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Side-lying leg lift, cross over: Lie on your injured side with your top leg bent and your foot placed in front of the bottom leg. Once it is easy to do the leg lifts, start strengthening your thigh muscles and groin muscles with the following elastic tubing exercises.
Resisted hip abduction: Stand sideways near a door with your injured side further from the door.
Resisted hip adduction: Stand sideways next to a door with your injured side closer to the door. Sport Injury Expert, QiVantage CoFounder , Traditional Martial Arts Practitioner, and Coach. Sports hernia can strike athletes from all sporting backgrounds, yet is still a poorly understood condition. A hernia is an out-pouching of organs or tissue from the abdominal cavity through a weakened or ruptured area in the abdominal wall musculature. These two muscles share an aponeurosis, or fibrous covering, which connects the muscles to each other and the pubic bone. The other significant anatomical feature of the groin area is the presence of the inguinal canal. Seeking to standardise the diagnosis of athletic pubalgia, a group of radiologists from medical centres and universities around the world defined the radiographic parameters found on magnetic resonance imaging (MRI) in patients with athletic pubalgia. These practitioners theorise that hernia-like symptoms arise from the proximity of the rectus to the inguinal canal. Theory #2 – At the department of surgery at Drexel University in Philadelphia, Pennsylvania, physicians examined two decades of sports hernia patient records and noted trends in both diagnosis and treatment. These practitioners found that chronic groin pain stems from disruption of many of the muscles within the pubic complex.
Theory #3 – Theories 1 and 2 centre around defects in the pubis and adductor muscles of the leg.
The reason Campanelli’s nomenclature differs is that he agrees with studies that show surgical findings of posterior abdominal wall defects in 80-100% of the cases of groin pain(4). Groin pain specialists in Sydney, Australia think they finally located the elusive sports hernia. This theory is that when athletes endure repeated loading and stress to the pubic symphysis, the joint eventually degenerates, creating an unstable pelvis.
According to these groin pain specialists, the elusive sportsman’s hernia is a dynamic phenomenon. Sportsman’s hernia is most commonly diagnosed in soccer, hockey and Australian football players with chronic groin pain. When an athlete presents with groin pain, conservative measures are always implemented first.
There are as many surgical approaches to treatment as there are theories to the cause of chronic groin pain. Keeping in mind that these are case series studies, it is still interesting to consider that whether someone performs a repair to the rectus and adductor muscles or a hernia repair with surgical mesh placed along the posterior abdominal wall, the evidence suggests that the athlete usually benefits. With the recent advances in MRI and real-time imaging, there may be some standardisation in the diagnosis of chronic groin pain in the near future and the repairs implemented should become more individualised. If you play soccer, hockey, or Australian football, you are already at high risk for a groin disruption injury.
The best way to minimise your risk is through stretching and strengthening the core musculature around the pelvis and the adductor muscles of the thigh. There is a continuum of injury within the pubic complex that results from an imbalance in the pubic musculature, namely the rectus abdominis and the adductor longus.
As diagnostic imaging becomes more standardised, management should become more individualised to the patient.
Apply Ice If your groin pull is accompanied by pain and swelling, it is a good idea to apply ice at the area to bring the swelling down. Anti-inflammatory Medication Take some anti-inflammatory medication to get relief from pain especially if it becomes intense. By taping and immobilizing the groin muscle, there are lesser chances of further damage especially in cases of physical exertion.
Engage in Thigh Strengthening Exercises Men and women who are into competitive sports must engage in lower body workouts and strength training. This will help the adductor muscles to become strong, toned, and prevent them from being injured during play. Elevating the Leg Elevating the leg that has the injury is an effective way of immobilizing the muscle pull. Groin strains are common in football and groin pain is not uncommon in sports such as cricket particularly bowling and in jumping sports such as triple jump, high jump, basketball and netball.
The most common cause of groin pain is a strain and inflammation of the adductor muscle tendons.
Avulsion fractures can cause pain in the groin area to occur from powerful muscle contractions that actually tear off the bone.
Osteitis pubis has also been described as a cause for groin pain and X-rays or MRI scans will show evidence of inflammatory changes at the symphysis pubis. Labral tears and femoral acetabular impingement (FAI) are a source for hip pain in the athlete and non athletic people.
Osteoarthritis of the hip will cause groin pain and also frequently pain radiating to the inside of the knee.
The ‘sports hernia’ has been suggested as a cause of groin pain but is a rather ill defined diagnosis. Pain from the sacroiliac joints is usually felt in the lower back and buttock muscles but can radiate down the back of the thigh as well. This article was written by Libby Sharp who is a leading UK physiotherapist and Pilates rehabilitation expert. Disclaimer: All content on this website is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Being a professional athlete or a professional businessman, many patients suffer from leg injuries each year. This day in age people tend to jump at the opportunity to pop a pill before trying to weigh out all of their healing options. ColdCure® compression leg wraps are designed specifically for the treatment of the pain and swelling from soft tissue injuries of the leg.
The BFST®(Blood Flow Stimulation Therapy) Wrap is designed to promote blood flow in injured tissue below the dermal (fat and skin) layer. As an FDA Registered Medical Device the BFST® wrap is suitable for use in hospital and therapeutic clinics. After treatment the straps can be further tightened to provide snug support and protection for the injured leg. Cold compression wraps are standard medical products for the treatment of pain and inflammation. The King Brand ColdCure® Leg Wrap is a medical grade cold compression wrap designed for use in hospitals and injury therapy clinics (Home use is becoming a lot more common). Improving on the RICE standard of injury care, ColdCure® wraps are specifically designed to operate at refrigeration (not freezer) temperatures. The over-sized cold packs in all ColdCure® wraps contain specially formulated gel with more cooling power per lb than standard wraps. The wraps use Rigid Gel® technology so that the gel does not flow away from the injured area when pressure is applied. As professional therapists and medical practitioners you know that it is in your best interest to treat your patients quickly and completely. Even with their superior design and performance these devices are low enough priced that they can be used by patients for in-home self-treatment which also improves treatment results and patient satisfaction. King Brand soft tissue rehabilitation medical products are the #1 choice by top Athletic Therapists and Medical Practitioners world-wide. Tie a loop in one end of a piece of elastic tubing and put it around the ankle on your injured side. Tie a loop in one end of the tubing and slip the loop around the ankle on your injured side.

A hernia can be caused by anything that increases the intra-abdominal pressure, like coughing or heavy lifting. Athletes may complain of groin pain for several months without recalling a specific mechanism of injury.
This area, supported skeletally by the pelvis and femur, is where the transition of forces is greatest during athletic activities that require powerful starts, stops, and kicking, such as soccer and hockey. The rectus abdominis, the central-most abdominal muscle, originates as a broad, flat muscle and narrows significantly at its insertion on the pubis, causing a concentration of forces near the pubic symphysis joint. The adductor longus and rectus abdominis are antagonist muscles, with opposing force vectors generated by each.
It runs between the layers of the anterior abdominal wall (made of the internal and external oblique muscles) and the posterior abdominal wall (composed of fascia and the conjoint tendon – the common tendon of the internal oblique and transverses muscles).
The thought is that the pain originates from tears in the rectus abdominis or adductor longus tendons, or the common aponeurosis shared by both. Recent advances in MRI have allowed visualisation of an injury to the lateral border of the rectus not previously noted(1).
They also suggest that once a weakening of either the rectus abdominis or the adductor longus muscles compromises the stability of the pelvis, a strain can occur in the other muscles that try to provide compensatory stability.
They report that currently, they see ten times the number of patients in clinic for sports hernias than they did 20 years ago(2). However, at the University of Insubria in Italy, one researcher sites a different origin for the chronic groin pain experienced by many athletes. The experience of his surgical centre shows that there are usually additional defects in the rectus abdominis and external oblique muscles as well. They agree that the underlying mechanism of injury is the imbalance of opposing muscles that results in pelvic instability.
To visualise it, you must conduct a real-time imaging study, such as an ultrasound, computed tomography (CT) or MRI while the patient actively strains, as in an abdominal crunch. These sports carry an inherent risk in the sudden starts, stops, changes in direction and kicking that they demand. If one limb is just five millimetres shorter than the other, it increases the ground reaction forces the pelvis must endure(3).
The typical course of treatment includes ice, rest, stretching, strengthening and physiotherapy. The treatment studies reported in the medical literature are Level IV studies, which means they are largely case series reports without any controls and with poor reference standards.
No matter where the athlete is along the continuum of injury, repairing any part of the pubic complex seems to result in at least some improvement in pelvic stability. Pilates and yoga address both flexibility and strength and should be an integral part of your off-season training. Recent medical diagnostic imaging now reveals that sportsman’s hernias do exist and can be reliably diagnosed with real-time imaging that corresponds with a history and physical exam. It is this imbalance that leads to injury and weakness of the posterior abdominal wall and thus, the hernia.
Surgical results are often excellent, with most returning to previous level of play within three to six months. If the pull is major, avoid any kind of physical exertion that may cause strain to the muscle. Seek the help of a fitness trainer who will make you do some specific stretching exercises to relieve the muscle pull.
See a doctor right away who may recommend specific muscle relaxing medicines to bring the pain down. The adductor muscles insert in the pubic ramus of the pelvis and the action of these muscles is to bring the leg across the body such as in kicking a ball or the crossover action of skating. The iliopsoas muscle flexes the hip on the body and is a predominant muscle in dance and gymnastics. This usually is an acute event that can occur from the rectus femoris muscle pulling off of the anterior inferior iliac spine. The incidence of pelvic pain in pregnancy has been reported as between 41% to 77% in a review paper by Kanakaris et al in 2011. Usually the effects of relaxin are not felt until late in pregnancy but can come on earlier particularly if there is hypermobility or with multiple pregnancies.
Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review.
Gilmore’s groin: ten years experience of groin disruption — a previously unsolved problem in sportsmen. Use of this website and the information contained herein does not create a doctor-patient relationship. It is easy enough to take a pain killer such as ibuprofen or acetaminophen (analgesics) to help with the pain, but that makes it just as easy to re-injure your leg.
When a patient is immobile it can become draining and very tough to move on with everyday life. This group of medicines interfere with normal blood function that is crucial for the optimal healing process. The device disconnects at the wrap from the power supply and controller so that the user is free to move about the treatment clinic or home when not receiving treatment while still wearing the wrap for support and comfort.
Tighten the thigh muscle on your injured side and lift your leg about 8 inches off the floor. The pelvis is made of two bones that, along with the sacrum, form the bony ring of the lower trunk.
This opposition of forces, especially significant during sports that require kicking and powerful starts and stops, produces a constant strain at the pubic symphysis.
Because these muscles function in opposite directions and share a common fibrous sheath, even a micro-tear in one of them will affect the function of the other. The physicians observed this tearing in varying degrees among patients, from minimal tears in one muscle to complete tears in both the rectus and adductor longus muscles. Since there are indeed many other syndromes that manifest as groin pain, a general screening MRI is recommended to rule out other issues. They also agree that sports hernia is a misnomer; they perform few actual hernia repairs on patients who present with chronic groin pain.
The results showed defects in not only the rectus abdominis and adductor longus muscles, but also the pubic joint, the other adductor muscles of the leg, and even the hip (see table 1).
Campanelli postulates that because the adductor muscles are usually stronger than the abdominal muscles, the shear forces that cross the pelvis in sports like soccer result in a tearing or weakening of the muscles and fascia in the posterior abdominal wall(4).
The muscle defects in this area impact the nerves that pass through the inguinal region and result in a dilated and stiff external inguinal ring. However, they prefer to think of chronic groin pain as a groin disruption injury, which encompasses all of the above theories(3).
The strain first manifests as micro-tears where the tendons attach to the pelvis, then progresses to more significant tears within the muscles. If a mild bulge is seen in the posterior abdominal wall, there is usually an associated lesion in the conjoint tendon of the inguinal canal. However, there are some underlying biomechanical issues that may predispose an athlete to suffering a groin disruption injury. And muscle imbalances around the pelvic and hip joints increase the risk of chronic groin pain. If the injury lies somewhere along the continuum of a groin disruption injury, the pain will improve initially and return once the athlete returns to normal training activities. Despite the variability in the surgical approaches, these studies typically report good outcomes and return to play statistics ranging from 77% to 100%(5).
That said, recurrent groin pain is not unusual and athletes may need to visit a surgeon with a different speciality if the pain returns. Therefore, everyone playing these sports should consult with a physiotherapist for leg length measurements. If you are new to these exercise techniques, train with a qualified instructor until you have mastered the basics. When groin pain lasts more than six months and does not respond to conservative treatment, surgery is usually indicated.

Knowing your risk factors and integrating appropriate off-season core training should improve your standing in the battle of the bulge.
The adductor muscles play an important role especially if you are into contact sports like soccer, sprinting and swimming. At times ligament pulls are so serious, that they may need surgery and advanced physiotherapy. At this junction the lower spine (lumbar spine) articulates with the pelvis and the pelvis in turn articulates with the hip joint.
These muscle strains have been reported to be present in 10%- 28% of soccer and ice hockey players (Taylor). An over-tight and overused muscle can cause what is usually referred to as a “snapping hip” when the tendon of the muscle seems to click when the hip moves from flexion to extension with some rotation. It is thought to be associated with a shearing force at the symphysis pubis with actions such as landing on the stance leg while bowling. The pain is usually intermittent and can produce a sort of ‘catching’ pain that is there one minute and gone the next. In early stages the hip may respond well to an exercise programme and manual therapy from a musculoskeletal trained physiotherapist. It has been reported that a bulge is seen in the posterior inguinal wall of the abdomen and some weakening of the posterior abdominal wall is also usually present. Poor posture and core stability can cause the lumbar spine to adopt an increase curve which has the effect of inhibiting the important stabilising muscles such as transverses abdominus and multifidus. However they also report that the problem is self limiting and only 1-2% of patients had ongoing pain after delivery. In addition with an increasingly large abdomen the pelvis tilts forwards effectively inhibiting the action of core muscles such as transversus abdominus that forms a sheet at the bottom of the front of the abdomen and the multifidus muscles that lie at the back of the spine and connect each adjacent vertebra to its neighbour. Pain from both the symphysis pubis and the sacroiliac joints is felt particularly when walking and going up and down stairs as well as getting out of a chair, bed or car.
Always consult with your own doctor in connection with any questions or issues you may have regarding your own health or the health of others. We know this isn't the best solution for treating the pain, but narcotics and steroids are not desirable options either, especially for our regular patients who are not under professional medical supervision 100% of the day. ColdCure® technology provides control of the swelling and pain without the negatives of the drugs.
Tighten the front of your thigh muscle and bring the leg with the tubing forward, keeping your leg straight. Bring the leg with the tubing across your body sideways, crossing over your other leg and stretching the tubing.
The largest of these muscles, the adductor longus, lies immediately below the rectus abdominis. The resulting instability at the point in the pelvis where shear forces are the greatest further weakens other areas. The resulting weakness in the posterior abdominal wall muscles leads to a sportsman’s hernia (see figure 2). While not felt on clinical examination, these real time images provide proof that there can be, at perhaps the end of a continuum of injury, a real hernia in the posterior abdominal wall when straining.
Groin pain that persists for more than six months and does not respond to conservative measures is the hallmark of this syndrome and is usually treated surgically.
Regardless of the type of surgical repair, most athletes return to play in three to six months.
Simple exercises using a band at home can also make a great impact on your strength in these areas (see figures 3-5, above). The surgical management technique often reflects the speciality of the physician, rather than the actually diagnosed impairments. Rest and physiotherapy treatment will be needed to restore stability in the pelvis to prevent overstrain of the adductor muscles. This can cause pain in the groin area when lifting the leg to do ballet movements such as developpe or kicking a football. It will normally subside with rest but may need expert attention to improve core stability and sporting technique. This is a serious condition and the athlete must rest from all sport in order to allow the facture to heal. The labral tear could be caused by extreme hip movement such as in dancing or with a slight deformation of the hip such as a CAM or PINCER lesion when the shape of the joint might tend to cause the head of the femur (thigh bone) to ‘rub’ against the socket and tear the labrum. In late stages when the walking pattern is disrupted and pain is felt at rest or at night surgery may be needed to replace the hip. It is more than likely that the problem is multifactoral and that pelvic instability and muscle imbalance may contribute to overuse of the abdominal wall in such actions as a long kick in football. The increased lumbar curve increases tone in the iliopsoas muscle and as the femoral, lateral cutaneous, obturator, iliohypogastric, genitofemoral and ilioinguinal nerves all pass through the psoas muscle they may be pinched due to the increased tone in psoas. Other muscles such as hamstring and adductor muscles can then become over dominant and pull the pelvis out of alignment causing instability and making weight bearing on one leg difficult and painful.
The advice is to keep your legs together with rolling in bed or getting out of a chair or car. Also, some of the most common analgesics are known to interfere with your body's natural blood clotting process and result in additional inflammation.
As a professional healthcare provider, we recognize that the pain isn't the problem and we only care about curing the ailment. Even injured professional athletes who are under regular medical supervision are kept away from drugs if possible. Physical examination, however, does not typically reveal an actual hernia so there is little consensus among researchers or practitioners that sportsman’s hernias actually exist! This problem will need expert physiotherapy treatment to check postural alignment and core stability to take pressure off the iliopsoas muscle and improve function of the gluteus maximus muscle to stabilise the hip joint.
If the problem persists the diagnosis can be made with an MRI scan of the hip and arthroscopic surgery may be needed to repair the damage to the labrum. Modern surgical techniques usually have excellent results and rehabilitation is quick for both young and old. The fact that the hamstring muscles may be too tight and the effort of kicking a heavy ball may induce a ‘valsalva’ manoeuvre holding the breath and gripping the abdominal muscles in the effort of lifting the leg to kick the ball. Pain from the symphysis pubis is sometimes called Symphysis Pubis Dysfunction (SPD) and is usually felt at the front of the pelvis and may radiate in to the groin and down the inside of the leg. Sleep with a pillow between your legs and seek help from a specialist musculoskeletal trained physiotherapist who has experience in examining, diagnosing and treating pelvic pain. For best results and satisfaction, ColdCure® technology treatment serves to actually reduce inflammation and control pain without adverse side effects.
Pain killers are the easiest solution for any pain, but we all know it isn't the best solution.
The best possible solution for pain and swelling control is clearly using ColdCure® technology. Because the leg is made up of a lot of difference shapes, we have constructed our wrap to evenly distribute the gel in our packs no matter which region of the leg you are treating. It is possible to realign the pelvis with gentle manual therapy techniques which will help and you may be advised to wear a sacroiliac belt to add some support to the pelvis. We want our patients to think highly of us, and we also want them to live without pain through the healing process. No other wrap in the world has specifically designed cold packs for each and every part of the body. This exercise can be made easier by starting with your knees and hips flexed toward your chest. Although the enlarging abdomen is stretching the muscles it is still important to hold the tummy as flat as possible and make sure that your pelvic floor muscles are switched on at a low level.

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