Adductor Muscle strAins

The evaluation and treatment of groin pain in athletes is challenging, and the anatomy is complex. Multiple pathologies often coexist that may cause similar symptoms, and several organ systems can refer pain to the groin. Many athletes with groin pain have tried prolonged rest and various treatment regimens and received differing opinions regarding the cause of their pain. The rehabilitation specialist is often given a nonspecific referral of “groin pain” or “anterior hip pain,” the cause of which can be as simple as a tight iliopsoas (which may require stretching) or as complex as athletic pubalgia. Athletic pubalgia is defined as an injury to the rectus abdominis insertion onto the pubic symphysis, often accompanied by injury to the conjoined tendon insertion and the adductor longus attachment to the pelvis. The distinctive feature of this disorder is subtle pelvic instability and accompanying compromise of the transversalis fascia, eventually leading to incompetency of the posterior inguinal wall. The exact structures involved are not always clear unless surgery is performed, and overlapping conditions may exist. A muscle imbalance between the adductor muscles and abdominal muscles may be the underlying cause of athletic pubalgia, but this has yet to be proven.