Adductor Strain Rehabilitation Protocol

This protocol outlines a comprehensive rehabilitation program for adductor strains (groin pulls). It progresses through phases, ensuring adequate healing and return to pre-injury activity level. The timelines provided are guidelines and should be adjusted based on individual patient progress and pain levels. Close communication between the patient, physical therapist, and physician is essential.

Pathophysiology

Adductor strains typically occur due to sudden forceful contraction of the adductor muscles, often during activities involving rapid changes in direction, acceleration, or deceleration. The adductor longus is the most commonly affected muscle, followed by the adductor magnus and gracilis. The severity of the strain is graded as follows:

• Grade I: Mild strain with minimal pain, slight discomfort, and no significant loss of function.
• Grade II: Moderate strain with moderate pain, some loss of function, and possible bruising.
• Grade III: Severe strain with significant pain, substantial loss of function, and possible palpable defect.

Factors contributing to adductor strains include inadequate warm-up, muscle imbalances (weak adductors relative to abductors), poor flexibility, and previous history of groin injuries.

Special Tests

These tests help to diagnose and assess the severity of the adductor strain.

• Palpation: Palpate the adductor muscle group (adductor longus, adductor magnus, gracilis) to identify areas of tenderness.
• Resisted Hip Adduction: Patient performs hip adduction against resistance applied by the therapist at various angles (0, 45, and 90 degrees of hip flexion). Pain and weakness are indicative of an adductor strain.
• Pencil Test: The clinician places a pencil between the patient's legs and instructs the patient to squeeze. Pain suggests an adductor injury.
• FABER Test (Patrick's Test): This test assesses for hip joint pathology, but pain elicited in the groin region can also indicate adductor involvement.

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

Goals: Control pain and inflammation, protect the injured tissues, and initiate gentle ROM.

• Rest: Avoid activities that aggravate the pain. Crutches may be used for ambulation if needed.
• Ice: Apply ice to the injured area for 15-20 minutes every 2-3 hours to reduce pain and inflammation.
• Compression: Use a compression bandage to help control swelling.
• Elevation: Elevate the affected leg whenever possible.
• Pain Management: Over-the-counter pain relievers (NSAIDs or acetaminophen) may be used as directed by a physician.
• Gentle Range of Motion (ROM): Initiate gentle, pain-free ROM exercises, such as ankle pumps and knee extensions.
• Isometric Adduction Exercises: Perform isometric adduction exercises against a wall or resistance band. Hold for 5-10 seconds, repeat 10-15 times, pain-free. Focus on low intensity.

Phase II: Loading (Days 7-21, or as pain allows)

Goals: Restore ROM, improve strength and endurance, and begin functional activities.

• Continue RICE protocol as needed.
• Progressive ROM Exercises: Progress to active and active-assisted ROM exercises, including hip flexion, extension, abduction, adduction, and rotation. Emphasis on pain free movement.
• Stretching: Gentle stretching of the adductor muscles, holding each stretch for 30 seconds, repeat 3 times. Examples include: Butterfly stretch, groin stretch against a wall.
• Strengthening Exercises:
  • Resisted Hip Adduction: Use resistance bands or cable machine to perform resisted hip adduction exercises. Start with low resistance and gradually increase as tolerated.
  • Hip Abduction Exercises: Strengthen hip abductors to improve stability and balance. Examples include: side-lying hip abduction, standing hip abduction with resistance band.
  • Bridging: Strengthen the glutes and hamstrings.
  • Core Strengthening: Incorporate core strengthening exercises to improve stability and control. Examples include: planks, bridges, and abdominal crunches.
• Proprioceptive Exercises: Begin proprioceptive exercises to improve balance and coordination. Examples include: single-leg stance, wobble board exercises.
• Low-Impact Cardio: Begin low-impact cardiovascular exercises, such as walking or cycling, as tolerated.

Phase III: Return to Function (Days 21+, or as pain allows)

Goals: Restore full strength, power, and endurance, and return to pre-injury activity level.

• Continue strengthening and stretching exercises. Gradually increase the intensity and volume.
• Sport-Specific Exercises: Begin sport-specific exercises that mimic the movements and demands of the patient's sport or activity. Examples include:
  • Agility Drills: Cone drills, shuttle runs, figure-of-eight runs.
  • Cutting and Turning: Gradually increase the speed and intensity of cutting and turning movements.
  • Jumping and Landing: Progress to jumping and landing exercises, focusing on proper technique and control.
  • Kicking (if applicable): Begin kicking exercises gradually, focusing on proper technique and avoiding pain.
• Plyometric Exercises: Incorporate plyometric exercises to improve power and explosiveness. Examples include: box jumps, lateral hops.
• Gradual Return to Activity: Gradually increase the intensity and duration of training sessions. Monitor for any signs of pain or re-injury.
• Maintenance Program: Once the patient has returned to their pre-injury activity level, continue with a maintenance program to prevent future injuries. This should include regular stretching, strengthening, and proprioceptive exercises.