From the Research
The treatment for adductor origin tendinopathy primarily involves conservative management with a progressive rehabilitation program, focusing on eccentric strengthening exercises and pain management, with surgical options like tenotomy considered for persistent cases unresponsive to 3-6 months of conservative treatment. The most recent and highest quality study 1 suggests that a reasonable first line of treatment for tendinopathy should include a course of NSAIDs and eccentric exercise-based physical therapy. Key components of the treatment plan include:
- Relative rest from aggravating activities
- Ice application for 15-20 minutes several times daily to reduce acute pain and inflammation
- Pain management with non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (400-600mg three times daily) or naproxen (500mg twice daily) for 7-14 days
- A structured physical therapy program focusing on progressive strengthening of the adductor muscles, starting with isometric exercises and advancing to eccentric strengthening
- Specific exercises such as adductor squeezes, side-lying leg raises, and sliding side lunges, performed 3-4 times weekly for 8-12 weeks
- Manual therapy techniques like soft tissue massage and joint mobilization to improve tissue mobility
- Corticosteroid injections may provide short-term relief in recalcitrant cases but should be limited due to potential tendon weakening Studies have shown that surgical options like tenotomy or repair can be effective for persistent cases, with one study 2 reporting that 91% of patients improved after adductor tenotomy, and another study 3 showing that all patients were improved or free of symptoms after tenotomy of the adductor longus tendon. However, it is essential to note that surgery should be reserved for patients who are recalcitrant to conservative management, due to the potential risks and complications associated with surgical interventions 1. Overall, a comprehensive approach that addresses both symptom management and the underlying biomechanical issues is crucial for promoting tissue healing and gradually restoring function and strength to the affected adductor tendons.