From the Guidelines
Treatment for adductor (groin) tendinitis should prioritize relative rest, cryotherapy, and eccentric strengthening exercises to promote healing and pain relief. The goal of treatment is to reduce pain, inflammation, and promote recovery while minimizing the risk of further injury. According to 1, relative rest and reduced activity are essential to prevent further damage and promote healing. Cryotherapy, such as applying ice to the affected area for 10-15 minutes, several times a day, can provide acute relief of tendinopathy pain 1.
Some key considerations for treatment include:
- Reducing activities that cause pain and applying ice to the affected area to decrease inflammation
- Using over-the-counter pain medications like ibuprofen or naproxen to manage pain and reduce inflammation
- Performing gentle stretching exercises for the hip flexors and adductor muscles daily
- Gradually introducing strengthening exercises as pain subsides, focusing on the core, hip, and thigh muscles
- Considering physical therapy, with a typical program lasting 6-8 weeks, to support recovery
It is essential to note that while nonsteroidal anti-inflammatory drugs (NSAIDs) can provide short-term pain relief, they have no effect on long-term outcomes 1. Locally injected corticosteroids may be more effective than oral NSAIDs in acute-phase pain relief but do not alter long-term outcomes 1. Surgery is an effective option in carefully selected patients who have failed three to six months of conservative therapy 1.
In terms of specific treatment options, the evidence suggests that:
- Eccentric strengthening is an effective treatment of tendinopathy and may reverse degenerative changes 1
- Topical NSAIDs are effective and may have fewer systemic side effects, but it is unclear whether NSAIDs are better than other analgesics 1
- Therapeutic ultrasonography, corticosteroid iontophoresis, and phonophoresis are of uncertain benefit for tendinopathy 1
- Extracorporeal shock wave therapy appears to be a safe, noninvasive, effective but expensive means of pain relief for a number of chronic tendinopathies 1
From the Research
Treatment Options for Adductor (Groin) Tendinitis
- Conservative treatment is often the first line of treatment for adductor tendinitis, and may include:
- Eccentric exercise-based physical therapy 2
- NSAIDs 2
- Corticosteroid injections, although these may lack long-term efficacy 2
- Alternative injections, such as PRP, which have shown short-term efficacy 2
- Compression clothing therapy, manual therapy, and strengthening exercise, which have shown moderate strength of evidence and a grade of recommendation of D 3
- Prolotherapy, which has also shown moderate strength of evidence and a grade of recommendation of D 3
- Surgical treatment may be considered if conservative measures fail, and may include:
- Adductor tenotomy, which has been shown to be effective in eliminating pain and allowing for a fast return to sports activities 4
- Resection of the genital branch of genitofemoral nerve and ilioinguinal nerve neurolysis, which may also be performed in patients with sports hernia 4
- Arthroscopic lengthening of the musculotendinous unit and treatment of concomitant intra-articular abnormality, which may be considered for iliopsoas disorders 5
- Tendon release, which has been described in the central compartment, peripheral compartment, and at the lesser trochanter, with similar outcomes observed between the techniques 5
Efficacy of Treatment Options
- The available evidence from randomized trials is insufficient to advise on any specific conservative modality for treating exercise-related groin pain 6
- Exercise therapy, including strengthening of hip and abdominal muscles, has been shown to improve short-term outcomes and return to sports compared to physiotherapy consisting of passive modalities 6
- Multi-modal treatment, including heat, manual therapy, and stretching, has been shown to be effective in improving outcomes, although the evidence is limited 6
- The literature available on the conservative treatment for longstanding adductor-related groin pain syndrome is limited and characterized by a low level of evidence, and further research is needed to confirm the efficacy of various therapeutic interventions 3