt in the shoulder, arms and neck.
What structures can refer pain into the groin?
The main source of referred pain into the groin is the lower thoracic and lumbar spines (from the 12th thoracic vertebra to the 2nd lumbar vertebra – T12 to L2). Any problems affecting the intervertebral discs, ligaments, nerves and muscles of this area of the spine can mimic a groin problem.
How can Walker and Hall help you distinguish between a groin problem and referred pain
At Walker and Hall you will receive a thorough musculoskeletal examination which will examine all the structures that could possibly be responsible for your groin symptoms.
It is only following such an accurate examination and diagnosis that a treatment plan can be devised to address your problems.
You will be involved in all stages of your treatment given every opportunity to ask questions.