Groin Pulls and Strains

In many respects, the groin is a most unglamorous part of the athletic anatomy. Groin is a catch-all term, generally describing the place where the upper thigh and the trunk of the body join together; the groin is also commonly stated to include the genitalia.

In the stricter sports medicine sense, the groin is the intersection of the abductor muscles, responsible for the flexion of the upper leg, and the abdominal muscles at the fold created where the pelvis and the muscles, tissues, and bones of the thigh meet.

A strain of a muscle, also known as a muscle pull, is a tear of the muscle fiber, the extent of which is determined by the nature and the extent of the tearing. Strains may range from a slight stretch of the muscle (sometimes referred to as a micro-tear, due to the fact that any stretching will rip the muscle fabric) to a complete rupture. A muscle strain will result in a limitation of physical movement that generally corresponds to the degree of severity of the tear.

Groin strains are caused primarily by quick, explosive efforts to change direction or to accelerate. These types of movements tend to place significant stress on the abductors. Sports such as American football, soccer, and gymnastics commonly result in groin injuries.

The symptoms of a groin pull or strain will typically include one or more of the following: pain in the groin, often both persistent and severe; movement that is stiff, awkward, and limited; sensation of weakness when a person attempts to move the thigh muscle closest to the affected area; painful lateral movement; a significant tear in the muscle often involves bruising observable on the upper inside portion of the thigh; and in a worst-case scenario, the muscle attached to either the femur or the pelvis will detach with a particle of bone.

The immediate treatment for a suspected groin strain is conservative. The injured person should cease the activity, and commence a progression of RICE applications (rest/ice/compression/elevation). In some settings, such as professional sports, it is a relatively common occurrence for the injured athlete to receive an injection of painkilling medication. Most of these injections are made directly into the afflicted area to assist the athlete to continue. Such treatment is a danger to the long-term health of the athlete, as the initial groin muscle tear may worsen after the injury. Because the usual pain sensors are deadened by the analgesic effect of the injection, the injury may become more serious. The general recovery time from a groin pull may be as little as seven days (in the case of a mild strain), to as long as three months or more when there is a complete tear. The rehabilitation of the injury will be assisted if the athlete concentrates on the development of a combi-

New York Yankees pitcher Roger Clemens (L) throws to catcher Jorge Posada (R) in the first inning against the Boston Red Sox in a June 2000 game. Clemens was replaced for the second inning after he pulled a groin muscle.
nation of strength and flexibility in the groin and all adjacent muscle groups.

In recent years, the most debilitating of athletic groin strains is inaccurately referred to as a "sport hernia." While a hernia is an injury that occurs in a similar location of the body—the lower abdomen and its muscle structures—a true hernia involves a tear in the muscle abdominal wall, which causes the internal tissues to protrude. Heavy weightlifting or similar explosive muscle stress is a common hernia cause. The sport hernia (also known by the sports medicine name Gilmour groin) was formally identified by a British physician who had treated successive elite-level soccer players for chronic groin strain injuries. In each case, the ligament that supports the inguinal canal, through which the male spermatic cord passes to connect to the scrotum, becomes torn through sudden lateral or darting movements. This most serious of groin strains requires surgery, with no guarantee of success given the nature of the torn ligament and its relationship to the surrounding muscle structures. Noted American football player Donovan McNabb is one of many athletes in recent years to undergo this procedure.

SEE ALSO Hip and groin injuries; Musculoskeletal injuries; Sprains and strains; Stretching and flexibility.