Mr Gurdeep Biring, Consultant Orthopaedic and Trauma Surgeon at BMI The Chiltern Hospital and BMI The Shelburne Hospital, offers his insights on a rather common sports injury: the groin strain. Mr Biring explains how we can injure this area, what are the treatment options and the recovery...
What is the injury?
Hip and groin injuries are common amongst athletes, especially in football, hockey and rugby. Athletes who are involved in repetitive clicking, quick starts and changes in direction have a higher incidence of these types of injuries. A groin strain occurs in the muscles of the inner aspect of the thigh called the adductors. The muscles typically involved including the adductor longus, brevis and magnus. The injury occurs when the muscle is stretched beyond its limits and results in a tear. There are first, second and third degree tears dependent on how much of the muscle is torn:
• 1st degree: Mild pain with little loss of strength or movement
• 2nd degree: Moderate pain with mild/ moderate loss of strength/ movement
• 3rd degree: Severe pain with complete loss of strength and function
What are the symptoms?
There is pain in the groin and inner side of the thigh, or when bringing your legs together or raising your knee. A popping or snapping feeling can occur during the injury followed by severe pain.
What tests are required for diagnosis?
Plain x-rays are required to exclude any fractures. An ultrasound scan can be used to dynamically assess the muscle and its integrity. However a MRI scan is the gold standard test, which allows you to visualize all the tissues and associated structures and the extent of the injury.
What treatment is required?
The immediate treatment involves rest, ice and compression. Non-steroidal anti-inflammatories help ease the pain and shorten the recovery time. Activity modification along with physical therapy is required which consists of soft tissue mobilisation, stretching, frictional massage and neuro-muscular rehabilitation. Injections of platelet rich plasma (PRP) can also help the healing process in selected cases.
If there is complete rupture then an opinion from an orthopaedic surgeon is required. An initial period of non-operative treatment is tried for 6-12 weeks but if the pain persists and there is more than 2 cm of muscle retraction then surgery should be considered.
When do you require surgery?
When there is greater than 2 cm of retraction of the muscle with persistent pain. Open repair is required with good outcomes in those treated early on.
How long will it take to recover?
If treated conservatively then recovery should occur up to 6 weeks. If surgery is undertaken the postoperative rehabilitation begins with protected weight-bearing for 2-4 weeks. Strengthening exercises begin at 6-8 weeks. Mean return to play is 12 weeks.
Mr Biring has a clinic at BMI The Shelburne on a Monday evening and at BMI The Chiltern on a Tuesday evening, Thursday evening and Friday all day.