Groin Strains & Hockey: How to Prevent and Manage Them
Sports injuries are every athlete’s worst nightmare. At best, they’re a hassle, and at worst, they can end your season and take you out of the sport you love.
About 10-25% of all injuries in hockey are groin strains, and many of these injuries are related to overuse, fatigue, and biomechanical errors - things that can often be prevented or managed before an injury occurs.
What Is A Groin Strain & How Do They Happen?
Before we can talk about groin strains specifically, we need to discuss some relevant anatomy. Your “groin” muscles are officially referred to as the adductor muscles (including the adductor longus, adductor magnus, adductor brevis, gracilis, and pectineus). These muscles work to pull your leg in towards your midline, squeezing your legs together. If you put a fist between your legs and squeeze, this works your adductors. Working in opposition to your adductors are your abductors, which primarily consist of your glutes. These glute muscles (aka your butt muscles) work opposite the adductors, pulling your leg away from your midline (like when doing a side leg raise), and they are also responsible for extending your leg behind you.
Another important concept to consider is how our bodies create stability. When we move, we have muscles that are contracting to create the movement (like your glutes when bringing your leg out to the side). At the same time, the muscles opposite are contracting to slow and control that movement (in this case, your adductors would be controlling your leg as you bring it out to the side). These opposing muscle groups need to be matched in both strength and endurance, meaning that they can create enough force for a long enough time to manage the work that they do. When there is an imbalance in strength or endurance, our ability to stabilize and control our movement breaks down, opening the door for an injury to occur.
Groin strains specifically occur when your leg moves too far out from your body, particularly while you’re trying to pull it in. In hockey, this often happens when you overstride or another player’s leg, arm, or stick pulls your leg out from under you. Basically, your adductors are trying to pull the leg inwards, but they’re stretched too far or they’re too weak for that to happen effectively. The end-result is that adductor muscle fibers are stretched, damaged, and torn, creating the symptoms associated with a groin strain. Strains also occur more often when the muscles get tired or fatigued, like near the end of a game or a practice, when the muscle is less able to respond to what you’re asking it to do.
There are certain things that increase your risk of a groin strain. These include:
Muscle Imbalance - A strength imbalance between the adductors (groin) and abductors (glutes) can cause groin strains. If the glutes/abductors are too strong, they’ll pull your leg out harder or faster than your adductors/groin muscles are able to handle, creating a strain.
Anterior Pelvic Tilt - Because of our culture today, most of us spend a lot of time sitting. This sitting posture tightens up our hip flexors and our back muscles, pulling our pelvis into a forward tilt (a similar position to sticking your butt out behind you). Even if we don’t sit a lot, the standard hockey player spends a lot of time in an athletic stance (crouched forward, slightly squatting, ready to go) which will contribute further to this anterior/forward tilt. This forward tilt brings the ends of your adductor muscles together, allowing them to get shorter and tighter over time, making them more susceptible to groin strains.
Poor Core Stability - Your arms and your legs need a solid base if they’re going to move correctly, particularly at the high speeds necessary for sports. If your core is too weak or gets tired too fast, your limbs lose this solid base and problems can start to arise.
Previous Groin Strains - If you’ve injured your groin in the past, you’re more likely to injure it again in the future (if you don’t do anything to address it). Muscles tend to get weaker after they’ve been injured, which is why proper rehabilitation and exercise of the injured muscle is an essential part of the healing process. Another factor to consider is the fact that future groin strains tend to get more severe than the ones before, so addressing these ASAP is critical.
Previous Injury of the Hips, Knees, Ankles, Feet or Shoulders - When it comes to your body, just about everything is connected, particularly when it comes to how you move. Injuries, particularly those that haven’t been properly treated or rehabilitated, can change how your entire body moves. Our bodies naturally compensate for an injury, avoiding putting pressure or load on an injured area to prevent further damage and pain, but these compensation patterns can quickly become a part of how we move even after we’ve healed, which often puts us at risk for another injury.
What Are The Symptoms of A Groin Strain?
Symptoms of a groin strain vary based on the severity of the strain. A grade 1 strain (a mild pull) will typically only result in mild symptoms, while a grade 2 strain (a partial tear) or a grade 3 strain (a complete tear or rupture) will produce more significant pain and dysfunction.
The symptoms of a groin strain include:
Pain along the inner thigh, usually described as sharp or burning
Pain that gets worse with adduction (squeezing the legs together)
Pain that gets worse with stretching the groin (abduction)
Typically able to point to the pain (“the pain is right here!”)
Possible bruising and swelling with more severe strains
Groin strains can significantly affect your sports performance. Even if it’s just mild pain, your body still isn’t able to utilize those muscles as effectively, and if it’s more severe damage, the muscle fibers themselves are too damaged to do the work you want them to. Additionally, having one groin strain puts you at higher risk for more in the future, particularly if you don’t rehab the groin strain and address the causes/imbalances that caused it to happen.
How Do I Prevent A Groin Strain?
Ideally, we want to prevent an injury before it happens. This is usually the easiest option, as you won’t have to worry about spending time out of the game. Additionally, doing work to prevent an injury will often reduce the time it takes for you to heal and get back in the game, as your body is in better condition and is overall better prepared for the injury.
Proper warm-ups are an important part of preventing any injury, and muscle strains in particular can be prevented with a good warm-up. A warm-up prepares your body for activity and gets your muscles ready to work. Typically, you want your warm-up to be dynamic and specific to the activity you’re doing. Some basic movements like jumping jacks, air squats, leg swings, and hip circles can be used for most activities, but you also want to add in something similar to what you’ll be doing. For a runner, this might include a slow walk building into a slow jog, then your full run. A hockey player would want to build up slowly from a slow skate to the all-out sprints you’d do in a game.
Beyond warming up, you also need to address any muscular imbalances and weaknesses you have. Everyone is unique, so it can be difficult to say exactly what you need without a full history and examination, but hockey players often tend to have weaker adductors and a forward-tilting pelvis, as we discussed. To address those, here are a few exercises to consider adding to your routine:
Copenhagen Adductor Exercise - Find a stable surface that’s about the height of your knee or thigh, like a chair, a bench, or a box. Lie on one side, supporting yourself on your elbow, with your top knee resting on the box/chair. Pushing down with your top leg, lift your bottom leg and body off the floor slowly. When you reach the top, hold for 3 seconds, then slowly lower down for 3 seconds. Repeat 5-10 times on each side, 2-3 times per day. The most important part of this exercise is the hold and the lowering; the lifting part is still relevant, but the hold and the lowering increase strength more than the lift. If this is too easy, do this exercise with your ankle on the raised surface instead of your knee, increase the hold time, or increase the number of repetitions. If this is too hard or causes pain, skip this for now and do the next exercise for 1-2 weeks then retry this one.
Side-Lying Adductor Lift - Lie on one side, bending your top leg so your foot is flat on the floor supporting you. Keeping your bottom leg straight, lift it straight up off the floor, hold it at the top for 3 seconds, then lower it down slowly for 3 seconds. Repeat 10-20 times on each side, 2-3 times per day. To increase the challenge, add some ankle weights or a resistance band. If this is too challenging, decrease the hold time and just lift and lower the bottom leg.
Bridging - Lying on your back, place your feet as close to your butt as possible. Lift your hips and back off the ground, focusing on contracting your glutes/butt muscles. Hold at the top for 5 seconds, then slowly lower down. Repeat 10-20 times on each side, 2-3 times per day. To increase the challenge, add a resistance band around your knees, or place some dumbbells over your hips. To decrease the challenge, hold for a shorter time or move your feet out slightly. If you’re struggling to activate your glutes, using a resistance band and lifting your toes up off the ground while doing the exercise can really help focus in on those. Your foot position here is key - if your feet are too far from your butt, you’ll get more hamstring activation and less glute activation. Why are we strengthening our glutes? Well, sometimes the issue with athletes is that both the adductors and abductors are weak, creating strain issues. Additionally, these exercises help to make sure that things are contracting in a coordinated fashion and can also help reduce lower back and SI joint pain.
Isometric Adduction - Sitting, laying down, or leaning against a wall, place a soccer ball (or a ball of similar size and softness) between your knees. Squeeze your knees together for 10 seconds, then relax. Repeat this 10 times, 2-3 times per day. If this gets too easy, squeeze harder or hold the squeeze for a longer time. If this is too hard, hold the squeeze for a shorter time. If you do this with both knees bent and knees straight, that will strengthen more of the adductors, as some are activated more in each position. You can do both ways every time you do the exercise, or you can alternate every day (doing knees straight today, knees bent tomorrow, and so on).
Core Stability - Visit our previous blog by clicking here for some exercises to help build your core strength. The “Big 3” exercises featured in this article were developed and put together by Stuart McGill, a world-renowned low back pain and stabilization expert. You may need to level these up, but start with the basic version, just to make sure you’re able to do it.
These specific exercises were selected to cover the most ground with the least amount of work, but they’re not all-encompassing. The modified Hölmich protocol is a more rigorous program used to treat groin strain and chronic groin pain, that will also provide benefits for preventing a groin strain. It adds in things like balance exercises, more low back and core strengthening, and more dynamic and one-legged exercises.
Unfortunately, no injury is 100% preventable. Things happen that are outside of our control. Someone pulls our legs out from under us, or we get too tired and our legs can’t quite keep up with us, and we can pull a groin muscle. That’s life. So, we need to learn how to manage these injuries when they arise.
How I Manage & Treat A Groin Strain?
If you do injure your groin, don’t worry. There are so many things you can do while you’re recovering. You don’t need to just sit on the couch until you’re better - in fact, just sitting on the couch will probably increase your recovery time and make it more likely that you’ll get injured again in the future. That old “rest for 2 weeks” recommendation is no longer supported in the literature. That’s not to say that you should get right back into your full activity after an injury, but you need to move and incorporate activity to help your body recover the best.
Currently, the recommended way to manage most musculoskeletal injuries is represented by this acronym: PEACE & LOVE. PEACE is for immediate management (0-72 hours after injury), and LOVE guides your recovery after 72 hours and your return to activity. In the following bullet points, we’ll break this down for groin strains.
Protection - Avoid activities and movements that cause pain for 24-72 hours after injury. Resting for longer than 72 hours can lead to an extended recovery time
Elevation - You can try to elevate your groin above your heart, but this could be a challenge since it’s so close to your torso. Don’t worry about this one.
Avoid Anti-inflammatories and Icing - Ice and anti-inflammatory medications like ibuprofen or other NSAIDs can impair healing, especially in the first few days. You NEED inflammation for your ankle to recover properly. They should only be used for pain relief if the pain is unmanageable otherwise.
Compression - An ace wrap wound snugly around your injury thigh can provide some compression, as can certain kinesiotaping patterns. Elevation and Compression both decrease some of the annoyance of inflammation without totally getting rid of the inflammation needed to promote healing.
Education - Knowing about your injury and the best ways to treat it can improve your recovery. Reading this blog, watching some videos, and doing some more reading about groin strains are good ways to learn about your ankle sprain and how to manage it.
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Load - Using your pain as a guide, gradually start to use and put weight on your groin and leg. If you start using the injured muscles sooner (without increasing pain too much), your tissue will repair and recover better and more functionally. If you don’t use your groin muscles early, then the injured tendons and muscles will form disorganized scar tissue, which is less mobile and less functional than the organized scar tissue that will develop if you start using it earlier. This can lead to a higher risk of injury and increased pain in the future.
Optimism - Confidence, positivity, and a manageable level of stress are key to recovering well. Injuries can be stressful, especially in sports where you have pressure from your coach, team, classmates, and parents. Confidence and positivity help you to recover faster, and maintaining a manageable stress level can reduce the risk of chronic pain and problems. Groin strains are usually quite manageable, particularly if you incorporate these PEACE & LOVE methods, early rehabilitation, and chiropractic care.
Vascularization - Pain-free cardiovascular exercise increases blood flow and promotes healing in your injured ankle. For lower body injuries like a groin strain, arm cycling is a great option; regular biking could be a good option as well, depending on whether or not it aggravates your groin.
Exercise - After an injury, you need to be active to restore mobility, strength, and proprioception (position sense) in the injured area. Specific rehabilitative exercises can help you get back to where you were and reduce the risk of re-injury. The prevention exercises we mentioned earlier would work well to strengthen and rehabilitate your groin. The modified Hölmich protocol is another great option to rehab your groin. You need to rehabilitate your groin to best reduce your risk of future ankle sprains and instability.
Exactly how long the healing and recovery process takes will depend on the severity of the initial injury, whether or not you have any flare-ups, and the steps you take to promote your health and healing. Typically, a low-grade groin strain can take up to two or three weeks to heal enough to get you back to regular activity. A more severe strain can take two or three months to get back to that point. If you take action early, your recovery time will tend to be shorter and it will be easier for you to get back to your normal activity.
In addition to these recommendations, chiropractic care is something to consider as you’re recovering. Through gentle adjusting and soft tissue work, we can reduce pain from your injury and address any soft tissue changes that might impair your recovery. And often when your leg is hurting and you’re not moving quite right, you can easily throw things out of whack, and suddenly your back or your knees or something else entirely will start hurting, in addition to your already injured leg. Chiropractic care can help reduce those issues, while also helping to guide you through the recovery process, working with you to get you back to the sport you love.
Other Considerations
There are other factors to consider when managing a potential groin strain. Most prominently, issues in the hip joint can create pain in the groin, which may be easily mistaken for a groin strain. If you don’t recall a specific injury occurring, a lack of mobility in the hip may be contributing to your groin pain.
Sometimes, groin pain can also be caused by more significant issues. Again, if you don’t recall a specific injury occurring, there are other things to consider. These more significant issues can include hernias, stress fractures of the femur, or issues with the urinary tract or reproductive organs. Any of these issues can cause pain in the groin, though this pain is less likely to be aggravated by activity and more likely to be constant and unchanging (meaning that the pain is the same regardless of the position you’re in or the activity you’re doing). If your pain does change with activity and position, don’t worry too much about these issues.
Parting Thoughts
Groin strains are incredibly common in sports, and they’re incredibly annoying. It’s important to recognize if you’re at risk for getting one, and how you can go about preventing and treating them. It’s also important to note that prevention isn’t just a “one-and-done,” you need to do it consistently throughout the preseason and the in-season for it to have a substantial effect.
And, if you get injured, try not to worry about it too much. Know that there are things you can do to help yourself recover and come back as strong or stronger than you were before. Know that you don’t just have to sit on the couch for weeks on end waiting for your groin to feel better.
At Northbound Chiropractic, we work with you through your injury. We can guide you along the way, providing appropriate soft tissue, chiropractic, and nutritional treatments to promote healing and recovery. Once you've recovered, we work with you to address the dysfunctions, imbalances, and weaknesses that may have led to the injury, while also working to prevent you from getting injured again.
If you or a family member is dealing with a groin strain or another sports injury, or you want to maximize your performance, call or text us at 763-373-9710 or click the button below to learn about scheduling your first visit!
Wishing you the best,
Dr. Nicholas Carlson
Northbound Chiropractic
Serving Delano, MN, Maple Plain, and the rest of Wright and West Hennepin Counties