Adductor Tendinopathy | What is it? How do you treat it?
Adductor tendinopathy is a condition that typically affects the inner thigh area and is a common source of groin pain. Its is often referred to as a ‘groin strain’. Let’s explore what adductor tendinopathy is, its causes, symptoms, and how we approach treatment.
What are the adductor muscles?
The adductor muscles of the hip are a group of muscles located on the inside compartment of the thigh; consisting mainly of the adductor longus, adductor brevis and adductor magnus. They are primarily responsible for adduction, which is the movement of bringing the thighs together. As well as this they contribute to stabilising the hips and pelvis during activities.
What is adductor tendinopathy?
As used in many medical terms, ‘itis‘ is latin for inflammation. So adductor tendinitis basically means inflammation of the tendon.
What’s going on?
In recent years, it has been identified that adductor ‘tendinopathy‘ is a more appropriate label for this condition. ‘Opathy’ being latin for ‘disorder of’, is used in recognition of the fact that the condition is most commonly chronic and degenerative in nature, rather than acute and inflammatory (which ‘itis’ would imply).
Tendons, and in general all soft tissues, are in a constant continuum of healing. When a tendon becomes painful in the first 3-6 weeks, be it a first time episode or a flare up of a persistent problem, we class this as the ‘reactive phase’. This is typically when symptoms are more acute and irritable.
Over time the inflammation becomes more degenerative in nature due to a build up of scar tissue. This is termed as a ‘disrepair’ of the natural healing process.
Adductor tendinopathy symptoms often include:
- Groin pain, particularly when palpating the adductor tendons or during leg adduction
- Stiffness in the groin area, especially in the morning or at the beginning of activities
- Difficulty running, flexing the hip, or bringing the legs together against resistance
Adductor tendinopathy | Common causes & risk factors
- Overuse and repetitive stress on the adductor muscles and tendons
- Sudden changes in tendon loading, such as rapidly increasing training intensity
- Activities involving side-to-side movements and quick directional changes, e.g. football, hockey, netball
Adductor tendinopathy treatment
Treatment for adductor tendinopathy is centred around three simple steps. In the case of chronic tendinopathy (i.e. the injury is older than three months), we often skip straight to step two.
1. Reduce Pain
In an acute pain episode or flare up, follow the ‘POLICE’ protocol in the initial 48-72 hours:
- Protect > using good supportive footwear or taping can often help
- Optimal Load > general rest and offloading for the next few days, before steadily reintroducing movement as pain allows
- Ice > cold compress for 10-15mins every 2-3 hours to aid pain relief and reduce inflammation
- Compression > compress the injured area with using compression clothing
- Elevation > raise and support the injured area above the level of your heart to reduce swelling
2. Reset
Extracorporeal Shockwave Therapy (SWT) is a relatively new intervention that has scientifically proven, excellent results with specific conditions including adductor tendinopathy. Shockwave therapy owes its heritage to lithotripsy, a treatment that’s been around since the 1970s. Lithotripsy uses focused shockwaves to break apart kidney stones so they can be passed. A number of years later, a bit of lateral thinking and a strong evidence base now presents SWT as the ‘gold standard’ treatment for chronic tendinopathy.
As noted above, symptoms of tendinopathy fail to improve due to the stalled healing process in which the tendon is in a state of disrepair (more commonly called scar tissue). SWT as part of adductor tendinopathy treatment aims to agitate or shock the injury back to its acute phase of healing. It uses acoustic energy – almost like pressing the ‘reset’ button. SWT ‘resets’ the stalled healing process. It expedites a return to activity and has a noticeable reduction in pain. It is then vital to introduce progressive load to the tissues to ensure an optimum recovery.
3. Strengthen
As we know the adductors play a crucial role in absorbing and producing force when walking, running and jumping. As a result, part of adductor tendinopathy treatment should focus on regaining localised strength of the deep hip/pelvic muscles, as well as improving any weak links in the kinetic chain.
A systematic review in 2021 showed that a tailored, progressive strengthening programme should be used as part of adductor tendinopathy treatment.
As with the majority of tendon injuries, they typically take several months to recover. A rehabilitation period of 6-18 months isn’t unusual so patience is required
If you have any questions regarding adductor tendinopathy or any other injury, you can book an appointment online here or call our friendly reception team on 0114 267 8181.
