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Adductor strain Cheat Sheet (DRAFT) by

Management , classification, prevalence

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Adductor Muscles

More inform­ation about this on the upper leg muscles cheat sheet
Sudden change of direction - rapid adduction of the hip against abduction force - stresses tendon
Sudden accele­ration (sprin­ting) - most common
Most injured at the muscul­ote­ndinous junction - area of poor blood supply and rich nerve supply

Adductor muscles

Contain: adductor Longus, adductor brevis, adductor Magnus, gracilis, pectineus, obturator externus
Innervated by obturator nerve apart from the pectineus (femoral)
Magnus­/longus is the most strained due to mechanical disadv­antage - not made for explosive movements & longus has low tendon to muscle ratio


Acute: involves muscul­ote­ndinous juncti­on/­muscle belly
Chronic: proximal irritation at the tendinous junction
Grade 1: Pain with minimal loss of mobility or strength
Grade 2: Partial loss of strength and function
Grade 3: complete muscle­/tendon disruption with loss of function


People who play sport which involves forceful eccentric contra­ction of the adductors (espec­ially in external rotation and abduction of the leg)
- Kicking, sprinting, forceful trunk rotation, side to side cutting , sudden changes in direction
- Ice hockey , soccer , football, rugby running, tennis, basket­ball, powerl­ifters (sumo stance)
- Usually occurs again after previous adductor injury
- inadequate physical condit­ioning (decreased ROM, previous hip/groin injury, inadequate stretc­hin­g/s­tre­ngt­hening of adductors)
- Athletes with thigh adductor : abductor strength ratio of <4:5
- Age
- Excessive pronation or leg-length discre­pancy


- Sudden onset of pain on proximal inner thigh , can radiate distally
- Pain provoked by movement , muscle stretch and eccentric contra­ction
- Bruisi­ng/­swe­lling in modera­te-­severe injuries
- Tenderness over inguinal ring and proximal inner thigh
- Pain on passive abduction or resisted adduction
- +ve thigh adductor squeeze test (adductor Magnus and gracilis)
- Neurol­ogical testing unrema­rkable, but sometimes adductor weakness and or sensory loss over medial thigh can occur (obturator neurop­athy)
- Assessment of lumbar spine, SI and hip (biome­cha­nical)
- Assess for hyperp­ron­ation, lower crossed , glut med weakness


- MRI showing oedema of adductors on the right
- Plain film radiog­raphs can help rule out tendon avulsion or bony pathology (AP and frog-leg of the hip)
- Ultrasound can be considered if no bony pathology is suspected


- Osteistis pubis (tende­rness over pubis symphysis)
- Athletic pubalgia (sports hernia, abdominal pressu­ris­ation tests +ve)
- inguinal hernia
- hip pathology ( FAI, avascular necrosis, SCFE, LCP, transient synovitis , degene­ration, f#
- GI/GU pathology
- Referred lumbro­sacral pain
- Neuropathy of obturator, iliohy­pog­ast­ric­,il­ioi­nguinal nerve
- Iliopsoas bursit­is/­ten­dinitis
- Rec fem tendinitis


- RICE for 48 hours
- Rehab phase 1: hip ROM and stretching of uninvolved muscles, isometric adduction, non weight bearing progre­ssive resistance for hip flexion, extension and abduction, streng­thening of trunk, upper body and contra­lateral lower extremity
- Balance board exercises
- Patient can carry onto phase 2 when patient can perform pain free concentric adduction
- Phase 2: ball squeezes, sumo squats, single leg stance, standing adduction with resistance band and seated, lunges, lateral squats and lat lunges, sliding board, patient advised to swim or cycle
- When patients can passively move and the affected side and strength equal to than the unaffe­cted, phase 3 can begin
- Phase 3: more load, intensity and speed, sport specific drills
- Athletes are allowed to return to sports when they regain full pain free ROM and 75% full strength
- Should be better within 4 weeks if acute. If modera­te-­acute , 4-8 weeks recovery, chronic up to 6 months
- Reassure patient that discomfort when returning is not uncommon
- Consider LP SMT, STW, myofascial release
- Address biomec­hanical dysfun­ction
- Patient advised to wear proper footwear and not run on hard/soft surfaces
- Adductor streng­thening can prevent strains
- Consider surgical referral if strain is no better with conser­vative care, full thickness tears/­avu­lsion injuries with persistent weakness of the affected limb


- Favourable
- Minimal pain and normal function if fully rested and rehabed
- >20 weeks after injury recovery for athletes