Adductor tendonitis is characterised by pain in the upper inner thigh and groin area. However, this name has fallen out of favour as the latest evidence suggests that there is no inflammation associated with this injury. The more commonly accepted term now is adductor tendinopathy. The good news is it can be treated effectively with physiotherapy intervention.
The adductor muscles are a group of 5 muscles located on the inner thigh, including the adductor longus, brevis and magus, with the muscles attaching to the pelvic bone via the adductor tendon. The muscle group allows you to move your hip inwards and helps control hip movements outwards.
What is adductor tendonitis / tendinopathy?
Adductor tendonitis/tendinopathy typically occurs slowly over time due to increased loading of the adductor muscles and subsequent overloading of the tendon. This can start to produce adductor-related groin pain once the tendon starts to undergo physical and chemical changes.
Tendinopathies can be thought to be on a continuum that moves through different phases. Initially, the tendons start to change shape and become thicker, due to chemical and structural changes in the tendon.
The tendon thickens in order to reduce the stress so it can cope with more loading. While the tendon continues to thicken the tendon fibres become disorganised, leaving the tendon with reduced capacity to cope with the force from the muscle contraction.
Over time due to long term overloading and poor general health, the tendon can move into the degenerative phase, where the death of tendon cells occurs and further disorganisation of the collagen fibres of the tendon. Changes in this phase are irreversible and generally means the tendon is less tolerant to load.
However, all is not lost, as there are likely portions of the tendon that aren’t in the degenerative phase whose capacity to tolerate load can be improved.
Who gets adductor tendonitis / tendinopathy?
Adductor tendinopathies are more common in active and sporting populations, especially in sports that involve a continual and rapid change of direction and kicking, for example, ice hockey, soccer and Australian Rules Football. A 2015 study found that when playing the same sport, males were more likely to sustain adductor injuries when compared to females.
People are more likely to sustain an adductor injury in sport if they have had a previous groin injury, have weak adductors (inner thigh) muscles, play a higher level of field sports or have low levels of sports specific training.
In the non-sporting population, poor movement patterns during exercise can also stress the adductor tendons. Muscle length imbalance, strength differences or weak adductors in the lower limb or abdominals can influence the development of groin tendinopathy. Some other factors that can contribute include lack of warm-up, obesity, age-related weakness, degeneration or genetics.
Adductor tendonitis / tendinopathy symptoms
Adductor/groin tendinopathy can be characterised by pain at the upper ⅓ of the adductor muscle compartment (commonly the adductor longus tendon) in the inner thigh. It can also radiate down the inside of the leg or extend towards the pubic region in the lower abdomen. Onset is usually gradual and has a link to a change in activity or period of overloading. Whereas Adductor muscle strains are more common in the middle of the muscle belly and usually have a specific moment of onset. There may also be associated bruising within the muscles of the groin with a strain.
According to a study that looked at return to sport after criteria-based rehabilitation of acute groin muscle strains found that Recovery time can vary from 2-4 weeks for grade 1 injuries, 4-8 weeks for grade 2 injuries and 8-12+ weeks for grade three injuries.
People with adductor tendinopathy can report pain when contracting the adductor muscle i.e. squeezing legs together against resistance or when stretching the adductor muscles. Running, especially sprinting, will also most likely be painful, as well as kicking, hopping and deep split lunges or lateral lunges. Pain may be present with getting in and out of the car may as well as putting on pants, coughing and sneezing.
In severe cases, those with adductor tendinopathy may experience adductor muscle pain when walking as well.
How does physiotherapy help adductor tendonitis / tendinopathy?
Physiotherapy treatment for adductor tendinopathy varies depending on the severity and the stage the tendinopathy is in. In the acute stages, some manual therapy provided by a physiotherapist such as soft tissue massage in the adductor muscles can help reduce pain and improve your confidence and mobility.
Load management and a progressive strengthening program targeting the inner thigh muscles is where the strongest evidence lies for treating adductor tendinopathy. Strength exercises help promote new tendon fibre growth and therefore help the healing of the tendon, as well as increasing the load tolerance of the tendon.
A physiotherapist can help prescribe the best exercises for you, depending on your symptoms and what stage your tendinopathy is in and your current fitness levels. Exercises will start basic and slowly increase in difficulty as pain and function improve. This translates into less pain day today, greater ease of performing day to day activities and your preferred type of exercise.
Load management is also very important in the management of adductor tendinopathies. Physiotherapists can provide education and advice on how to relatively rest your tendon and avoid aggravation to allow healing in the early stages.
Adductor tendonitis / tendinopathy exercises
Early-stage exercises will include isometric contraction of the adductor muscles, gently loading the adductor tendons. This is when the muscles contract without motion. An example of this would be a ball squeezed between the knees in a crook lying.
Mid-stage exercises look to improve the strength of the adductors through their entire range of motion, Some examples of some mid-stage exercises include; theraband adduction in standing, side-lying adduction, adduction sliders and Copenhagens. This stage also includes strengthening the surrounding muscles including the gluteals, hamstrings, quadriceps and abdominals.
End-stage rehabilitation of adductor tendinopathy includes a gradual return to running at varying speeds, change of direction drills and sports specific exercises.
Strength exercises should be completed 2-3 x per week for 8-12 weeks in order to see the greatest benefits. Pain with exercise is okay, but keeping pain at a low level e.g. 4-5/10 should reduce the chance of doing too much too soon and aggravating your condition. Having some lingering pain after an exercise session is ok, so long as your pain returns to baseline within 24 hours.
In the video below, you can see some adductor tendinopathy rehab exercises in action. When undertaking exercise targeted at your adductors (or any area for that matter), for optimal results, it is best to first seek advice regarding which exercises are most suitable for you.
How to prevent adductor tendonitis / tendinopathy from returning?
To prevent adductor tendinopathy from returning it is important to continue to undertake a strength and conditioning program to maintain the strength of the adductor muscles as well as other muscles surrounding the pelvis including gluteals and hamstrings. Completing sports specific exercises in training ensures that there is muscular strength and stability around the groin that matches the demand of the athlete’s sport or activity, for example sprinting, jumping, change of direction.
The Copenhagen exercise is a particular exercise that has been proven in the literature to be one of the best in the prevention of adductor tendon injuries and the development of chronic groin pain. In a study from 2019 that compared 35 semi-professional football teams, the intervention group performed Copenhagen exercises 3 times per week during pre-season and one time per week during the season, whereas the control group trained as normal. The intervention group had a lower prevalence of groin injuries in the season compared to the control group, proving that the inclusion of Copenhagen exercises is beneficial in reducing adductor injuries.
It is also important to manage your load appropriately and allow for sufficient recovery time and adaptation between training sessions i.e. not too much training too soon.
Acute adductor tendinopathy that has only been around for a short period of time can take up to 4 to 8 weeks to recover. However, if the adductor tendon pain has been around for longer than, for example, months or years, it is considered chronic groin pain and most likely in the degenerative phase. Therefore it can take up to three to six months to heal.
Adductor tendonitis can be a difficult condition to treat because it might not cause pain until the tendon is overused. The good news is that, with the right treatment plans, you can get relief and avoid the risk of re-injury and undergoing more invasive treatment options, such as surgery.
For an expert opinion on the next steps for you, or to chat to a physiotherapist with experience in treating adductor tendinopathy/tendonitis, don’t hesitate to reach out by calling the clinic on 8490 0777 or send us an email at firstname.lastname@example.org
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