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20 questions about groin injuries

20 questions about groin injuries

1) What is a groin injury exactly?
All symptoms around the groin area are called groin injuries. Examples of these are the irritation, or worse, of the ligament between the pubic bones after pregnancy, squeezed sinnaws or inflammations. These will not be discussed here. Considering the range of possibilities, you should always see a doctor so as to get a good diagnosis.

2) Are a groin injury and a groin rupture the same?
No, they are absolutely not. A groin rupture is a weak spot in the abdominal wall. This could cause a bulge, for example by pressure from within while lifting something heavy. This is not trainable and will have to be corrected through surgery, in case of much inconvenience, by means of placing a fortifying mat beneath your skin.

3) Then what are those sportsmen always talking about?
In sports, a groin injury is an injury caused by training too heavily,by straigning or rupture of the muscles on the insides of the upper legs (adductors, especially the adductor longus). The injury is mostly situated near the transition of muscle to tendon or at the connection of tendon and pubic bone (adductor entendinitis). The symptoms in the muscle are often the result of a wrong move while conjunction problems have a more structural cause.

4) Where would it hurt?
Most of the times, there is a sharp pain in the groin or the muscles on the insides of the upper legs. Also, it will hurt if you put some pressure on the muscles and the pubic bone. The pain can radiate to the stomach.
Putting both legs together will cause the pain to increase because the injured muscle is put to work. You could quite often find a swelling or a bruise visible at the injured area.

5) How seriously should one take a groin injury?
It depends on the injury's degree. In any case, you should never ignore it and further actions are to be taken.

6) Why degree?
At a first degree injury, symptoms are irritation/straigns (no ruptures are visible yet) and loss of strength is marginal. You experience some pain at the day of training and/or while beginning your warm-up exercises. You are now warned and you can prevent it from getting worse.

At second degree, you are dealing with a muscle rupture. By now, the tissue is clearly torn and strength has declined considerably.

Third degree means total rupture. Immediate surgery is required. Fortunately, this third degree injury is a very rare one.

Sometimes, a division into four degrees can be given.

7) Could anyone get such an injury?
Yes, anyone going outside during winter, slippery-slide, can get a groin injury. The risk of getting into an unplanned splits, and any attemps at preventing that, could mean an overload that is serious enough to cause a groin injury.
Sports also give many candidates for an injury.
Firstly, we have gymnasts working up to the, well-meant, splits. Secondly, tennis players who run across the field, sliding with legs wide apart from left to right and all the way back.

8) Are there any other risk factors?
People with shortened muscles, an altered posture in the spinal column/pelvis or a difference in leg length have a higher risk. Insufficient warm-up exercises can cause you trouble as well.

9) Are these all of the personal factors?
A very important factor is the training and competition level of the individual. As soon as you start to ask more from your body than your physical condition permits, you have a higher risk. Also, fatigue, and the enclosed loss of concentration, will increase the risk of uncontrolled moves and this kind of injuries. The inlamed tendon on the pubic bone in particular is often caused by frequently repeating movements.

10) Which other factors are of influence?
Quite often, you can find the wrong pair of shoes or bad training grouds (too slippery) as the cause of arising trouble. Besides that, in colder days it is important to do warm-up exercises wearing jogging pants that will keep your legs warm.

11) When I start getting symptoms, what should I do for First Aid?
* Cool the injured area by putting ice (a cold-pack) on it for ten to fifteen minutes. You can repeat this treatment once every hour. Protect the skin and genitals from freezing over by placing a thin towel in between.
* Put on a pressure bandage. By external pressure you can prevent part of the internal bleeding. This only works in the muscles antinode.
* Stop training, start sparing your muscles. It is quite well possible you will have to look for extra support and use a pair of crutches.
When in doubt, it will do you good to pay the (sports) doctor a visit.

12) Once I have done that, what else is there to do?
At grade one, you can carefully start to put some pressure on after a week or two. If the symptoms continue to exist, you should definitely see a doctor or a Sports Medical Advice centre (SMA).
Injuries and inflammations at the tendons conjunction often need more time. Without luck they will cost you six to eight weeks. When rehabilitating, never cross the pain level.
At second or third grade, visiting a doctor or specialist is desirable.

13) How can I build up pressure?
First you could do some light exercises like carefully shifting weight from your non-injured to your injured leg. Once you can do that without pain, cycling is a good start to stimulate blood circulation and the recovery of your groin.

14) I believe my condition does not improve quickly by this advice. Is there a better alternative?
No. Unfortunately you will have to choose between condition improvement or recovery. Of course, you can train the other parts of your body in a fitness centre, as long as you take care not to use the adductors.

15) Will taking rest suffice in making full recovery?
To recover it will. Physiotherapy (massage) and sauna will speed up the process. To prevent new injuries, you will have to remove the root of your problem. The recovered muscles will have to be put to length and strength again.

16) How do I stretch those muscles?
The easiest way is to stand legs wide apart, both feet firmly to the ground and toes pointing forwards, and to lean over to one side. The torso has to remain straight. You can carefully bend the leg you have put your weight to. You will feel the stretching in the adductors of the other leg is increasing. Once you have repeated this twenty seconds several times, you can start stretching the other side. In any case, do not "bounce" and be sure to be standing on a rough background. Because if you start to slip away, symptoms will never decrease. While stretching, never cross the pain level.

17) Are these all of the muscles I need to stretch?

No, at 16) is mentioned only the most important stretching exercise to the long adductor. But, you also have a "short adductor" of that muscle (adductor brevis). You can stretch it by sitting on the ground and placing your feet together. Sit up straight and let your knees slowly sink to the floor. You can leave your elbows on your legs as extra weight. In this exercise as well, do not "bounce", repeat a few times and stay away from the pain level.

18) How can I put the muscles to strength again?
That will be quite easy. Any move where you put your knees together with force will do. Even in your office or during class, you can train without anyone noticing. Just hold a book between your legs and start squeezing. But do not overdo it, because the burden could be too much (again). Power exercises that use a strong elastic band, dynaband or (bicycle) tube as resistance work well, too.
In fitness centres of course, you can do various exercises.
While you are training anyway, it will do you good to give your abdominal muscles a boost in quality in the same time.

19) Can I take extra measures when I pick up sports training again?

Yes, besides a good set of warm-up exercises and slowly building up the weight of your training, it can be useful to let yourself get taped in for the first few training sessions or competitions. Also, you should wear warm enough clothing to keep your muscles warm.

20) Now I know how I can get it and how to recover. So how can I prevent it?
It is most important to do a decent warm-up with enough exercises.
And: listen to your body, it is the best advisor you will get.

Arie Meijboom
Sportmassagepraktijk Meijboom, Castricum
maart 2005

Translation by Maaike de Wijs