Adductor tendinopathy (groin pain)

Adductor tendinopathy causes pain in your upper-inner thigh (your groin). You will feel a soreness or ache that gets worse after any physical activity involving acceleration or twisting, as these actions put strain on your adductor muscles. Other symptoms of adductor tendinopathy include:

• Pain in the hip area
• Pain on the bone in your groin
• Your groin area feeling tender to the touch
• Pain and/or stiffness at night or when getting up in the morning
• Pain when squeezing your legs together
• Pain further down the leg
• Difficulty running and/or sprinting
• Difficulty twisting and changing direction

Injuries to your tendons most commonly come from gradual wear and tear following repeated physical exercises or ageing. If you make the same motions with your legs on a regular basis (such as kicking or lunging), you are more likely to cause damage to the tendons and muscles that are used for that motion.

When your tendons become stressed, small tears can happen, which can lead to swelling and discomfort. These tears easily repair themselves if you rest and give them some time to heal. However, if you continue to apply pressure to a tendon that has already been strained, it won’t be able to repair itself and the damage will get worse, leading to more pain as well as reduced movement in your upper thigh area.

Adductor tendinopathy can also happen when your inner thigh tendons are overworked to compensate for weaker muscle groups in the hips or legs. So, a problem with your hips or legs might also lead to a problem with your adductor tendons.

Common causes of adductor tendinopathy

Sports and activities such as football, martial arts, horse riding, or running require repetitive movements that can lead to you needing chronic adductor tendinopathy treatment. These movements include:

• Rapid acceleration or deceleration
• Twisting and turning of your hips
• Kicking
• Lifting and opening your leg
• Stretching or flexing your legs
• Quick side-to-side motions

Other causes of adductor tendinopathy

• Poor movement patterns that stress tendons in your groin
• Differences in muscular length placing strain on groin muscles
• Weakness in the abdominal area (your stomach muscles)
• Inactivity and/or fatigue
• Obesity
• Lack of warming up prior to exercise

In less severe cases, non-surgical treatment will be enough to address the issue. However, in instances where your groin pain has continued despite the use of non-operative methods, surgery is the recommended route. So, we will try less invasive treatments first, and only suggest surgery if these don't work.

Non-surgical treatments for adductor tendinopathy include:

Modifying your activities

To start with, adductor tendinopathy rehabilitation will involve avoiding activities and movements that increase pain in your groin area. Reducing pressure on the tendons that have become strained due to repetitive movements is a key part of helping them recover and heal.

You might then be advised to use the RICE method (Rest, Ice, Compression, Elevation) three times a day for between 10 and 20 minutes, as this helps reduce swelling in the affected area. This form of rehabilitation is often used during the first 48 hours after meeting with your physiotherapist.

Massage therapy

Due to the way adductor tendinopathy can cause a feeling of constant tightness in the groin, massage therapy can be used to bring relief to this area. This is done using a gentle massage technique applied to your inner thigh area around the groin, rather than directly onto the muscle that is painful. The massage releases tension across the affected area. Pressure is usually applied for around five minutes at a time, followed by rest.

Adductor tendinopathy exercises (physiotherapy)

Adductor tendinopathy can be managed very effectively using a personalised physiotherapy routine. The process initially focuses on returning to a full range of motion to the groin area. The next step is a series of muscle strengthening exercises. Supporting the growth of adductor muscles means they can handle greater pressure, which can take the strain off your tendons and make them less likely to become torn or inflamed further down the line.

Your physiotherapy programme may involve you lying flat on your back and squeezing a ball between your feet, which strengthens your groin muscles. Working on your abdominal core muscles and muscles in your hip area may also be recommended, as these two areas support your groin and protect it from too much strain.

The exercises we recommend will be tailored to you as an individual, based on factors like your age and fitness levels, as well as the activities or sports you want to get back to.

Medication and injections

Our consultants can prescribe medication to reduce the swelling in your groin area, such as ibuprofen or naproxen. They might also give you a cortisone injection. Cortisone is a highly effective drug for reducing inflammation and reducing pain in tendons that are strained, allowing you to get back to your normal life with less pain and more freedom of movement.

Adductor tendinopathy recovery time

As long as your adductor tendinopathy is identified early and you're careful to avoid movements that make the condition worse, recovery time can be relatively quick. Non-surgical treatment can rehabilitate the issue in four to 12 weeks.

In cases of chronic adductor tendinopathy treatment, where the problem has been present for months or even years, it can take up to six months before you return to a full range of pain-free movement.

• Where it hurts
• What makes the pain worse
• How the injury came about
• Your exercise regime
• Past health issues

After asking these questions, they will then do a physical examination. This starts with checking for tenderness directly over your groin/inner thigh area, followed by tests to determine whether there's pain when you do certain movements with your legs. You may also be asked to do something called the 'squeeze test', which involves squeezing the consultant or physiotherapist's fists between your legs. Other tests could include raising your thigh while they press against it, or closing your legs together while they push against them.

If there is tenderness directly over the groin/inner thigh area, along with pain when going through the resistance tests, we should be able to confirm that you have adductor tendinopathy. In most cases, the next step is a recommendation of rest followed by a course of physiotherapy.

If your pain is severe, or if symptoms don't improve with early treatment, an MRI scan might be required. This helps your consultant determine if there is any swelling, how torn the tendon is, and the most suitable rehabilitation process, along with enabling them to rule out any other conditions. Once the scan has taken place, they will either prescribe a physiotherapy programme or, for more serious conditions, recommend surgery.

Avoid drinking alcohol

You will be advised to avoid drinking alcohol during the 48 hours prior to your surgery. For more information, speak to your consultant.

Eat a balanced diet

Your consultant will give you advice about the kind of food you should eat and avoid before surgery.

Assess your medications

If you are taking any medications, your consultant will provide detailed information on whether you should avoid taking this medication before coming to the hospital, along with what kind of medication you might need to take after the surgery.

Stock up on food and supplies

After adductor tendinopathy surgery, your mobility will be limited. You won't be able to make quick trips to the shop, so make sure that you or someone in your support network gathers a good number of supplies that will keep you going for a week or so.

Your surgeon and healthcare team will take care to provide all the information you need before the surgery, including travel arrangements, what to bring, and any pre-operative testing that might be required.

During the operation, your surgeon will make a small incision above your adductor longus, which is the tendon that attaches to your pelvis. By releasing this tendon from where it links with the pelvis, chronic tension and pain can be reduced. The injured tendon is no longer being anchored to the bone and causing constant discomfort. The tendon heals by reattaching itself to the surrounding tissues, rather than the pelvis.²

Adductor release surgery is a common procedure with a very high success rate.

Recovering in hospital

You will be taken to your recovery room, with your legs stretched out to the sides. An ice pack will be placed on the groin area to reduce swelling. When you have fully recovered from the anaesthetic (around two hours), you can go home. You will need crutches to help you walk.

One to three days after surgery

For the first few days, you will need to stay in bed, with your legs kept out to the sides and a pillow placed between your legs when sleeping. Keeping your legs positioned in this way ensures that the cut tendon does not reattach to your pelvis. You can remove the outer dressing on the second day and have a shower. The wound can get wet, but avoid soaking it in the bath.

Three to seven days after surgery

You will be able to walk around three days after the surgery. You'll need to continue to stretch your inner thighs every two hours to ensure your tendon heals in the right way. When sleeping, keep placing pillows between your legs to guarantee they stay apart.

One to 12 weeks after surgery

One week after surgery, you can get going with your adductor tendinopathy rehabilitation programme. This might start off with stretching exercises, moving into muscle-strengthening exercises after two weeks, carried out one to two times a day. You might be asked to ride a stationary bike for 10-20 minutes before each stretching exercise.³

Your physiotherapist will tailor the exercise programme to align with how you progress during recovery. In most cases, full range of motion and strength returns after eight weeks, and you can go back to your chosen sports and activities after 12 weeks.

How do you treat adductor tendinopathy?

Generally, adductor tendinopathy is treated by encouraging rest and avoiding physical activities that contribute to your groin pain. This is followed by a series of stretching exercises that relieve tension in the affected area, as well as strengthening exercises. Strengthening muscles around your groin, such as your abdominals and hip muscles, increases the ability of your abductor muscles to deal with persistent pressure, reducing the chances of tears and inflammation.

If tests confirm that you have chronic adductor tendinopathy, which develops either after living with the condition for a pronged period or when you suffer a sudden tear, surgery may be required.

Can I cycle with adductor tendinopathy?

We recommend that you avoid cycling if you have adductor tendinopathy - even if you aren't in pain when doing so. Your muscles may be able to handle the pressure, but your tendons won't be able to, leading to further inflammation and worsening any tears that may have already developed. Speak to a physiotherapist or to an orthopaedic consultant and they will help you find a treatment plan that will allow you to heal so that you can get back to cycling.

If you are recovering from surgery for adductor tendinopathy, on the other hand, your physiotherapist might encourage you to work on an exercise bike for 10-20 minutes before launching into any stretching and/or strengthening exercises. Please note that you should always wait until two weeks after surgery before starting this programme. Rest assured that your physiotherapist will provide detailed advice and guidance that is tailored to you.

How long is adductor tendinopathy recovery time?

Adductor tendinopathy recovery time depends on both the severity of the condition and how long you have been experiencing pain. For those who notice the problem early and refrain from aggravating the issue once it shows up, a full recovery can be made with just four weeks of physiotherapy.

People who have lived with adductor tendinopathy for prolonged period of time will undergo a longer recovery period. This could be anywhere between three and six months.

• Flexible appointment times and locations that suit you
• The freedom to choose which hospital and consultant meet your needs
• Personalised, consultant-led treatment plans tailored to your specific requirements
• Comfortable and safe private facilities maintained by expert multidisciplinary teams
• Private ensuite rooms and delicious healthy meals
• Affordable, fixed-price packages (aftercare included)
• Flexible payment options to help you spread the cost of treatment

If you would like to learn more about treatment for adductor tendinopathy, book your appointment online today or call a member of our team directly on 0141 300 5009.