What is the recommended treatment for groin muscle strain?

Treatment for Groin Muscle Strain

The recommended treatment for groin muscle strain includes rest, ice application for 20-30 minutes multiple times daily, and avoiding activities that cause pain while gradually implementing a structured rehabilitation program focused on strengthening and flexibility exercises. 1, 2

Initial Management (First 48-72 Hours)

• Rest and Activity Modification:

  • Avoid activities that cause pain to prevent further damage 1
  • Relative rest rather than complete immobilization to prevent muscle atrophy 1
  • Use of crutches may be necessary if weight-bearing causes significant pain 2

• Ice Application:

  • Apply cold therapy (ice wrapped in a damp cloth) for 20-30 minutes, 3-4 times daily 1
  • Most effective method: ice and water mixture in a bag surrounded by a damp cloth 1
  • Avoid direct ice-to-skin contact to prevent cold injury 1

• Compression:

  • Consider applying a compression wrap to promote comfort 1
  • Ensure compression does not compromise circulation 1
  • Note: Evidence shows compression wraps may not reduce swelling or improve recovery time 1

• Pain Management:

  • NSAIDs for short-term pain relief 1, 2
  • Consider topical NSAIDs for localized relief with fewer systemic side effects 1, 2
  • Acetaminophen (1000mg every 6 hours, not exceeding 4000mg daily) as an alternative 2

Rehabilitation Phase (After Acute Pain Subsides)

• Exercise Therapy (begin within 48-72 hours as tolerated):

  • Eccentric strengthening exercises are particularly effective for tendinopathy 1, 2
  • Focus on hip, trunk, and functional strengthening 2
  • Gradually increase intensity and duration of exercises 2
  • Stretching exercises to maintain and improve flexibility 1

• Progressive Return to Activity:

  • Criteria for return to full activity: pain-free movement, normal strength and flexibility, and adequate functional performance 2
  • Supervised exercises focusing on proprioception, strength, coordination lead to faster return to sport 2
  • Continue home exercise program for long-term recovery 2

Common Pitfalls and Caveats

• Misdiagnosis: Groin pain can be caused by various conditions beyond muscle strain, including stress fractures, avulsion injuries, sports hernias, or osteitis pubis 3, 4. Ensure proper diagnosis before initiating treatment.

• Inadequate Rest: Returning to activity too soon can lead to re-injury or chronic problems 5.

• Overuse of Ice: Limiting cold application to 20-30 minutes prevents cold injury to tissues 1.

• Overlooking Rehabilitation: Simply waiting for pain to subside without proper rehabilitation often leads to recurrence 2, 5.

• Inappropriate Use of Corticosteroids: The role of corticosteroid injections in muscle strains is controversial and may have deleterious effects on tendon healing 1.

• Failure to Address Risk Factors: Not identifying and addressing factors that contributed to the initial injury (muscle imbalances, inadequate warm-up, excessive fatigue) increases recurrence risk 5, 6.

For most patients with groin muscle strain, the long-term outcome is excellent with appropriate conservative management, and complications are few 5. Surgery should be reserved only for patients who have failed 3-6 months of appropriate conservative therapy 2.