Treatment for Acute Adductor (Groin) Muscle Strain
For an acute pulled groin muscle, immediately begin the PRICE protocol (Protection, Rest, Ice, Compression, Elevation) combined with NSAIDs for pain control, followed by supervised exercise therapy starting within 48-72 hours—avoid prolonged immobilization beyond 3-5 days as this delays recovery without improving outcomes.
Immediate Management (First 3-5 Days)
PRICE Protocol Implementation
- Apply ice for 20-30 minutes, 3-4 times daily using ice and water surrounded by a damp cloth—never place ice directly on skin to prevent cold injury 1, 2
- Use a compression wrap to promote comfort while ensuring circulation is not compromised 1, 2
- Elevate the injured leg above heart level when possible to reduce swelling 1
- Rest from activities that cause pain, but avoid complete immobilization beyond what is necessary for initial pain control 1, 2
Pharmacological Pain Management
- NSAIDs are the first-line medication to reduce pain and swelling in the acute phase, which may accelerate return to activity 2, 3
- Consider adding cyclobenzaprine (muscle relaxant) as an adjunct to rest and physical therapy for relief of muscle spasm associated with acute, painful musculoskeletal conditions—use only for short periods (up to 2-3 weeks) 4, 3
- Avoid opioids as they cause significantly more side effects without superior pain relief 5
Early Mobilization Phase (After 3-5 Days)
Supervised Exercise Therapy
Begin supervised exercise therapy within 48-72 hours after injury—this has Level 1 evidence for effectiveness and is superior to non-supervised home exercises 5, 1, 6
The exercise program should include:
- Range of motion exercises focusing on gentle adductor stretching 1, 3
- Strengthening exercises targeting the adductor muscles, abdominal wall muscles, iliopsoas, quadriceps, and hamstrings 1, 3, 6
- Proprioception training to prevent recurrent injuries 1, 6
- Coordination and functional exercises specific to the athlete's sport or activity 1, 6
Functional Support
- Consider semirigid or lace-up supports rather than elastic bandages for functional treatment, especially for athletes with history of recurrent strains 2
Critical Pitfalls to Avoid
- Do not prolong immobilization beyond 3-5 days—this is the most common mistake that delays recovery without improving outcomes 5, 1
- Do not delay supervised exercise therapy—early exercises have the strongest evidence for optimal recovery and prevention of chronic problems 5, 1
- Do not apply heat to acute injuries—cold therapy is appropriate for the acute phase 5, 2
- Do not skip the adductor test during physical examination—have the patient lie supine with hips abducted and flexed at 80 degrees, then attempt to pull legs together against resistance; sharp groin pain indicates positive test 3
Return to Activity Timeline
- For mild strains: Gradual return to activity at 2-3 weeks depending on pain-free progression through rehabilitation 5
- For moderate to severe strains: Full return to sports at 6-8 weeks depending on physiotherapy results 5
- Monitor for persistent pain or difficulty with sports-specific movements—these indicate incomplete rehabilitation and increase reinjury risk 5
When Conservative Treatment Fails
If symptoms persist beyond 6-8 weeks despite appropriate conservative management, consider:
- Manual therapy combined with strengthening exercises—this has moderate strength of evidence for longstanding adductor-related groin pain 7
- Prolotherapy as an option for chronic cases—this has moderate strength of evidence 7
- Surgical intervention (such as adductor longus tenotomy) may be indicated when nonsurgical treatment fails, though this is rarely needed for acute injuries 8, 9