It was late in the third period of Wayne's fourth hockey game in 5 days, and he was exhausted, but he wasn't going to let it show. He was still going all out and sprinting after every loose puck. But on one play, he was skating fast and tried to make a sudden change in direction when he felt a sharp pain in his right groin and could barely make it off the ice.
The next day Wayne's groin felt tight and painful, and there appeared to be some swelling in the area, so he went to see a doctor. The doctor asked some questions, examined him, and told Wayne he had a grade 2 groin strain.
What Is a Groin Strain?
A groin strain — also known as a groin pull — is a partial or complete tear of one or more of the muscles that help you squeeze your legs together.
There are five of these muscles, called the adductor muscles: The pectineus, adductor brevis, and adductor longus (the short adductors) run from your pelvis to your thighbone. The gracilis and adductor magnus (long adductors) run from your pelvis to your knee.
Groin strains are a common injury in hockey and skiing, as well as sports like football and track and field that require running or jumping. They can range from grade 1, which is a mild injury with few symptoms and a short recovery time, to grade 3, which is a complete or nearly complete tear of a groin muscle.
What Are the Symptoms of a Groin Strain?
The symptoms of a groin strain vary somewhat depending on the grade of the strain. All groin strains will cause pain and tenderness in the affected area, and many will hurt when you bring your legs together or raise your knee. If a strain is severe, you may feel a popping or snapping sensation during the injury and severe pain afterward.
Here's what you'll likely notice for different grades of groin sprain:
- Grade 1 – Mild pain that may not be noticeable until after you finish exercising, followed by tightness and tenderness. With this type of strain, a person probably won't have trouble walking, and activity will usually not be limited.
- Grade 2 – Moderate pain and tightness in the groin, along with some minor swelling and bruising. With a grade 2 strain, the leg may feel weak, and you'll probably feel increased pain when you stretch the muscle. Walking may be affected and running can be difficult.
- Grade 3 – Severe pain, considerable swelling and bruising, and an inability to squeeze the legs together. Someone who's had a complete tear might be able to feel a gap in the muscle. Walking will be very difficult.
How Is a Groin Strain Diagnosed?
If you see a doctor for a strained groin, he or she will ask about your symptoms and what you were doing when the injury happened. The doctor will examine the affected area to check for swelling, bruising, and tenderness — and to rule out another condition with similar symptoms, such as a sports hernia. In rare instances, the doctor may send you for an MRI scan to determine the extent of the tear.
The doctor will grade your strain. Grade 1 means that less than 10% of the muscle fibers are torn. Grade 2 strains are those where 10% to 90% of the fibers are torn. (Because of the big range in grade 2 strains, a doctor might grade strains on a scale from 2- to 2+.) Grade 3 means that the muscle is either completely or almost completely torn or ruptured.
What Causes a Groin Strain?
Groin strains usually happen when the adductor muscles get stretched too far and begin to tear. Strains also can occur when the adductor muscles suddenly have stress put on them when they aren't ready for it (as when someone doesn't go through a proper warm-up before playing) or when there's a direct blow to one of the muscles.
Some of the risk factors that can make a groin pull more likely include:
- Sports that require sprinting, bursts of speed, or sudden changes in direction. Examples include track and field, particularly the hurdle and long jump events, basketball, soccer, football, rugby, hockey, and skiing.
- Tight muscles. Muscles that haven't been warmed up and stretched properly are more likely to tear. This is especially true in cold weather.
- Poor conditioning or fatigue. Weak muscles are less able to handle the stress of exercise, and muscles that are tired lose some of their ability to absorb energy, making them more likely to get injured.
- Returning to activities too quickly after an injury. Groin strains need time and rest to heal completely. Trying to come back from a strain too soon will make you more likely to injure your groin again.
How Can You Prevent a Groin Strain?
The main thing you can do to help prevent a strained groin is to warm up and stretch before any exercise or intense physical activity. Jog in place for a minute or two, or do some jumping jacks to get your muscles warmed up. Then do some dynamic stretching (ask a coach, athletic trainer, or sports medicine specialist to show you how to do this type of stretching).
Some other things you can do to try and prevent groin strains include:
- Keep your muscles strong and flexible year round. Get regular exercise (even in the off-season) and follow a good stretching program.
- Increase the duration and intensity of your exercise slowly. A good rule of thumb is to make sure you add no more than 10% each week to the miles you run or the time you spend playing a sport.
- If you feel pain in your groin, stop your exercise or activity immediately. If you're worried that you might have strained your groin, give it time to rest, and don't resume your activity until you are pain-free and your injured adductor muscles feel as strong as the uninjured ones.
- Learn and use proper technique when exercising or playing sports. Your coach or trainer can give you pointers and tips for your sport.
- Wear shoes or skates that fit correctly and offer your feet good support. Replace shoes with a new pair when they show signs of wear or the soles start to lose their shape. The same goes for skates — you want to be sure they maintain good ankle and foot support.
How Should You Treat a Groin Strain?
Most groin strains will heal on their own in time. The key is patience because it can take a while to fully recover. Even if you feel better, a groin strain may not be fully healed, and you risk starting over with the injury if you get back in the game too soon.
Mild to moderate strains will need around 4 to 8 weeks of proper rehabilitation. More severe strains will take longer to heal. Only the most severe muscle tears require surgery. To treat a groin strain, take these steps and be sure to follow your doctor's advice:
- Use the RICE formula:
- Rest. Limit the amount of walking and physical activity you do. If you have a lot of pain, you may need to use crutches.
- Ice. Use a bag of ice or cold compress to help reduce swelling. This should be done as soon as possible after the injury and then three or four times a day for 20 to 30 minutes at a time until the swelling and pain are gone.
- Compress. Use bandages or wraps to help support your groin and keep the swelling down.
- Elevate. This may be difficult with a groin strain, but if you are lying down, try putting pillows under your pelvis to elevate your hips and thighs.
- Take anti-inflammatory medications. Painkillers such as ibuprofen and acetaminophen can help relieve pain and reduce swelling in the affected area.
- Follow a rehabilitation exercise program. Once the pain and swelling go away, talk with your doctor about a rehabilitation and exercise program to improve strength and flexibility in your groin. This type of program is an absolute must when it comes to groin strains. Without this step, an injury can last and really interfere with an athlete's performance.
In the event of a complete muscle tear, or if the treatments above don't help after a few months, a doctor may call for surgery as a last resort. In this case, a surgeon will either attempt to reattach a torn tendon to a bone or stitch torn muscle tissue back together. Some people are able to return to previous levels of activity after surgery. A doctor will only choose this option as a last resort — and fortunately it's rarely needed.
Most groin strains heal on their own as long as the athlete follows a doctor's or physical therapist's instructions about rest and rehabilitation. The key is patience.
It can be frustrating to wait the full time needed to get back in the game, but this is one kind of injury you don't want to mess with. Get your doctor's signoff for any kind of exercise.
The good news is that once you're fully healed, you should be able to play as you used to.