Treatment of Inguinal Ligament Strain
For an inguinal ligament strain, functional treatment with early exercise therapy focusing on proprioception, strength, coordination, and function is the most effective approach to promote recovery and prevent recurrence.
Initial Management
Rest and Activity Modification:
- Avoid activities that exacerbate pain
- Limit activities that involve running, jumping, or quick directional changes initially
Pain Management:
- NSAIDs may be used for short-term pain and inflammation management (2-7 days) 1
- Apply ice for 15-20 minutes several times daily during acute phase to reduce swelling
Rehabilitation Protocol
Early Phase (Days 1-7)
- Begin gentle range of motion exercises:
- Ankle circles
- Alphabet drawing with toes
- Gentle stretching of the affected area 1
Intermediate Phase (Weeks 1-3)
- Progress to strengthening exercises:
- Resistance band exercises in multiple directions
- Heel raises (progressing from bilateral to unilateral)
- Core strengthening exercises 1
Advanced Phase (Weeks 3-6)
- Proprioceptive training:
- Balance exercises on stable surface, progressing to unstable surfaces
- Single-leg stance with eyes open, then closed
- Balance board exercises 1
Functional Support
- Functional support is preferred over immobilization 2
- Consider using a brace during recovery and for prevention of recurrence
- For prevention, both tape and brace may be used based on patient preference 2
Return to Activity
- A graded return to work/sports schedule should be based on:
- Pain-free walking
- Full range of motion
- Restored strength
- Ability to perform specific movements without pain 1
Long-term Management
- Continue proprioceptive and strengthening exercises long-term to prevent recurrence 1
- Use semi-rigid or lace-up supports during high-risk activities 1
- Regular follow-up to assess effectiveness and mechanics
Common Pitfalls to Avoid
- Inadequate rehabilitation: 20% of strains can develop chronic instability without proper rehabilitation 1
- Neglecting proprioceptive training: Essential for preventing recurrent strains 1
- Premature return to full activity: Can lead to re-injury and chronic problems
- Overreliance on passive treatments: Active rehabilitation is key to recovery
Special Considerations
- In severe cases where conservative management fails after 4-6 months, surgical options may be considered 1
- Professional athletes may require more aggressive management for quicker recovery 1
- Enthesopathy at the pubic insertion of the inguinal ligament may be a cause of chronic pain and may benefit from steroid injection in refractory cases 3
The evidence strongly supports early functional treatment with exercise therapy as the cornerstone of management for inguinal ligament strain, with emphasis on proprioception, strength, and coordination to promote optimal recovery and prevent recurrence.