Adductor Strain, Tendinopathy, and Sciatica

What is an Adductor Muscle Strain?  

An adductor muscle strain is characterized as an acute injury to the muscles of the groin. Although various muscles in the human body can be injured, the adductor longus, medius, magnus, and the gracilis are some of the most well-known muscle groups to be affected by an injury.  Strains are muscle tears that generally occur due to the powerful contraction of the muscles against resistance, often during what is referred to as an eccentric load.

An eccentric load describes some muscle contraction while the muscle is lengthening, versus concentric, where the muscle is shortening during some muscle contraction. Most weight-lifting exercises and physical activities involve concentric contraction. By way of instance, the bench press involves eccentric contraction. Moreover, tears can occur at the origin of the muscle, at the muscle-tendon junction, or inside the belly of the muscle(s). Tears most frequently happen at the muscle-tendon junction. The least common tendon injury occurs in the region of its bony attachment.  

Adductor muscle strains may be graded I-III depending upon their seriousness. A grade I injury involves a moderate strain with some pain and discomfort, tenderness, and bleeding, but no fiber disruption. The adductor muscle’s overall integrity is maintained, although a Grade II injury involves further damage. A grade III injury involves disruption resulting in a loss of tendon integrity. Most adductor muscle strains are considered to be grade I or II injuries.  

Causes and Symptoms of an Adductor Strain

As previously mentioned, an adductor muscle strain occurs during acute muscle contraction, such as kicking, pivoting, or skating. Factors that can predispose a person to injury include failure to properly stretch or warm up and fatigue from overuse. The risk of experiencing an adductor strain increases with sports involving strides like sprinting, soccer, and hockey. Sports with repeated movements like football, martial arts, and gymnastics can also substantially increase the risk of experiencing an adductor strain. Struggling to warm up, stretch, or be properly conditioned can also cause injury.  

The symptoms associated with an adductor muscle strain most commonly involve a variety of painful symptoms, which are most frequently related to other types of muscle strain. Common symptoms of an adductor muscle strain include a sudden onset of pain and discomfort, occasionally accompanied by the feeling of a pop in the inner section of the thigh, as well as the inability to maintain action after the first onset of painful symptoms. Because an adductor strain may cause groin or hip pain, many patients and healthcare professionals may confuse this type of injury with sciatica or sciatic nerve pain. 

Diagnosis and Treatment for an Adductor Strain

A healthcare professional can diagnose an adductor muscle strain through the patient’s medical history and a physical evaluation. Clinical findings include tenderness to palpation or touch, bruising through the inner thigh, as well as swelling and heat within the region of the injury. There might be a palpable defect over the area of the injury with acute tears. Motion testing of the hip is normal; however, pain generally occurs while the patient is asked to contract the muscles. In these cases, asking the patient to bring their leg towards the midline can ultimately cause pain and is generally accompanied by weakness.  

X-rays are often not utilized to diagnose an adductor muscle strain; however, they are appropriate in instances in which there is tenderness at the site of bony insertion or in young patients and/or athletes. In children, the attachment sites of a muscle and/or tendon are weaker and vulnerable to fracture. MRI can provide the precise location of an injury, and the extent might help estimate return to play or, in rare cases, help identify any other cases which may require surgical interventions. 

Many adductor muscle strains respond positively to conservative treatment. The utilization of ice therapy and anti-inflammatory medicine is appropriate for acute muscle strains. As symptoms improve, stretching and exercises are generally not recommended. The healthcare professional may suggest a physical therapy program. Surgery may be required for adductor muscle tendon tears. Repair entails an open incision within the site of injury and reattachment of the tendon. Surgery is also essential in patients who have chronic pain whose symptoms don’t respond to conservative therapy.  

What is Adductor Tendinopathy?

Adductor tendinopathy is generally characterized as pain on palpation of the adductor tendons, adduction of the legs, and/or the injured leg. Pain can develop gradually or cause sudden and severe, sharp pain. A swelling or a lump may also be experienced from the adductor muscle(s), stiffness in the groin area, or an inability to contract or extend the adductors. In acute cases, exercises and physical activities will be restricted because the tendon can’t sustain repeated tensile loading.

Causes and Symptoms of Adductor Tendinopathy

The adductors are triggered in many sports, such as running, soccer, horse riding, gymnastics, and swimming. The repetitive movements and the continuous change of direction in physical activities activate the adductor tendon, making athletes more likely to develop adductor tendinopathy and other groin injuries. Other causes of adductor tendinopathy can include over-stretching of the adductor tendons or a sudden increase in training, especially in the type of training.

Adductor tendinopathy may occur due to considerable leg length discrepancy, which affects gait pattern. Poor or abnormal movement patterns may also overly stress the adductor tendons. Muscular length gaps, strength imbalances, or muscular weakness in the thoracic or the abdominals can also be powerful in developing adductor tendinopathy. Other causes include a failure to warm up properly, inactivity, fatigue, obesity, age-related weaknesses, genetics, or degeneration.

Diagnosis and Treatment for Adductor Tendinopathy

A healthcare professional can safely and effectively develop an appropriate treatment plan following a thorough diagnosis, or further investigations could be undertaken, including ultrasound, MRI, or CT scans. Achieving pain relief through the utilization of NSAIDs may be ineffective due to the non-inflammatory nature of the injury. Steroid injections are also not necessarily recommended due to potential tendon rupture if these are injected directly into the tendon.

Physical therapy is often recommended for the treatment of adductor tendinopathy, although there’s no golden standard for the proper rehabilitation of the adductor tendon. Recovery is extremely variable across individuals because the injury may be degenerative or even due to previously failed healing. Strengthening exercises and physical activities are also recommended to promote proper healing. Treatment should be customized to the patient to avoid recurrence.

Other treatment for adductor tendinopathy generally consists of avoiding exercise or physical activity in the first 48 hours. The patient should then apply the RICE treatment three times per day for 10-20 minutes to help reduce swelling and inflammation from any sudden trauma. If the painful symptoms have decreased, blood flow stimulation therapy could be started to help promote the healing process. Active treatment is subsequently suggested to follow up with rehabilitation.

Furthermore, rehabilitation aims to restore the adductor muscle and tendon properties, where strength training is beneficial to the adductor structure, muscle building, and biomechanics. Recent research studies have also demonstrated that an eccentric-based exercise program is the most effective as well as heavy-slow eccentric and concentric exercises for enhancing both function and symptoms. For effective treatment identifying the stage of the tendinopathy is also essential. 

Differential Diagnosis of Hip Pain and Discomfort

Most commonly well-known as a groin strain, an adductor muscle strain is a type of injury which affects one of a group of muscles found at the top of the thigh. Meanwhile, adductor tendinopathy can affect the tendons of the adductor muscles. Both of these type of injuries can ultimately cause a variety of painful symptoms and they generally require time to heal properly. Because of the location of the injury, many patients and healthcare professionals may confuse groin injuries with sciatica without proper diagnosis. Proper diagnosis is essential to follow-up with proper treatment. – Dr. Alex Jimenez D.C., C.C.S.T. Insight

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Fibromyalgia Magazine

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Additional Topic Discussion: Severe Sciatica

Back pain is one of the most prevalent causes of disability and missed days at work worldwide. Back pain is the second most common reason for doctor office visits, outnumbered only by upper-respiratory infections. Approximately 80 percent of the population will experience back pain at least once throughout their life. Your spine is a complex structure made up of bones, joints, ligaments, and muscles, among other soft tissues. Injuries and/or aggravated conditions, such as herniated discs, can eventually lead to symptoms of sciatica or sciatic nerve pain. Sports injuries or automobile accident injuries are often the most frequent cause of painful symptoms; however, sometimes, the simplest of movements can have these results. Fortunately, alternative treatment options, such as chiropractic care, can help ease sciatic nerve pain, or sciatica, through the utilization of spinal adjustments and manual manipulations, ultimately improving pain relief.  

 

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