Adductor Strain Rehabilitation Protocol

This protocol outlines a comprehensive physical therapy rehabilitation program for adductor strains, commonly referred to as groin strains. It is divided into phases based on the healing process and functional capabilities. This protocol serves as a guideline; progression should be based on individual patient presentation, pain levels, and clinical judgment. Consulting with a physician is crucial for diagnosis and clearance for return to sport/activity.

Pathophysiology

Adductor strains typically occur due to excessive force placed on the adductor muscles during activities involving rapid changes in direction, sprinting, kicking, or forceful hip adduction. The adductor muscles, primarily adductor longus, magnus, brevis, pectineus, and gracilis, are responsible for bringing the leg toward the midline of the body. These strains can range from mild (grade 1) with minimal fiber disruption to severe (grade 3) with complete muscle rupture. Risk factors include inadequate warm-up, poor flexibility, muscle imbalances, and previous groin injuries.

Phase I: Protection (Days 1-7, or until pain is controlled)

The primary goal of this phase is to reduce pain and inflammation, protect the injured tissues, and promote early healing.

• Goals:
  • Minimize pain and inflammation.
  • Protect injured tissues.
  • Initiate gentle range of motion.
• Interventions:
  • RICE: Rest, Ice (15-20 minutes every 2-3 hours), Compression (using a groin wrap), and Elevation.
  • Pain Management:
    • Modalities such as electrical stimulation (TENS) or ultrasound (under physician's guidance).
    • Pharmacological management as prescribed by a physician (e.g., NSAIDs).
  • Gentle Range of Motion (ROM):
    • Pain-free passive and active-assisted ROM exercises.
    • Examples: hip flexion, extension, abduction, adduction, internal and external rotation within pain-free limits.
    • Goal: Maintain joint mobility and prevent stiffness.
  • Isometric Exercises:
    • Gentle isometric adduction exercises against a wall or therapist resistance.
    • Hold for 5-10 seconds, repeat 10-15 times, focusing on minimal pain.
    • Other isometrics: Hip flexion, abduction, extension (low intensity).
  • Assistive Device: Crutches may be used if ambulation is painful.
• Progression Criteria:
  • Pain is controlled at rest and during gentle ROM.
  • Minimal swelling.
  • Able to perform pain-free isometric adduction.

Phase II: Loading (Days 7-21, or when able to perform pain-free isometrics)

The goal of this phase is to gradually increase strength, flexibility, and proprioception, preparing the muscle for functional activities.

• Goals:
  • Increase strength and endurance of adductor muscles.
  • Improve flexibility and range of motion.
  • Restore proprioception and balance.
• Interventions:
  • Progressive Resistance Exercises:
    • Begin with light resistance and gradually increase the weight or resistance bands.
    • Examples: Adductor squeezes with a ball between the knees, hip adduction machine (if available), side-lying hip adduction with resistance band, standing hip adduction with resistance band.
    • Focus on controlled movements and proper form.
    • Include exercises for hip abductors, flexors, extensors, and core musculature to address any muscle imbalances.
  • Stretching Exercises:
    • Gentle static stretching of the adductor muscles, holding each stretch for 30 seconds, repeat 2-3 times.
    • Examples: Butterfly stretch, side lunge stretch, groin stretch against a wall.
    • Progress to dynamic stretching exercises as tolerated.
  • Proprioceptive Exercises:
    • Single-leg stance exercises on a stable surface, gradually progressing to unstable surfaces (e.g., foam pad, balance board).
    • Balance drills with perturbations.
    • Agility drills (e.g., shuttle runs, cone drills) starting with slow, controlled movements and progressing to faster speeds.
  • Cardiovascular Training:
    • Low-impact activities such as cycling or elliptical training to maintain cardiovascular fitness.
• Progression Criteria:
  • Able to perform resisted adduction exercises without pain.
  • Full, pain-free range of motion.
  • Good balance and proprioception.

Phase III: Return to Function (Days 21+, or when strength is ~80% compared bilaterally)

The goal of this phase is to gradually return the patient to their pre-injury activity level by focusing on sport-specific or activity-specific exercises.

• Goals:
  • Restore full functional capacity.
  • Return to sport/activity without pain or limitations.
  • Prevent re-injury.
• Interventions:
  • Sport-Specific Training:
    • Gradually increase the intensity and duration of sport-specific drills.
    • Examples: sprinting, cutting, jumping, kicking, depending on the patient's sport.
    • Focus on proper technique and biomechanics.
  • Plyometric Exercises:
    • Begin with low-impact plyometrics and gradually progress to higher-impact exercises.
    • Examples: box jumps, single-leg hops, lateral bounding.
  • Agility Training:
    • Advanced agility drills with rapid changes in direction and speed.
    • Examples: figure-eight runs, carioca drills, agility ladder drills.
  • Maintenance Program:
    • Continue with strengthening and stretching exercises to maintain muscle strength and flexibility.
    • Emphasize proper warm-up and cool-down routines.
• Return to Sport Criteria:
  • Full, pain-free range of motion.
  • Strength is at least 90% compared to the uninjured leg.
  • Able to perform all sport-specific activities without pain or limitations.
  • Successful completion of a functional testing battery (see below).
  • Physician clearance.

Common Special Tests

• Adductor Squeeze Test: Patient supine, knees bent, therapist squeezes a ball between the patient's knees. Positive test: pain in the adductor region.
• Palpation of Adductor Muscles: Palpate along the length of the adductor muscles for tenderness.
• Resisted Hip Adduction Test: Patient supine, therapist applies resistance to hip adduction. Positive test: pain in the adductor region.
• FABER (Patrick's) Test: Assesses hip joint pathology. Can indirectly stress the adductors.

Disclaimer: This protocol is intended as a general guideline and should be adapted to the individual needs of each patient. It is crucial to consult with a qualified physical therapist or physician for a comprehensive evaluation and treatment plan.