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The effectiveness of active training in long-standing adductor-related groin pain

Groin pain, particularly from the adductors is a common problem both for elite sports people and amateurs across several different sports. Amongst male soccer players alone this can range from 10-18% of the population every year. Adductor muscle pain is often long-standing and difficult to manage. There have been several studies over recent years looking into addressing groin pain and providing evidence for physiotherapists and sports rehabilitators alike to better manage patients with these symptoms but it remains a topic of much discussion. The biggest difficulty for researchers is that groin pain can be multifactorial because of the anatomical nature of the area. This blog and research is looking only at adductor-related groin pain (ARGP).http://activephysicaltherapy.ie/wp-content/uploads/2014/09/Longstanding-Groin-Pain.jpgThis blog, looking at research from Homlich et al, addresses one of the most common causes for ARGP and suggests a programme that appears to provide relief and prevention combined. Homlich et al understand that muscle imbalance has a huge part to play in ARGP and that looking to correct this imbalance could be the long term answer to not only relieving symptoms but allowing preventative strategies for people most at risk of developing ARGP. The authors understand that the adductor muscles are key in stabilising the hip and pelvis but in doing so can often be overloaded and therefore put the pelvis at risk of destabilisation. Previous laboratory tests have shown that strengthening these muscles can protect them from injury.

Homlich’s study looked at 68 participants, all athletes who had suffered from groin pain for at least two months. The participants were all males and all reported pain in the adductor muscle or tendon or the insertion to the pubic bone. The participants were split into two groups, the first received a programme of active exercises to be completed three times per week with a home programme to be completed in between. The second group receive manual physiotherapy only, with no active exercise. The initial exercises consisted of:

  • Static adduction against a ball with knees bent and knees straight
  • Sit ups forward and obliques
  • Combined abdominal sit up with hip flexion
  • Balance on a wobble board
  • One foot exercises on a sliding board

The programme then progressed to:

  • Abduction and adduction inside lying
  • Back extensions
  • Weighted abduction and adduction exercises in standing
  • Dynamic coordination exercises in standing
  • Skating movements on a sliding board
  • Balance
  • Abdominal sit ups

The physiotherapy treatment consisted of:

  • Laser treatment
  • Friction massage
  • Adductor stretching
  • TENSThe results of the study were positive for the active exercise group being the most beneficial. 67% of this group reported ‘excellent’ outcomes, and 79% of those returning to their sport at their previous level without any groin pain, with the average time for this return being 18.5 weeks. It must also be said, that both groups improved significantly and no participant recorded their outcome as worse. The physiotherapy with no active treatment was not as effective, however, 14% of participants did return to their sports symptoms free.

As with any study, there is strengths and weakness which need to be considered when reading research papers, some include:


  • All participants were comparable at baseline, they were similar in terms of age, gender, level of sport and length of time with current injury.
  • The authors detailed both treatments clearly and outlined instructions for selecting the groups and recording the information making it easy for the reader to understand and follow


  • All of the participants were stopped from participating in their sport, so perhaps the ‘relative rest’ from their sport contributed to the improvement in symptoms, it would have been beneficial to have a control group to compare
  • There was a very small population of participants and this makes it difficult to generalise to other larger populations

As with any piece of research the results are not conclusive and require more robust and detailed studies to develop a more definitive claim. Having said that, this study provides some good ideas for rehab that have had good results in the population studied and could have similar results for people suffering from ARGP. This study does indicate that for more than ¾ of the population, ARGP was resolved with a progressive active exercise programme. This study also suggests that ensuring strength within the adductor muscles using some of the ideas above can prevent muscle imbalance and therefore protect against future groin pain.

This research is further support for the approach that our physiotherapist take in treating ARGP by emphasising the importance and guiding patients through a progressive exercise programme whilst supplementing this with manual techniques.