A Simple Groin Assessment For Sports Physios
Groin injuries can be stubborn which is why it is so important to make sense of your initial assessment.
With the amount of tests and tricks available to you it can be more than overwhelming. Today I’ll share with you the building blocks that have helped me progress athletes throughout my career in professional sport.
The first thing to consider with your groin assessment is the athlete’s injury history. You want to know why the adductors are taking on an excessive load in the first place.
What Tissues Are They Not Loading?
Firstly, with your generic objective assessment you need to establish what tissues your athlete is not subconsciously loading.
Movements And Testing
Hip Internal Rotation Flexion
If you push the athlete’s leg up and there’s resistance then there will be tissues that are contributing to that stiffness. If you do feel resistance prior to full hip flexion it is more likely that the glute is struggling to lengthen more so than the hip capsule.
From my experience beginning work on the hip capsule tends to only result in short-term changes. Consider starting by desensitising the glute, that way the gains you get now will stick around for longer.
It is also worth testing and comparing the hip internal rotation in supine and prone. When we check internal rotation in supine the hip will also have to be flexed which in turn lengthens the adductor magnus. If you test hip internal rotation in prone then the adductor magnus will be in a shortened position. Considering both positions can help you begin to clinically reason which tissues may need to be desensitised.
If they feel pain or a pull whilst testing abduction it can mean that the tissues aren’t happy to lengthen at this point in time. Sometimes an athlete may be able to be specific where they feel this pulling experience.
After these key tests we can begin to go on to any other key tests you may use such as neural tests or looking at the lumbar spine.
Motor Output Through The Adductors
We usually use this test at three angles, 0°, 45° and 90°. At each angle make a ball with your fist, put it between the medial condyles and ask the athlete to squeeze.
At this point you are looking for their intent and asking if there is any pain experience. If there is a big difference between one position or another then this is very valuable information and can be used to help with finding the true cause.
If every position is painful then it may lead you to focus on desensitising the adductors as part of your 20% focus on calming the symptoms.
Using Clinical Reasoning
These tests are incredibly useful for beginning to clinically reason. We know that when we squeeze at 45° the adductors will be recruited the most.
At 0° the adductor magnus is shorter. Another important aspect to consider at 0° is the medial aspects of the rectus femoris and the idea that these tissues could be struggling to load in the frontal plane.
The Diaphragm and Pelvic Floor
The part of this test in which I have found the most value is at 90° and just past 90°. In this position the body is influenced by the diaphragm and pelvic floor. As your athlete brings their knees up you posterior rotate the illiums, the sacrum tucks under, but what really needs to happen is the pelvic floor must ascend. When it can move out of the way the obliques can contract. The obliques contract with ribcage depression and the ribcage can only fully depress if the diaphragm lengthens and the pelvic floor ascends. It is a chain of motion.
It is common that an athlete may have a poor squeeze because they have a poor ability to get the hip up into flexion in the first place. This means that you can restore full range of motion to the hip, recheck the squeeze and the athlete should be fine.
If your athlete is strong at 90° and 45° but is weak at 0° you need to make sure the proximal rectus femoris is desensitised and loading efficiently. To cross reference you can hold the athlete’s leg at an angle and push through the dorsum of the foot. The athlete will have to dorsiflex the ankle, then load will have to be tolerated through the knee and then the hip.
More At Work
It is not just obliques and abductors that need to work. There are plenty of other tissues that need to load. If you take the hip to 90° you’ll get a posterior tilt and the pelvic floor will ascend. If the athlete’s system is stressed then this may add to these tissues not being as pliable as they should.
Strong Squeeze but Painful Squeeze
Over my years in professional sport I have performed this test, the athlete has had a strong squeeze but a painful squeeze. In this scenario I would assess one limb at a time. If there isn’t any pain here then I would hypothesise that the tissue is producing excessive force to make up for weakness elsewhere.
As always when using this information you need to try to implement the 80/20 rule. 20% of your time is spent treating the symptoms but your real focus needs to be on finding the true cause of the issue before you send your athlete back to their normal activities.
Finally, this is not the only way to look at the body. I’m simply sharing the way I go about performing a groin injury assessment. I began to implement this approach and step-by-step system after being consistently failed by traditional approaches over my 13 year career in professional sport. I began to clinically reason, hypothesise, use a constraint based process but most importantly I began to understand how the systems of the body work together.
If you want more information in how to implement some of these techniques I’ve shared click here.