Runner's guide to avoiding groin injuries

Beat running-related groin injuries

The groin plays a vital part in the running action, so a runner suffering from a groin injury is going to find the act of running very difficult indeed. At the first signs of a proper groin injury, expert advice should be sought. Here's the runners' guide to avoiding groin injuries.

The groin

The groin is a complicated area for a number of reasons. It is where the relatively stable abdomen and the very mobile legs join, and where the powerful muscles responsible for flexing the hip and the trunk are inserted into bone.

In most cases the muscles will be acting to move the leg in relation to the trunk, which should ideally be kept as stable as possible for greatest efficiency. For instance, the hip flexors will be called into action when kicking a football, when a sprinter blasts out of the blocks, when running uphill or even performing sit-ups.

One of these muscles, the rectus femoris (part of the quadriceps), also acts to straighten the knee. Therefore, lifting (flexing) the leg in front of the body whilst the knee is bent, involves this muscle contracting and stretching at the same time (think of a sprint runner coming out of his blocks). This puts the muscle at risk of injury if strength, flexibility and co-ordination are not perfect.

The adductors

Another important group of muscles in this area are the adductors, which are located on the inside of the thigh. Injuries here are common in running, soccer, rugby, hockey, basketball, netball and racquet sports — anything involving a sudden change of direction. The adductors act to bring the legs together, as in gripping the sides of a horse when riding.

In running they are important stabilizers, helping to limit side to side movement and thereby improving the efficiency of forward running momentum. In running, the adductors can be injured in sprinting as they contract strongly to prevent the tendency to move from side to side such as in the first few strides of a sprint runner from the blocks.

Distance runners can develop problems due to running on uneven or slippery ground, on the side of a hill or even on a road with a steep camber. It may be possible to pinpoint a particular episode that produced the groin injury, such as a tackle in football or inadvertently doing the splits whilst running on a slippery surface.

However, it is quite likely that underlying deficiencies may have made the injury more likely. In particular, poor flexibility in the hip joints (especially in male runners) or in the lower back, and muscle weakness may have played a part. It is therefore vitally important that in addition to dealing with the recent injury that any underlying inadequacies are addressed in order to reduce the chance of further episodes occurring.

Adductor running injuries

These muscles (usually the adductor longus) are injured when the leg is forced outwards at the hip. Pain will be felt immediately, towards the top of the inner thigh near to the pelvic bony origin of the adductor muscles. Depending on the severity, running or even walking may either be impossible or only with a limp. As the muscle lies close to the surface, you will often be able to identify a tender spot on probing. Contracting the adductor muscle, by trying to bring the legs together against resistance, will produce pain, as will stretching the leg out to the side.

Immediate treatment, as in all acute injuries, should be to stop the running activity, apply ice (never directly to the skin) and apply a compression bandage. Within a few days, stretching exercises can start.

Stretching exercises for injured runners

These exercises are best performed non-weight-bearing to begin with. You could try the following:

  • Sit down with legs in front and knees straight. Move your legs as far apart as possible and gradually bend forward at the hips until a stretching sensation is felt along the inside of the thighs.
  • Lie on your back with your knees bent and your feet together. Whilst keeping your feet together let the knees fall away to the side. It may help to press down on the insides of the knees with your hand.

These stretching exercises should stop short of the point where pain would be provoked.

Although not able to run at this time, cycling may be pain-free and can be used to maintain aerobic fitness. As well as attending to flexibility, as discomfort settles, efforts should be made to strengthen the adductors.

Begin with isometric exercises (the muscle contracts without the leg moving) such as squeezing a ball between the knees, either sitting or lying flat. The next stage would be strengthening exercises done on an adductor machine in the gym or with an elastic band attached to a fixed object. Start with the legs apart, contract the adductor muscles to bring the legs together. In the final stages of recovery, more dynamic movements should be carried out. These might include running sideways (side-slip), without crossing the legs to begin with, or astride jumps onto a bench (a favourite in circuit training).

Runners' hernias

A hernia is an area of weakness in the muscles that form the abdominal wall. The pressure inside the abdomen increases when we cough, sneeze or strain and if there is a weakness the pressure will cause a bulging in that area. The most common site for a hernia is in the groin (inguinal hernia) just above the groin crease.

There is also a variant on the classic inguinal hernia called a sportsman's hernia or Gilmore's groin. The condition itself probably reflects a mixture of pathologies, with various degrees of disruption of some of the muscles in and around the groin area. In some ways it could be considered as the earliest stages of a hernia, before an obvious bulging of the abdominal contents has developed.

Pain, often a dull ache, in the lower abdomen is the main symptom. Referred pain may also be felt in the inner thigh. Running, kicking and performing sit-ups may produce the pain, as can coughing and sneezing. The runner with a sportsman's hernia may find that relatively short periods of rest will allow the symptoms to settle. However, the pain usually returns when more intensive run training begins and surgical repair may be required but is usually very successful.

Less common running groin problems

As well as the two problems described above, the origin of groin pain can be any of the other anatomical structures in the region. The hip joint itself lies very deep within the groin area and hip joint pain will be experienced here rather than on the outside of the leg. However, hip joint pain can be due to arthritis, joint strain, capsulitis or even a stress fracture.

Back problems can also present runners with groin pain as can various problems involving the internal organs such as bladder, kidney, bowel and reproductive organs. The bones at the front of the pelvis (pubic rami) may also be the site of stress fractures.

For that reason, and in view of the serious nature of some of these conditions, unless the symptoms are typical of an adductor injury and respond well to treatment, it is advisable to seek professional help if you have a running-related groing problem.

A final word about groin injuries

The most common type of groin injuries can usually be diagnosed and treated quite easily. Adequate treatment and then working on flexibility, balanced muscle strength and core stability will help to prevent acute injuries giving rise to chronic problems.

There are also many less common causes for groin pain, therefore if the symptoms are unusual or don't respond to treatment, professional advice should be sought.

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