Fall and winter sports have hit the ground running – or skating rather! Which means it’s time to start thinking about adductor strains. Ice hockey and soccer have the highest rate of adductor/groin injuries (24.5%) compared to other sports, with 40% of those injuries resulting in lost playing time.[1] Adductor strains are most common in skating sports such as hockey, or kicking sports like soccer, where there are sudden changes of direction and speed.[1] Adductor strains occur from a strong eccentric contraction of the adductor muscles.[2]
The adductor muscle group consists of five muscles: adductor longus, adductor magnus, adductor brevis, gracilis, and pectineus. The adductors work to primarily adduct the leg (move it towards midline) and stabilize the pelvis during standing and weight bearing activities.[2,3] The adductors also act as a secondary hip flexor, hip extensor, and hip rotator.[2,3] The adductor longus is the most commonly injured adductor muscle in hockey / soccer players.[3]
Many studies have reported weakness of the adductor muscles to be a risk factor for injury in athletes that play ice hockey or soccer.[2–4] Furthermore, a decrease in the ratio of hip adductor to hip abductor strength has also been linked to adductor injury in cutting, acceleration/deceleration, and change of direction sports.[4] Tyler et al, found preseason hip adductor strength to be 18% lower in NHL players that sustained a groin injury over the subsequent season.[5] Additionally, players who sustained an adductor injury had a 78% adduction/abduction strength ratio compared to the 95% strength ratio in uninjured players.[2] This emphasizes the importance of hip abductor strengthening for staying healthy during hockey or soccer season. See recent blog HERE for ways to use mTrigger biofeedback for hip abductor strengthening.
Although most adductor strains resolve in 4 – 8 weeks with appropriate therapeutic intervention, an appropriate exercise program designed to strengthen the hip adductor muscle may play a significant role in preventing adductor strains.[3,4] With that being said, let’s look at some progressive strengthening exercises with the use of mTrigger biofeedback to maximize strengthening of the adductors.
Clinical Application
One of the best exercises to target the adductors is the Copenhagen plank. This exercise has a very high EMG activation of the adductor muscles and works both concentric and eccentric muscle functions.[4,6] Additionally, it has an added benefit of targeting the core muscles and encourages co-activation of the hip joint and pelvis muscles that stabilize the trunk.[6]
Another exercise with great EMG activation of the adductors is a simple standing hip adduction with an elastic band.[4] Adding biofeedback to adductor exercises helps emphasize the proper form and correct muscle activation during new exercises.
It is a good idea to perform exercises bilaterally. This will challenge the adductors as either a prime mover (lunge leg) or a stabilizer (trail leg).[6] Furthermore, the adductors are most active during the lateral push off with skating, so it is smart to mimic this movement in a strengthening program.[6] Take this alternating lateral lunge for example:
A focus on eccentric movements, as seen in this adductor slide out exercise, becomes increasingly important as a strength program progresses to meet the demands of faster sport-specific movements.[6] Athletes with persistent issues after returning to sport demonstrated a larger deficit in eccentric adductor strength, highlighting the importance of an active strengthening program.[6]
Summary
The best and most efficient way to maintain strength of the adductors during preseason and throughout the season is through an active progressive strengthening program.[6] There should be an emphasis on both adductor and abductor stretching to provide better balance around the hip/pelvis. Exercises should progress in difficulty and focus on both concentric and eccentric contraction of the adductor muscles. Finally, performing exercise on both sides challenges the adductors in different ways and reflects a more realistic sport-specific movement pattern.
Eccentric Training with mTrigger
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Biofeedback for Hamstring Injuries
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References
[1] Kerbel YE, Smith CM, Prodromo JP, et al. Epidemiology of Hip and Groin Injuries in Collegiate Athletes in the United States. Orthop J Sport Med [Internet]. 2018 [cited 2022 Sep 26];6. Available from: https://pubmed.ncbi.nlm.nih.gov/29780846/.
[2] Tyler MS TF, Fukunaga DPT T, Gellert DPT J. REHABILITATION OF SOFT TISSUE INJURIES OF THE HIP AND PELVIS. Int J Sports Phys Ther [Internet]. 2014 [cited 2022 Sep 26];9:785. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223288/.
[3] Kiel J, Kaiser K. Adductor Strain. StatPearls [Internet]. 2022 [cited 2022 Sep 26]; Available from: https://www.ncbi.nlm.nih.gov/books/NBK493166/.
[4] Schaber M, Guiser Z, Brauer L, et al. The Neuromuscular Effects of the Copenhagen Adductor Exercise: A Systematic Review. Int J Sports Phys Ther [Internet]. 2021 [cited 2022 Sep 26];16:1210. Available from: https://pubmed.ncbi.nlm.nih.gov/34631242/
[5] Tyler TF, Nicholas SJ, Campbell RJ, et al. The association of hip strength and flexibility with the incidence of adductor muscle strains in professional ice hockey players. Am J Sports Med [Internet]. 2001 [cited 2022 Sep 26];29:124–128. Available from: https://pubmed.ncbi.nlm.nih.gov/11292035/.
[6] Thorborg K, Sportsphysio M. Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures and Longstanding Adductor-related Groin Pain. J Athl Train [Internet]. 2022 [cited 2022 Sep 26]; Available from: https://pubmed.ncbi.nlm.nih.gov/35834724/.
Image: https://www.yoganatomy.com/adductors-muscles-attachments-actions/
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