Hip Adductor Strain
What is a hip adductor strain?
A hip adductor strain is a tear of one or more of the adductor muscles — the group of muscles on the inner thigh that draw the leg inward toward the midline of the body. The adductor group includes five muscles: adductor longus, adductor brevis, adductor magnus, gracilis and pectineus. Of these, the adductor longus is by far the most commonly injured, typically tearing at or near its origin on the pubic bone.
Adductor strains are graded the same way as other muscle injuries — grade 1 involves minor fibre disruption with minimal strength loss, grade 2 is a more significant partial tear with moderate pain and weakness, and grade 3 is a complete rupture. The vast majority of adductor strains are grade 1 or 2. Complete adductor longus avulsions — where the tendon pulls off the pubic bone — do occur and may require surgical consideration.
The term "groin strain" is often used interchangeably with adductor strain, though technically groin pain can arise from several structures including the hip joint itself, the iliopsoas, the pubic symphysis and the inguinal region. Accurate diagnosis of which structure is actually producing the pain is essential before treatment, as a hip flexor stretch program will not help someone whose pain is actually coming from the adductor longus tendon, and adductor strengthening will not help someone whose pain is from femoroacetabular impingement.
Who gets adductor strains?
Adductor strains are particularly common in sports involving sudden changes of direction, kicking, and explosive lateral movements — football codes, soccer, hockey, basketball, martial arts and dance. They are one of the most common injuries in Australian rules football and rugby league, and are notoriously slow to resolve and prone to recurrence when not properly managed.
Previous adductor strain is the strongest risk factor for future injury. Weak adductors relative to abductors, reduced hip range of motion, and fatigue are also recognised risk factors.
What are the symptoms?
The acute presentation is sudden onset sharp pain in the inner thigh or groin during a sprint, kick, tackle or explosive change of direction. Bruising and swelling develop over the subsequent hours in higher-grade tears. Tenderness is localised to the adductor longus muscle belly or its origin at the pubic tubercle. Walking is usually possible but painful, and activities requiring hip adduction, hip flexion against resistance, or a lateral change of direction are significantly aggravating.
Chronic adductor-related groin pain — where symptoms have been present for weeks or months, often building gradually rather than from a single acute event — is a distinct presentation requiring a different approach. This is more often related to adductor tendinopathy at the pubic attachment, osteitis pubis, or a combination of both, and is common in high-volume running and kicking athletes.
How is it diagnosed?
Clinical assessment involves palpation of the adductor muscles and their attachments, assessment of hip adduction strength against resistance, and specific provocation tests including the squeeze test (adduction against resistance in various hip positions) and assessment of hip range of motion. The Copenhagen Hip and Groin Outcome Score is a validated outcome measure used to track progress in athletes with groin pain.
Ultrasound is the most accessible imaging for acute adductor tears — it visualises the muscle, identifies the location and extent of the tear, and rules out complete rupture or avulsion. MRI provides more comprehensive information for complex or chronic presentations, and is essential for assessing osteitis pubis and pubic bone stress reactions that may coexist with adductor pathology.
How can physiotherapy help?
In the acute phase — the first 48 to 72 hours — the priority is protecting the healing tissue, managing pain and swelling, and maintaining pain-free range of motion without loading the tear. Ice, compression and gentle movement within comfortable limits are the foundation. Crutches may be needed for higher-grade tears where weight-bearing is painful.
As the acute phase settles, progressive rehabilitation begins. Early isometric adduction exercises — where the muscle contracts without movement — are the first active loading intervention, providing pain relief through isometric analgesia and beginning the process of tendon loading that is essential for recovery. These progress to isotonic strengthening through increasing range, and eventually to the eccentric and sport-specific loading that is required before return to sport.
Hip abductor and gluteal strengthening is equally important — the adductors and abductors work as a force couple governing lateral hip stability, and an imbalance between the two is a consistent finding in athletes with recurrent groin pain. Addressing this imbalance is one of the most important factors in preventing recurrence.
For chronic adductor tendinopathy and osteitis pubis, the rehabilitation approach is more prolonged and requires a very specific progressive loading program — typically the Copenhagen adductor program — that gradually builds tendon capacity over eight to twelve weeks or more. This is a condition where patience and consistency of the program matters enormously, and where rushing progression is the most common reason for failure.
Dry needling assists with pain management and muscle relaxation in the acute and subacute phases. Real time ultrasound can be used to monitor healing of the tear and guide progressive loading decisions. Clinical Pilates provides a useful controlled environment for hip adductor and abductor strengthening during rehabilitation when full sport training is not yet appropriate.
Return to sport is guided by objective criteria — pain-free adductor strength testing, squeeze test negativity, and sport-specific movement performance — rather than a fixed number of weeks. For footballers and other field sport athletes, a graduated return-to-training protocol that progressively reintroduces cutting, kicking and contact before full match play is standard.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in groin and hip injury management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
A hip adductor strain is a tear of one or more of the adductor muscles — the group of muscles on the inner thigh that draw the leg inward toward the midline of the body. The adductor group includes five muscles: adductor longus, adductor brevis, adductor magnus, gracilis and pectineus. Of these, the adductor longus is by far the most commonly injured, typically tearing at or near its origin on the pubic bone.
Adductor strains are graded the same way as other muscle injuries — grade 1 involves minor fibre disruption with minimal strength loss, grade 2 is a more significant partial tear with moderate pain and weakness, and grade 3 is a complete rupture. The vast majority of adductor strains are grade 1 or 2. Complete adductor longus avulsions — where the tendon pulls off the pubic bone — do occur and may require surgical consideration.
The term "groin strain" is often used interchangeably with adductor strain, though technically groin pain can arise from several structures including the hip joint itself, the iliopsoas, the pubic symphysis and the inguinal region. Accurate diagnosis of which structure is actually producing the pain is essential before treatment, as a hip flexor stretch program will not help someone whose pain is actually coming from the adductor longus tendon, and adductor strengthening will not help someone whose pain is from femoroacetabular impingement.
Who gets adductor strains?
Adductor strains are particularly common in sports involving sudden changes of direction, kicking, and explosive lateral movements — football codes, soccer, hockey, basketball, martial arts and dance. They are one of the most common injuries in Australian rules football and rugby league, and are notoriously slow to resolve and prone to recurrence when not properly managed.
Previous adductor strain is the strongest risk factor for future injury. Weak adductors relative to abductors, reduced hip range of motion, and fatigue are also recognised risk factors.
What are the symptoms?
The acute presentation is sudden onset sharp pain in the inner thigh or groin during a sprint, kick, tackle or explosive change of direction. Bruising and swelling develop over the subsequent hours in higher-grade tears. Tenderness is localised to the adductor longus muscle belly or its origin at the pubic tubercle. Walking is usually possible but painful, and activities requiring hip adduction, hip flexion against resistance, or a lateral change of direction are significantly aggravating.
Chronic adductor-related groin pain — where symptoms have been present for weeks or months, often building gradually rather than from a single acute event — is a distinct presentation requiring a different approach. This is more often related to adductor tendinopathy at the pubic attachment, osteitis pubis, or a combination of both, and is common in high-volume running and kicking athletes.
How is it diagnosed?
Clinical assessment involves palpation of the adductor muscles and their attachments, assessment of hip adduction strength against resistance, and specific provocation tests including the squeeze test (adduction against resistance in various hip positions) and assessment of hip range of motion. The Copenhagen Hip and Groin Outcome Score is a validated outcome measure used to track progress in athletes with groin pain.
Ultrasound is the most accessible imaging for acute adductor tears — it visualises the muscle, identifies the location and extent of the tear, and rules out complete rupture or avulsion. MRI provides more comprehensive information for complex or chronic presentations, and is essential for assessing osteitis pubis and pubic bone stress reactions that may coexist with adductor pathology.
How can physiotherapy help?
In the acute phase — the first 48 to 72 hours — the priority is protecting the healing tissue, managing pain and swelling, and maintaining pain-free range of motion without loading the tear. Ice, compression and gentle movement within comfortable limits are the foundation. Crutches may be needed for higher-grade tears where weight-bearing is painful.
As the acute phase settles, progressive rehabilitation begins. Early isometric adduction exercises — where the muscle contracts without movement — are the first active loading intervention, providing pain relief through isometric analgesia and beginning the process of tendon loading that is essential for recovery. These progress to isotonic strengthening through increasing range, and eventually to the eccentric and sport-specific loading that is required before return to sport.
Hip abductor and gluteal strengthening is equally important — the adductors and abductors work as a force couple governing lateral hip stability, and an imbalance between the two is a consistent finding in athletes with recurrent groin pain. Addressing this imbalance is one of the most important factors in preventing recurrence.
For chronic adductor tendinopathy and osteitis pubis, the rehabilitation approach is more prolonged and requires a very specific progressive loading program — typically the Copenhagen adductor program — that gradually builds tendon capacity over eight to twelve weeks or more. This is a condition where patience and consistency of the program matters enormously, and where rushing progression is the most common reason for failure.
Dry needling assists with pain management and muscle relaxation in the acute and subacute phases. Real time ultrasound can be used to monitor healing of the tear and guide progressive loading decisions. Clinical Pilates provides a useful controlled environment for hip adductor and abductor strengthening during rehabilitation when full sport training is not yet appropriate.
Return to sport is guided by objective criteria — pain-free adductor strength testing, squeeze test negativity, and sport-specific movement performance — rather than a fixed number of weeks. For footballers and other field sport athletes, a graduated return-to-training protocol that progressively reintroduces cutting, kicking and contact before full match play is standard.
Our physiotherapists Eliane Machado and Bethany Kippen and Exercise Physiologist Ash O'Regan all have experience in groin and hip injury management.
To book or find out more, call us on 07 3706 3407 or book online below. We see patients from across Brisbane's southside including Tarragindi, Coorparoo, Holland Park, Greenslopes and Mt Gravatt.
