Optimizing Groin Injury Recovery Through sEMG-Guided Rehabilitation

With the NHL Finals in full swing, hockey fans are watching some of the most elite athletes in the world compete at the highest level. While goals, speed, and physicality often steal the spotlight, the demands placed on the hip and groin musculature are substantial. Ice hockey consistently demonstrates one of the highest rates of adductor and groin injuries among major sports, accounting for approximately 24.5% of reported injuries. (1) These injuries commonly occur during powerful skating strides, rapid changes of direction, and explosive acceleration and deceleration, making the hip adductors a critical muscle group for both performance and injury prevention. (1)

The adductor muscle group consists of three primary muscles—the adductor longus, adductor magnus, and adductor brevis. The adductor longus is the most commonly injured adductor muscle in hockey players. (2,3) The adductors work to adduct the leg (move it toward the midline) and stabilize the pelvis during standing and weight-bearing activities. (2,3) The adductor longus also functions as a secondary hip flexor, hip extensor, and hip rotator. (2,3)

Many studies have reported weakness of the adductor muscles to be a risk factor for injury in athletes that play ice hockey. (2,3,4) Furthermore, a decrease in the ratio of hip adductor to hip adductor strength has also been linked to adductor injury in cutting, acceleration/deceleration, and change of direction sports. (5) 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) This emphasizes the importance of hip abductor strengthening for staying healthy during hockey season.

Although most adductor strains resolve in 4-8 weeks with appropriate therapeutic intervention, an appropriate exercise program designed to strengthen the hip adductor muscles 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 the benefit of strengthening the adductors. 

Clinical Application

One of the best exercises to target the adductors in the Copenhagen plank. This exercise has a very high EMG activation of the adductor muscles and works both concentric and eccentric muscle functions. (5,6) 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. Adding biofeedback to adductor exercises helps emphasize the proper form and correct muscle activation during new exercises. (4) 

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. 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

Biofeedback for Hamstring Injuries

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 . 2018 ;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 . 2014 ;9:785. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4223288/.
3. Kiel J, Kaiser K. Adductor Strain. StatPearls . 2022 ; 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 . 2021 ;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 . 2001 ;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 . 2022 ; Available from: https://pubmed.ncbi.nlm.nih.gov/35834724/.

Image: https://www.yoganatomy.com/adductors-muscles-attachments-actions/