The most common acute injuries about the hip and pelvis from athletic competition are muscle strains. The musculature of the groin most often affected includes the adductor group (gracilis, pectineus, adductor brevis, adductor longus, and adductor magnus). The rectus abdominus, rectus femoris, and iliopsoas are also common muscles that can be affected. The mechanism of injury can be overuse causing microtears or a sudden forceful movement. A position of external rotation and eccentric forces often cause flexor / adductor strains, and the injury most typically occurs at the myotendonous junction or the tendonous insertion.
Signs and Symptoms
A strain can be felt as a sudden sensation of tearing or twinge while playing or may not be noticed until after the activity. Symptoms include pain and swelling. Focal areas of tenderness and swelling are often detected. With more severe injuries, a defect may be palpable. The history of injury, localized tenderness, and pain with resistance are the most notable measures for diagnosis.
Avulsions should be ruled out with an AP pelvis radiograph. Differential diagnosis also includes hernia, internal derangement of the hip (e.g. labral tears and chondral injuries), nerve entrapments, osteitis pubis, fractures and stress fractures.
Strains should be treated with RICE and analgesics as needed for a minimum of 2 to 3 days. Range of motion exercises should be initiated early. As pain resolves, gentle isometric exercise progressing to more dynamic resisted exercise can be performed using pain as a guide. The athlete can gradually return to play when pain-free. A protective spica bandage may assist in the early phase of return to sport for flexor / adductor strains. The most common complication is recurring symptoms and in chronic cases, surgery may be indicated but is rare.
Training programs should be specific for the level of athlete, timing during the season, and goals of the athlete. It is important to focus on general conditioning, specifically strength, endurance, and flexibility. Programs should include warm-ups and cool downs for training and matches.