What is the treatment for groin muscle strain?

Treatment of Groin Muscle Strain

Exercise-based treatments are the cornerstone of management for groin muscle strain, with a recommended duration of at least 3 months for optimal outcomes. 1

Initial Management (Acute Phase: 0-7 days)

RICE Protocol

• Rest: Relative rest and reduced activity to prevent further damage and promote healing 1
• Ice: Apply cold therapy with melting ice water through a wet towel for 10-minute periods, 3-4 times daily 1, 2
• Compression: Use compression wraps to reduce swelling, but avoid overtightening 2
• Elevation: Elevate the affected area to reduce swelling 2

Pain Management

• NSAIDs: Recommended for short-term pain relief (though they don't affect long-term outcomes) 1, 2
  • Consider diclofenac for superior pain relief during motion 2
  • Topical NSAIDs may provide localized relief with fewer systemic side effects 1, 2
• Alternative analgesics: Acetaminophen can be used if NSAIDs are contraindicated 2

Rehabilitation Phase (Days 3-14)

Early Functional Treatment

• Begin active exercises within 48-72 hours of injury 2
• Progress to early weight-bearing as tolerated 2
• Consider using crutches initially if weight-bearing causes significant pain 2

Exercise Therapy

• Strengthening exercises: Focus on hip, trunk, and functional strengthening 1
  • Gradually introduce resistance band exercises, heel raises, and balance exercises 2
• Adductor-specific exercises: Include stretching and strengthening of adductor muscles 3
• Core strengthening: Target abdominal wall muscles, iliopsoas, quadriceps, and hamstrings 3, 4

Advanced Rehabilitation (2 weeks - 3 months)

Progressive Exercise Program

• Gradually increase intensity and duration of exercises 1
• Include eccentric strengthening exercises, which are effective for tendinopathy and may reverse degenerative changes 1
• Incorporate proprioception and coordination training to prevent recurrence 2

Functional Training

• Progress to sport-specific or activity-specific exercises 2
• Include exercises that mimic daily activities and work requirements 4

Support and Bracing

• Consider semi-rigid support for activities that stress the groin area 2
• Discontinue supportive devices when pain and swelling have significantly decreased 2

Long-term Management (Beyond 3 months)

Maintenance Exercise Program

• Continue with a home exercise program focusing on strength and flexibility 1
• Incorporate exercise therapy into regular activities to prevent recurrence 1

Return to Full Activity

• Return to full activity when:
  • Pain-free movement is achieved
  • Normal strength and flexibility are restored
  • Functional testing shows adequate performance 2

When to Consider Additional Interventions

Manual Therapy

• Consider joint mobilizations for the hip and pubic symphysis if progress plateaus 4
• Soft-tissue mobilization of the adductor muscles may provide additional benefit 4

Surgical Consideration

• Surgery should be reserved for patients who have failed 3-6 months of conservative therapy 1
• Most groin strains respond well to conservative management without requiring surgical intervention 5

Common Pitfalls to Avoid

1. Returning to activity too soon: This can lead to re-injury and chronic problems
2. Neglecting core and hip stabilizer strengthening: These are crucial for proper recovery
3. Focusing only on the adductor muscles: A comprehensive approach addressing abdominal and hip muscles is necessary 3
4. Overreliance on passive treatments: Active rehabilitation is more effective than passive modalities 5

The prognosis for groin muscle strain is generally excellent with appropriate management, with most patients achieving full recovery and return to previous activities 6.