Physical Therapist's Guide to
A groin strain is an injury to the groin—the area of the body where the abdomen meets the leg and the inner thigh muscles attach to the pubic bone. Typically, groin strains occur in the muscles of the upper inner thigh near the pubic bone or in the front of the hip. This injury tends to be more common in athletes and men; however, certain activities can increase the risk for anyone to experience a groin strain. Groin strains can occur during sprinting or any type of activity requiring forceful movement of the leg, such as jumping, kicking the leg up, or changing directions while running. Groin strains account for 10% of all hockey injuries and 5% of all soccer injuries. Physical therapists treat groin strains by reducing pain and helping patients improve muscle strength and leg motion and to increase the speed of recovery.
What is a Groin Strain?
A groin strain is an overstretch or tearing injury to the muscles of the inner thigh or front of the hip. Groin strains make walking, lifting the knee, or moving the leg away from or toward the body difficult and painful. Groin strains can occur from overuse of the muscles, or from a sudden contraction of the muscles.
Injury occurs when the muscles are either too forcefully contracted or too forcefully overstretched. Groin strains are graded according to the amount of muscle damage that occurs:
- Grade 1: Mild or partial stretch, or a tear of a few muscle fibers. The muscle is tender and painful, but maintains its normal strength. Use of the leg is not impaired, and walking is normal.
- Grade 2: Moderate stretch, or tearing of a greater percentage of the muscle fibers. There is more tenderness and pain, noticeable loss of strength, and sometimes bruising. Use of the leg is noticeably impaired, and limping when walking is common.
- Grade 3: Severe tear of the muscle fibers, sometimes a complete muscle tear. A “popping” sound may be heard or felt when the injury occurs. Bruising is apparent, and sometimes a “dent” in the muscle may be seen under the skin at the site of the tear. Use of the leg is severely difficult, and putting weight on the leg is very painful.
When groin muscles are strained or torn, muscle fibers and other cells are disrupted. Bleeding can occur, which causes bruising. Within a few minutes to a few hours after the injury, swelling can occur, causing the injured area to expand and feel tight and stiff.
Although groin strains most often occur in athletic activities such as football, soccer, and dance, they also can occur during everyday activities, such as lifting heavy items or slipping while walking.
How Does it Feel?
A groin strain causes sharp pain or spasms in the groin area or lower abdominal region. The pain can quickly resolve, or it can persist, developing into a throbbing pain at rest with sharp stabs of pain when you try to move your leg or walk. A lower-grade strain can be relatively pain free with everyday activities and walking, but aggravated with quick movements of the legs such as cutting, kicking, performing sit-ups, or sprinting/running. Higher-grade strains can cause the muscles to feel tight or weak. Simple movements that involve trying to lift the leg or knee, or bringing the knees together, can provoke pain, and even cause the groin muscles to spasm. If the groin strain involves a Grade 3 (complete) tear, a "pop" may be felt or heard when the muscle tears at the time of injury, and using the leg at all can be extremely painful.
Signs and Symptoms
With a groin strain, you may experience one or more of the following symptoms in the groin area or lower abdomen:
- Pain, a deep ache, and/or spasms
You might also experience one or more of the following symptoms:
- Weakness in the leg when trying to walk, climb stairs, or move the leg
- Limping when walking
- Difficulty performing daily activities that require standing and walking
How Is It Diagnosed?
If you see your physical therapist first, your therapist will conduct a thorough evaluation that includes taking your health history. The first goal of your physical therapist is to exclude any other serious conditions causing your symptoms that would warrant a referral to another health care provider. Since groin pain can be present with other diagnoses involving your hip, pelvis, or lower back, your physical therapist may ask specific questions or use additional tests to assess the possible contribution of these other regions to your pain.
Your physical therapist may ask you:
- What were doing when you first felt pain?
- Where did you feel the pain?
- Did you hear a “pop” when it occurred?
- Did you receive a direct hit to your leg or groin area?
- Did you notice any swelling in the first 2 to 3 hours following the injury?
- Do you feel pain when lifting your leg, walking, moving the leg away from you, or drawing your knees together?
Your physical therapist will perform special tests to help determine a diagnosis of a groin strain, such as:
- Gently moving your leg away from your body
- Asking you to resist against his or her hand as he or she tries to gently push your leg outward (muscle strength test)
- Gently feeling parts of the muscle to determine the specific location of the injury (palpation)
To provide a final diagnosis, your physical therapist may collaborate with an orthopedist or other health care provider. The orthopedist may order further tests—such as an X-ray or magnetic resonance imaging (MRI)—to confirm the diagnosis and to rule out other potential issues. These tests, however, are not commonly required for groin strain.
How Can a Physical Therapist Help?
Your physical therapist will design a specific treatment program to speed your recovery. This program will include exercises and treatments you can do at home to help you return to your normal lifestyle and activities.
The First 24 to 48 Hours
Immediately following your consultation, your physical therapist may advise you to:
- Rest the area by avoiding walking or any activity that causes pain. Crutches may be recommended to reduce further strain on the muscles when walking.
- Apply ice packs to the area for 15 to 20 minutes every 2 hours.
- Compress the area with an elastic bandage wrap.
- Consult with another health care provider for further services, such as medication or diagnostic tests.
Your physical therapist will design an individualized treatment plan for you based on your unique condition and goals. Your plan may include treatments to:
Reduce pain. Your physical therapist can use different types of treatments and technologies to control and reduce your pain, including ice, heat, ultrasound, electrical stimulation (TENS), taping, exercises, and hands-on therapy, such as massage. These treatments can lessen the need for pain medication, including opioids.
Improve motion. Your physical therapist will choose specific activities and treatments to help restore normal movement in the leg and hip. These might begin with "passive" motions that the therapist performs for you to gently move your leg and hip joint, and progress to active exercises and stretches that you perform yourself.
Improve strength. Certain exercises will benefit healing at each stage of recovery; your physical therapist will choose and teach you the appropriate exercises to steadily restore your strength and agility. These may include using cuff weights, stretchy bands, weight-lifting equipment, and cardio-exercise equipment, such as treadmills or stationary bicycles.
Speed recovery time. Your physical therapist is trained and experienced in choosing the right treatments and exercises to help you heal, return to your normal lifestyle, and reach your goals faster than you are likely to do on your own.
Promote a safe return to activities. Your physical therapist will collaborate with you to decide on your recovery goals, including your return to work or sport, and will design your treatment program to help you reach those goals in the safest, fastest, and most effective way possible. Your physical therapist will apply hands-on therapy, such as massage, and teach you exercises and work retraining activities. Your therapist also may teach you sport-specific techniques and drills to help you achieve any sport-specific goals.
Prevent future reinjury. Your physical therapist can recommend a home-exercise program to strengthen and stretch the muscles around your hip, upper leg, and abdomen to help prevent future reinjury of your groin. These may include strength and flexibility exercises for the leg, hip, and core muscles.
If Surgery Is Necessary
Surgery is rarely necessary in the case of groin strain, but if a groin muscle fully tears and requires surgical repair, your physical therapist will help you minimize pain, restore motion and strength, and return to normal activities in the speediest manner possible after surgery.
Can this Injury or Condition be Prevented?
The following recommendations can help you prevent a groin strain:
- Increase the intensity of activity or sport gradually, not suddenly. Avoid pushing yourself too hard, too fast, too soon.
- Always warm up before starting a sport or heavy physical activity.
- Follow a consistent strength and flexibility exercise program to maintain good physical conditioning, even in a sport's off-season.
- Strengthen the muscles of the inner thigh and groin.
- Wear shoes that are in good condition and fit well.
- Use correct lifting techniques.
Your physical therapist can help you learn more about any of the above recommendations, and offer specific training to help you achieve them.
Real Life Experiences
Brendan is a 35-year-old warehouse manager who enjoys skiing every winter. Yesterday, returning from work, Brendan slipped on an icy sidewalk near his home. His foot slipped out from underneath him and his right leg suddenly slid forward, while his left leg remained behind him. He fell down with his right leg and left leg stretched out in opposite directions, and immediately felt pain in his right groin area. His neighbor saw him fall and rushed to help him. He had difficulty standing up and climbing up his front steps; he limped back inside his house. His neighbor called Brendan’s physical therapist, and scheduled an appointment for the next day.
At his first physical therapy session, Brendan’s physical therapist performs tests that reproduce his pain to a moderate degree to assess his injury. He describes how he fell, and mentions that he is concerned because he has to climb stairs and walk a lot at work, and his yearly ski trip is just 3 weeks away. Brendan’s physical therapist determines the injury is a Grade 1 groin strain, and begins treatment right away to reduce his pain and swelling using ice and electrical stimulation.
During this first session, Brendan’s physical therapist teaches him how to compress and support the injury at home and at work using an elastic wrap, and shows him simple stretches and exercises that he can start in 48 hours to help restore motion. She recommends that Brendan take off work for 2 days, and tells him they will likely be able to start strengthening his leg in a few days. She says he may still be able to go skiing with his friends, although she can’t guarantee it. She reassures Brendan that she will reevaluate him every time he comes to the clinic, and she will adjust his treatment to help him recover as quickly as possible.
Over the next 3 weeks, Brendan attends his physical therapy sessions regularly, gradually performing more exercises and movements as his condition improves. He also performs his exercises and treatments at home just as his physical therapist instructs him to, and works with her on a steady program of strengthening and recovery. After the first week of physical therapy, he reports that he is able to function throughout the day at work with minimal discomfort.
As the time for his ski trip approaches, Brendan’s physical therapist designs drills that incorporate movements specific to skiing. Brendan reports he can perform these movements without pain.
After 3 full weeks of hard work in the clinic and at home, Brendan is discharged from physical therapy and enjoys a great ski vacation. At the bottom of the slope after his first run, he tells his friends he feels stronger and more fit than he has in years!
This story was based on a real-life case. Your case may be different. Your physical therapist will tailor a treatment program to your specific case.
What Kind of Physical Therapist Do I Need?
All physical therapists are prepared through education and experience to treat groin strains. However, you may want to consider:
- A physical therapist who is experienced in treating people with groin strains.
- A physical therapist who focuses their practice in orthopedics or sports rehabilitation.
- A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.
You can find physical therapists who have these and other credentials by using Find a PT, the online tool built by the American Physical Therapy Association to help you search for physical therapists with specific clinical expertise in your geographic area.
General tips when you're looking for a physical therapist (or any other health care provider):
- Get recommendations from family and friends or from other health care providers.
- When you contact a physical therapy clinic for an appointment, ask about the physical therapists' experience in helping people who have groin strains.
- During your first visit with the physical therapist, be prepared to describe your symptoms in as much detail as possible, and describe what makes your symptoms worse.
The American Physical Therapy Association (APTA) believes that consumers should have access to information that could help them make health care decisions and also prepare them for a visit with their health care provider.
The following articles provide some of the best scientific evidence related to physical therapy treatment of groin strain. The articles report recent research and give an overview of the standards of practice both in the United States and internationally. The article titles are linked either to a PubMed* abstract of the article or to free full text, so that you can read it or print out a copy to bring with you to your health care provider.
Ellsworth AA, Zoland MP, Tyler TF. Athletic pubalgia and associated rehabilitation. Int J Sports Phys Ther. 2014;9(6):774–784. Free Article.
Atkins JM, Taylor JC, Kane SF. Acute and overuse injuries of the abdomen and groin in athletes. Curr Sports Med Rep. 2010;9(2):115–120. Article Summary on PubMed.
Holmich P, Larsen K, Krogsgaard K, Gluud C. Exercise program for prevention of groin pain in football players: a cluster-randomized trial. Scand J Med Sci Sports. 2010;20(6):814–821. Article Summary on PubMed.
Hureibi KA, McLatchie GR. Groin pain in athletes. Scott Med J. 2010;55(2):8–11. Article Summary on PubMed.
Engebretsen AH, Myklebust G, Holme I, et al. Prevention of injuries among male soccer players: a prospective, randomized intervention study targeting players with previous injuries or reduced function. Am J Sports Med. 2008;36(6):1052–1060. Article Summary on PubMed.
Maffey L, Emery C. What are the risk factors for groin strain injury in sport: a systematic review of the literature. Sports Med. 2007;37(10):881–894. Article Summary on PubMed.
Nicholas SJ, Tyler TF. Adductor muscle strains in sport. Sports Med. 2002;32(5):339–344. Article Summary on PubMed.
Emery CA, Meeuwisse WH. Risk factors for groin injuries in hockey. Med Sci Sports Exerc. 2001;33(9):1423–1433. Article Summary on PubMed.
Gilmore J. Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med. 1998;17(4):787–793, vii. Article Summary on PubMed.
Johnson R. Ice hockey. In: Mellion MB, Walsh WM, Shelton GL, eds. The Team Physician's Handbook. 2nd ed. Philadelphia, PA: Hanley and Belfus; 1997:851. Product description is not available.
*PubMed is a free online resource developed by the National Center for Biotechnology Information (NCBI). PubMed contains millions of citations to biomedical literature, including citations in the National Library of Medicine's MEDLINE database.
Reviewed by Erica Sigman, PT, DPT, board-certified orthopaedic clinical specialist. Authored by Andrea Avruskin, PT, DPT. Reviewed by the editorial board.