Home Blog Groin Strain? Get Manual Therapy.

Groin Strain? Get Manual Therapy.

Written on October 28, 2010 at 6:06 am, by Eric Cressey

If you’ve had a groin strain (or adductor strain, for the anatomy geeks like me in the crowd) – or would like to prevent one in the first place – read on.

Those of you who check out this website regularly probably already know that I’m a huge advocate of good manual therapy – especially disciplines like Graston and Active Release.  One area where we constantly see athletes really “gritty” is the hip adductors (groin muscles) – and it’s one reason why we see so many groin strains in the general population.  Note that treatments DON’T have to be this aggressive to yield favorable outcomes; it’s just an extreme example of someone with a pale skin tone that makes it even more prominent:

Soccer and hockey players really overuse the adductors during the kicking motion and skating stride, respectively.  And, even outside athletic populations, you’ll see a lot of people who don’t activate the gluteus maximum well as a hip extension – so you have the adductor magnus taking over to help out with this important task.  The only problem is that the adductor magnus internally rotates and adducts the hip, whereas the glute max externally rotates and abducts the hip.  Movements get altered, one muscle gets overworked and all fibrotic, and the next thing you know you’ve got a nasty “tweak” just south of the frank and beans (or female equivalent).

Really, that’s not the issue, though.  Nobody is denying that groin strains occur – but there are different treatment approaches to dealing with this issue on the rehabilitation side of things.  Some professionals use manual therapy during their treatments, while others don’t.  Can you guess which school of thought gets my backing?

Well, it turns out that the “include manual therapy” side of the argument gets the backing of Weir et al in light of some new research they just published.  These researchers found that athletes with groin strains returned to sports 4.5 weeks sooner when they received manual therapy plus stretching and a return to running program as compared to an exercise therapy and return to running program only.  It took the average time lost down from 17.3 weeks to 12.8 weeks in those with good long-term outcomes! For a bit more information on the manual therapy discipline utilized in this particular study, check out this abstract.

Need a quick tutorial on how to come back from a groin strain?

1. Find a good physical therapist who does manual therapy.
2. Listen to and do everything he/she says.
3. If anything hurts in the gym, don’t do it.  In most cases, deadlifting variations are okay, but single-leg work will really exacerbate the pain.  Squatting is usually a problem at first, and then gets better over time.  It really depends on which of the adductors you strained.
4. When you are cleared for return to full function, keep hammering on glute activation and hip mobility as outlined in Assess & Correct.

5. Make sure you’re continuing to foam roll the area and getting the occasional treatment on them with that same manual therapy you had during your rehabilitation.  Here’s a great self myofascial release option with the foam roller:

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11 Responses to “Groin Strain? Get Manual Therapy.”

  1. Kevin Neeld Says:

    Eric-Great post. The hockey player I consulted with you about a few months back is now pain free on the ice and the leading scorer on his team in England. Manual therapy, intelligent exercise selection and some good ol fashion time away from your sport can do wonders for these injuries!

  2. Bri Hudak Says:

    Eric, I like the post and your thoughts (as usual)! As an ATC and PT student, I am a huge advocate for manual therapy. I’m glad that there is focus in this area of research.
    However, I urge people to read this study. I feel it was poorly done, and there were so many flaws. The biggest flaw was that the MMT group was allowed to warm up jog immediately, and begin the running program after 2 weeks. The ET group was not allowed to begin any running for 6 weeks! It’s no wonder why they were ready to return to sport much earlier!
    I think this is a great start, and more research should be focused here. But, because of the extreme differences in the interventions, it doesn’t show what the true benefits are of manual therapy.
    Don’t get me wrong – I agree with everything in your post! I just wish the author set up the interventions differently to show the actual benefit. It would make the clinical applicability much more convincing.

  3. Derek Says:

    Would you recommend this for a sports hernia/gilmore groin? I’ve had one for months now and despite complete rest it won’t get any better than 90% and I’m trying to avoid surgery

  4. Eric Cressey Says:

    Bri – I would agree that the study design wasn’t fantastic (especially since neither intervention showed outstanding long-term results), but I do feel like it’s a step in the right direction when it comes to understanding what does and doesn’t work.

  5. Brian Says:

    Don’t forget some of the best manual therapists trained in ART and Graston/SASTM are indeed Chiropractors! Many athletes and people in general are not made aware of this fact.

  6. Luka Hocevar Says:

    I had a groin strain that started about 3-4 months ago and things started getting a lot better when I got ART and Graston as well as working with a great PT. This can really be the “x” factor between it taking months and months to heal or being able to get back on the field/court sooner.

    @ Derek – my brother had a sports hernia and it was to a point where there was a tear in the inguinal region and it needed repair. If that is the case then you should se a specialist and see where to go with it. If you have the beginning symptoms of a sports hernia then ART/Graston and proper therapy as well as training around it can get you back on track.


  7. Steve Edling Says:

    I had a adductor that looked like your picture this summer from a waterski accident. I was pretty much healed up an d functioning well after 8 weeks. Active release, Graston, getting my pelvic areas adjusted, cold laser, and foam rolling and I’m good as new. Typically I’ll see patients with similar injuries that come in a year after and still having problems. This stuff works well. Keep up the great job you do. Steve Edling D.C. CCSP

  8. Marie Ande Says:

    Thanks for the post, especially the video! I’ve seen this injury in my hockey-playing husband & after I show him this post perhaps he’ll take your advice (since he dosn’t always take mine!)Marie

  9. Scott Umberger Says:

    Great post.. Very unique post for a very unique issue/injury.

  10. Carson Boddicker Says:

    There is little question that appropriate manual and movement therapy is one of the better ways to get the “reset” button. Groin strains and longstanding groin pain are no exception here.

    Carson Boddicker

  11. Chris Dukarski,PT Says:

    Hey Eric!!
    Great job every week. I have been following your blog for a while now and have purchased several of your products. Do you ever sleep?? We met at the spring Sports Med Symposium. It is interesting that this week you mention Graston and Active Release in your blog. We spoke at the time that my PT clinic in Beverly specializes in both. http://www.orthowellpt.com I would even add that Kinesio Taping would be another great addition for acute groin strains to cleanse the eccymotic region. Graston and Active Release would be contraindicated during the acute phase as they are designed to release chronic adhesions. It sounds like the article describes a manual pump massage technique that we advocate thru our training in Orthopedic Manual Therapy.

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