Massage therapy · Kitchener–WaterlooAdductor Tendinopathy

Adductor tendinopathy is a condition where the tendon of the adductor (inner thigh) muscles becomes damaged where it attaches to the pelvis, which leads to groin pain. It is usually caused by overuse: repeated small strains on the tendon over time (Valent et al., 2012). Doctors and therapists often call this "adductor-related groin pain". The typical signs are tenderness over the adductor tendon and pain when you squeeze your legs together against resistance (Weir et al., 2015).

The adductor muscles help to stabilise the pelvis and move the leg towards the middle of the body (adduction). They tend to be most active when running, especially when changing direction, accelerating and kicking (Valent et al., 2012).

When the groin muscles contract, a great deal of tension passes through the tendon where it attaches to the pelvis. When the tension becomes too much because of excessive force and repetition, the tendon can be damaged.

Adductor Tendinopathy Anatomy

How to Treat Adductor Tendinopathy

Exercise-based treatment works better than passive treatments for adductor-related groin pain, and hands-on (manual) therapy may be added alongside it, but not instead of it (Serner et al., 2015; Thorborg, 2023). I can guide you through a graduated strengthening programme, look at what contributed to the problem, and add hands-on work alongside your exercises. See the My Approach tab for how I work.

Relative Rest and Load Management

Complete rest is not usually needed. Instead, cut back on the activities that make your groin pain worse, such as running, jumping or kicking, while you keep up your strengthening programme (Thorborg, 2023). As your symptoms settle and your strength improves, gradually build these activities back up. I can help you plan a gradual return to your sport.

Tips

• When taking part in an exercise programme, make sure you warm up properly beforehand.
• Keep going with your strengthening exercises, even once the pain has settled, to help stop the problem coming back.
• Return to sport gradually rather than all at once (Thorborg, 2023).
• Allow your body proper time to recover between sporting activities.

Adductor tendon pain usually comes from asking the tendon to handle more than it's ready for, often through running, kicking and changing direction. Rest alone rarely fixes it. My aim is to settle it down, then build the tendon and the muscles around your hip back up gradually, while changing whatever has been overloading it.

I start by assessing how your hips, pelvis and lower back move, testing the strength of your inner thigh and hip muscles, and asking about your sport, training and what brings the pain on. That tells us what contributed to the problem and where to focus.

When It's Sore

• Cutting back the running, kicking and sharp turns that flare it, while keeping you active
• Pain-free holds, such as gently squeezing a ball between your knees
• Hands-on work for the hip, thigh and lower back muscles to ease tension pulling on the tendon, with warm or cool applications in the clinic

As It Settles

• Building up to side-lying and standing inner-thigh exercises, and later more demanding ones such as the Copenhagen side plank
• Strength work for the hips, trunk and the rest of the leg so the whole chain shares the load
• Once it's past the irritable stage, myofascial work, muscle stripping and cross-fibre work on tight spots in the inner thigh, followed by gentle stretching
• A home programme between visits and, when you're ready, gym-based strength work

Back to Sport

1. Valent, A., Frizziero, A., Bressan, S. et al. (2012) 'Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review', Muscles, Ligaments and Tendons Journal, 2(2), pp. 142–148.
2. Weir, A., Brukner, P., Delahunt, E. et al. (2015) 'Doha agreement meeting on terminology and definitions in groin pain in athletes', British Journal of Sports Medicine, 49(12), pp. 768–774. doi: 10.1136/bjsports-2015-094869
3. Serner, A., van Eijck, C.H., Beumer, B.R. et al. (2015) 'Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes', British Journal of Sports Medicine, 49(12), p. 813. doi: 10.1136/bjsports-2014-094256
4. Thorborg, K. (2023) 'Current clinical concepts: exercise and load management of adductor strains, adductor ruptures, and long-standing adductor-related groin pain', Journal of Athletic Training, 58(7–8), pp. 589–601. doi: 10.4085/1062-6050-0496.21