Sports Medicine
Sports Injury Prevention & Rehabilitation

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Adductor Tendinitis

(Also known as Adductor Tendinopathy, Adductor Tendonitis, Adductor Tendinosis, Groin Tendonitis, Groin Tendinopathy, Groin Tendinitis, Groin Tendinosis)
Note - Although recent research suggests that 'adductor tendinopathy' is the more appropriate term to describe overuse injuries to the adductor tendon, we will use the term 'adductor tendinitis' in this document as it is more widely known.

What is adductor tendinitis?
Adductor tendonitis is a condition characterized by tissue damage and inflammation to the adductor tendon at its attachment to the pelvis resulting in groin pain.
The muscles at the inner aspect of your thigh are known as the adductor muscles (groin). These muscles originate from the pelvis and insert into the inner aspect of the thigh bone (femur) and lower leg bone (tibia).
The adductor muscles are responsible for stabilising the pelvis and moving the leg towards the midline of the body (adduction). They are particularly active during running (especially when changing direction) and kicking.
During contraction of the groin muscles, tension is placed through the adductor tendon at its attachment to the pelvis. When this tension is excessive due to too much repetition or high force, damage to the adductor tendon may occur. Adductor tendonitis is a condition whereby there is damage to the adductor tendon with subsequent degeneration and inflammation.

Causes of adductor tendinitis
Adductor tendinitis is usually an overuse injury, which commonly occurs due to repetitive or prolonged activities placing strain on the adductor tendon. This typically occurs due to repetitive running, kicking or change of direction activities.
Occasionally, patients may develop this condition suddenly due to a forceful contraction of the adductor muscles often when they are in a position of stretch. This typically occurs during rapid acceleration whilst running (particularly when changing direction) or when a footballer performs a long kick.
Adductor tendinitis is commonly seen in running sports such as football, hockey and athletics (particularly sprinters, hurdlers, and long jumpers) as well as in skiing, horse riding and gymnastics.
Patients may also develop this condition following inappropriate or inadequate treatment of an acute groin strain.

Signs and symptoms of adductor tendinitis
Patients with this condition typically experience groin pain that develops gradually overtime. Patients usually experience pain on firmly touching the adductor tendon at its attachment to the pelvis. Pain may also increase when squeezing the legs together or when moving the affected leg away from the midline of the body (abduction).
In less severe cases, patients may only experience an ache or stiffness in the groin that increases with rest following activities requiring strong or repetitive contraction of the adductor muscles. These activities typically include running, kicking and change of direction activities. The pain associated with this condition may also warm up with activity in the initial stages of the condition.
As the condition progresses, patients may experience symptoms that increase during activity and affect performance. In severe cases of adductor tendinitis the patient may be unable to continue the activity and may limp as a result of pain.

Diagnosis of adductor tendinitis

A thorough subjective and objective examination from a physician is usually sufficient to diagnose adductor tendinitis. Further investigations such as an X-ray, ultrasound, MRI or CT scan may be required occasionally, to confirm diagnosis and assess the severity of the condition.

Treatment for adductor tendinitis
Most patients with this adductor tendinitis heal well with appropriate therapy. The success rate of treatment is largely dictated by patient compliance. One of the key components is that the patient rests sufficiently from ANY activity that increases their pain until they are symptom free.
Activities placing large amounts of stress through the groin should also be minimized, these include: running (especially with change of directions), kicking and jumping. By avoiding these activities, the body can begin the healing process in the absence of further tissue damage. Once the patient can perform these activities pain-free a gradual return to these activities is indicated provided there is no increase in groin symptoms.
Ignoring symptoms or adopting a 'no pain, no gain' attitude is likely to lead to the condition becoming chronic. In these instances, the injury may develop into other groin conditions such as osteitis pubis requiring an even longer duration of rehabilitation. Immediate, appropriate treatment in patients with adductor tendonitis is therefore essential to ensure a speedy recovery. Once the condition is chronic, healing slows significantly resulting in markedly increased recovery times and an increased likelihood of future recurrence.
Diligently following RICE in the initial phase of injury (first 72 hours) will greatly assist in improving recovery time in patients with this condition. This involves rest from aggravating activities, regular icing, the use of a compression bandage, and keeping the affected leg elevated. Anti-inflammatory medication may also help to reduce inflammation, pain and swelling. In severe cases of adductor tendonitis, the use of crutches when walking may be necessary to protect the adductor tendon from further damage and to hasten the healing process.
A graduated flexibility and strengthening program guided by a therapist is essential to recondition the adductor muscles and reduce the likelihood of injury recurrence. Careful assessment by the therapist to determine which factors have contributed to the development of the adductor tendonitis, with subsequent correction of these factors is essential to ensure an optimal outcome.
A graduated return to running program in the final stages of rehabilitation is required to recondition the adductor muscles for running in a safe and effective manner. This should include the implementation of progressive acceleration and deceleration running drills, as well as change of direction drills before returning to sport.

Prognosis of adductor tendinitis

Most patients with adductor tendinitis heal well with appropriate therapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had their condition for a long period of time. Early therapy treatment is vital to hasten recovery in all patients with this condition.

Contributing factors to the development of adductor tendinitis

There are several factors which can predispose patients to developing adductor tendinitis. These need to be assessed and corrected with direction from a therapist. Some of these factors include:
  • adductor muscle tightness
  • poor biomechanics
  • muscle weakness (especially of the groin, gluteals or core stabilisers)
  • inadequate rehabilitation following a previous adductor injury
  • muscle tightness (particularly of the adductors, gluteals, hip flexors, or hamstrings)
  • inappropriate training or technique
  • change in training conditions or surfaces
  • poor posture
  • poor foot posture (e.g. flat feet)
  • inappropriate footwear
  • decreased fitness
  • fatigue
  • inadequate warm up
  • joint stiffness (particularly the lower back, hip and knee)
  • poor pelvic and core stability
  • neural tightness
  • muscle imbalances

Therapy for adductor tendinitis
Therapy for patients with adductor tendinitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of future recurrence. Treatment may comprise:
  • soft tissue massage (particularly to the adductors and abductors)
  • electrotherapy (e.g. ultrasound)
  • stretches
  • muscle energy techniques
  • joint mobilization (in particular the lumbar spine and hip joint)
  • ice or heat treatment
  • the use of a compression bandage or strapping
  • education
  • biomechanical correction
  • the use of crutches
  • dry needling
  • progressive exercises to improve strength, flexibility, core stability, pelvic stability and balance
  • clinical Pilates
  • hydrotherapy
  • activity modification advice
  • technique correction
  • anti-inflammatory advice
  • prescription of orthotics
  • devising and monitoring a return to sport or activity plan

Other intervention for adductor tendinitis
Despite appropriate therapy management, some patients with adductor tendinitis do not improve adequately. When this occurs, the treating therapist or doctor can advise on the best course of management. This may include investigations such as an X-ray, ultrasound, CT scan or MRI, pharmaceutical intervention, corticosteroid injection or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. A review with a podiatrist may be indicated for the prescription of orthotics in patients with abnormal foot biomechanics. In very rare cases surgical intervention may be considered.