A recent study by Kerbel et al (2018) looked at the epidemiology of hip and groin injuries in US college athletes. 1984 hip/groin injuries were reported across 25 NCAA sports over 5 seasons. The top 4 reported injuries were soft tissue injuries, with just over 40% being adductor/groin tear and hip flexor tear. The most common mechanism of injury was non-contact, followed by overuse. So what are we missing when it comes to groin strains that leads to such a high number of non-contact and overuse injuries?
What are we missing #1 – it’s not an adductor strain
Just because someone has groin pain doesn’t mean they have a groin injury. Lots of other injuries and some more serious pathologies can show up as groin pain. First of all, serious pathologies such as stress fractures of the femoral shaft, fractures of the femoral neck, and avascular necrosis can present as groin pain as well as certain cancers. Screening for these conditions should be done first to rule them out or to refer out (Thorborg et al., 2018).
Intra articular hip pathologies such as FAI, hip labrum tears, and hip OA in older populations can also present as groin pain. We know that a high number of elite athletes have FAI and labrum tears on imaging but don’t always have symptoms. Insidious onset of groin pain with no mechanism of injury could also be an intra-articular issue (Thorborg et al., 2018). Often times this is treated like a groin strain but in reality we end up treating the symptoms and not the root cause.
There is also lots of soft tissue in the groin area, so it could also be any one of these as well. Ruling out hip flexor strain, inguinal hernia, abdominal hernia or osteitis pubis can help solidify an accurate groin strain injury (Thorborg et al., 2018).
What are we missing #2 – we are ignoring the adductors
It has been shown that the adductors are very active during forward skating. They had previously found that faster skaters produced more abduction range of motion during stride and more adduction during recovery (Upjohn et al 2008). This requires the adductor muscle group to work eccentrically during stride and transition quickly to concentric to pull the leg back under the body in preparation for the next stride. In another study, Chang et al. (2009) found that an increase in skating speed resulted in an increase in adductor magnus activity and duration of contraction.
The adductors sometimes get neglected when it comes to training. A lot of people tend to work in the sagittal plane and ignore the frontal plane. And the small amount of frontal plane training that occurs, it is mostly done in abduction – not adduction. Combine the lack of adduction strengthening during training with the volume of abduction/pushing in skating and we get a muscle imbalance between the adductors and abductors. There is evidence that suggests that an adduction/abduction ration lower than 80% can increase the risk of groin injury in hockey players (Tyler et al, 2001).
Strengthening the adductors also has the potential to increase a player’s skating speed. In Kevin Neeld’s book Ultimate Hockey Training (2012), he discusses the different factors influencing skating speed. In his book, speed is defined as speed = stride length x stride frequency. Increasing stride length and be done by getting lower to increase joint ranges of motion or by increasing propulsive force aka push off power. Increasing stride frequency is limited by how fast a player can recover his stride leg back under his body. It has been shown that faster players have a higher stride rate than their slower counterparts (Chang et al, 2009). In order to increase stride rate, there must be a fast transition from push off to recovery in order to commence the next stride. The adductors therefore must work quickly to pull the leg back under the body. The faster the leg gets under the body, the faster the next stride occurs increasing the stride rate and making the player faster on the ice. Strong and powerful adductors can improve the rate of recovery and increase stride frequency.
Transferring training into sport, adductor strength can increase skating speed and reduce the risk of injury in athletes. Try this progression of exercises to strengthen your adductors.
What are we missing #3 – poor adductor tissue quality
Hockey players often complain of tight hips. Taking into consideration the amount of work the adductors do while skating as mentioned above, the adductors are bound to get tight. This chronic cycle of muscles getting tighter and tighter every time we skate can lead to changes in range of motion at the hip which can 1) impact skating speed and performance (see previous paragraph for explanation) 2) increase risk of injury by pushing soft tissue limits of range of motion. So we have to take care of our adductors with things like self-myofascial release, soft tissue work and static stretching. Making this a routine before and after you skate can save you a lot of grief in the future. Check out these self myofascial release techniques and stretches to give your adductors some TLC.
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