What is the treatment for a pulled groin?

Treatment of Pulled Groin (Inguinal Ligament Strain)

Begin functional treatment immediately with early exercise therapy and functional bracing rather than prolonged rest or immobilization, as this approach optimizes recovery and minimizes time away from activities. 1

Acute Phase Management (First 48-72 Hours)

NSAIDs for symptom control:

• Use NSAIDs to reduce pain and swelling in the acute phase 1
• These provide symptomatic relief while allowing early mobilization

Avoid traditional RICE protocol:

• RICE (Rest, Ice, Compression, Elevation) is not recommended as a primary treatment modality based on current evidence 1
• While ice may provide some pain relief, evidence for its efficacy in soft tissue injuries is limited and of low quality 2

Limited immobilization only if severe:

• If pain is severe, use rigid support for less than 10 days maximum to decrease pain and edema 1
• Must be followed immediately by functional treatment 1

Primary Treatment Approach (Weeks 1-6)

Functional support (preferred over immobilization):

• Use a functional brace for 4-6 weeks rather than immobilization 1
• Semi-rigid supports are more effective than elastic bandages 1
• Choose between brace versus tape based on patient preference 1

Early exercise therapy (critical component):

• Initiate exercise therapy as soon as possible to recover joint functionality 1
• Begin with range-of-motion exercises, then progress to strengthening 1
• Focus specifically on: proprioception, strength, coordination, and function 1
• Eccentric strengthening of the adductors and core stability exercises improve strength and functional activity 3

Manual mobilization:

• Combine manual mobilization with exercise therapy to enhance treatment effects 1
• Joint mobilization provides short-term increases in range of motion and decreases pain 1

Advanced Treatment Considerations

For chronic or recalcitrant cases:

• Ultrasonography is accurate and sensitive for diagnosing partial muscle/tendon ruptures and provides valuable information about location and extent of injury 4
• Dry needling may reduce pain and improve symptoms in adductor strains when combined with eccentric strengthening 3
• Surgery (such as adductor longus tenotomy) is reserved only for cases where nonsurgical treatment has failed after a well-planned rehabilitation program 4

Return to Activity Protocol

Immediate functional approach:

• Implement immediate functional treatment with a return-to-work or return-to-sport schedule to minimize absence from activities 1
• Use supervised exercises focusing on proprioception, strength, coordination, and function when returning to sports 1

Recurrence prevention:

• Incorporate exercise therapy into regular training activities for individuals with recurrent strains 1
• Continue functional support devices for protection against future strains, particularly in those with history of recurrent injuries 1
• Provide education on proper biomechanics and joint protection 1

Critical Pitfalls to Avoid

Do not prolong immobilization:

• Prolonged immobilization results in less optimal outcomes compared to functional support and exercise strategies 1

Do not delay proper diagnosis:

• Perform thorough physical examination 4-5 days post-injury when pain and swelling have subsided 1
• Consider differential diagnoses including pelvic stress fractures, avulsion injuries, hernias, and chronic prostatitis, which are commonly overlooked 5, 4

Do not neglect exercise therapy:

• Exercise therapy is crucial for recovery and preventing recurrent injuries 1
• A multidisciplinary approach is valuable in many cases 4