(Also known as Adductor Tendinopathy, Adductor Tendinitis, Adductor Tendinosis, Groin Tendonitis, Groin Tendinopathy, Groin Tendinitis, Groin Tendinosis)
N.B. Although recent research suggests that ‘adductor tendinopathy’ is the more appropriate term to describe overuse injuries to the adductor tendon, we will use the term ‘adductor tendonitis’ in this document as it is more widely known.
What is adductor tendonitis?
Adductor tendonitis is a condition characterized by tissue damage and sometimes swelling to the adductor tendon at its attachment to the pelvis resulting in groin pain.
The muscles at the inner aspect of your thigh are known as the adductor muscles (groin). These muscles originate from the pelvis and insert into the inner aspect of the thigh bone (femur) and lower leg bone (tibia) (figure 1).
Figure 1 – Anatomy for adductor tendonitis
The adductor muscles are responsible for stabilising the pelvis and moving the leg towards the midline of the body (adduction). They are particularly active during running (especially when changing direction) and kicking.
During contraction of the groin muscles, tension is placed through the adductor tendon at its attachment to the pelvis. When this tension is excessive due to too much repetition or high force, damage to the adductor tendon may occur. Adductor tendonitis is a condition whereby there is damage to the adductor tendon with subsequent degeneration and sometimes swelling.
Causes of adductor tendonitis
Adductor tendonitis is usually an overuse injury, which commonly occurs due to repetitive or prolonged activities placing strain on the adductor tendon. This typically occurs due to repetitive running, kicking or change of direction activities.
Occasionally, patients may develop this condition suddenly due to a forceful contraction of the adductor muscles often when they are in a position of stretch. This typically occurs during rapid acceleration whilst running (particularly when changing direction) or when a footballer performs a long kick.
Adductor tendonitis is commonly seen in running sports such as football, hockey and athletics (particularly sprinters, hurdlers, and long jumpers) as well as in skiing, horse riding and gymnastics.
Patients may also develop this condition following inappropriate or inadequate treatment of an acute groin strain.
Signs and symptoms of adductor tendonitis
Patients with this condition typically experience groin pain that develops gradually overtime. Patients usually experience pain on firmly touching the adductor tendon at its attachment to the pelvis (figure 1). Pain may also increase when squeezing the legs together or when moving the affected leg away from the midline of the body (abduction).
In less severe cases, patients may only experience an ache or stiffness in the groin that increases with rest following activities requiring strong or repetitive contraction of the adductor muscles. These activities typically include running, kicking and change of direction activities. The pain associated with this condition may also warm up with activity in the initial stages of the condition.
As the condition progresses, patients may experience symptoms that increase during activity and affect performance. In severe cases of adductor tendonitis the patient may be unable to continue the activity and may limp as a result of pain.
Diagnosis of adductor tendonitis
A thorough subjective and objective examination from a physiotherapist is usually sufficient to diagnose adductor tendonitis. Further investigations such as an X-ray, ultrasound, MRI or CT scan may be required occasionally, to confirm diagnosis, assess the severity of the injury and rule out other conditions.
Treatment for adductor tendonitis
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Prognosis of adductor tendonitis
Most patients with adductor tendonitis heal well with appropriate physiotherapy and return to normal function in a number of weeks. Occasionally, rehabilitation can take significantly longer and may take many months in those who have had their condition for a long period of time. Early physiotherapy treatment is vital to hasten recovery in all patients with this condition.
Contributing factors to the development of adductor tendonitis
There are several factors which can predispose patients to developing this condition. These need to be assessed and corrected with direction from a physiotherapist. Some of these factors include:
- muscle tightness (particularly of the adductors, gluteals, hip flexors, or hamstrings)
- poor biomechanics
- muscle weakness (especially of the groin, gluteals or core stabilisers)
- inadequate rehabilitation following a previous adductor injury
- inappropriate or excessive training or activity
- inadequate recovery periods from sport or activity
- change in training conditions or surfaces
- poor posture
- poor foot posture (e.g. flat feet)
- inappropriate footwear
- inappropriate running technique
- inadequate fitness
- inadequate warm up
- joint stiffness (particularly the lower back, hip and knee)
- poor pelvic and core stability
- neural tightness
- muscle imbalances
- being overweight
Physiotherapy for adductor tendonitis
Physiotherapy for patients with adductor tendonitis is vital to hasten the healing process, ensure an optimal outcome and reduce the likelihood of future recurrence. Treatment may comprise:
- soft tissue massage (particularly to the adductors and abductors)
- electrotherapy (e.g. ultrasound)
- muscle energy techniques
- joint mobilization (in particular the lumbar spine and hip joint)
- ice or heat treatment
- the use of a compression bandage or strapping
- biomechanical correction
- the use of crutches
- dry needling
- progressive exercises to improve strength, flexibility, core stability, pelvic stability and balance
- clinical Pilates
- activity modification advice
- technique correction
- anti-inflammatory advice
- prescription of orthotics
- footwear advice
- devising and monitoring a return to sport or activity plan
Other intervention for adductor tendonitis
Despite appropriate physiotherapy management, some patients with this condition do not improve adequately. When this occurs, the treating physiotherapist or doctor can advise on the best course of management. This may include investigations such as an X-ray, ultrasound, CT scan or MRI, pharmaceutical intervention, corticosteroid injection, autologous blood injection or referral to appropriate medical authorities who can advise on any intervention that may be appropriate to improve the condition. A review with a podiatrist may be indicated for the prescription of orthotics in patients with abnormal foot biomechanics. In very rare cases surgical intervention may be considered.
Exercises for adductor tendonitis
The following exercises are commonly prescribed to patients with adductor tendonitis. You should discuss the suitability of these exercises with your physiotherapist prior to beginning them. Generally, they should be performed 3 times daily and only provided they do not cause or increase symptoms.
Your physiotherapist can advise when it is appropriate to begin the initial exercises and eventually progress to the intermediate and advanced exercises. As a general rule, addition of exercises or progression to more advanced exercises should take place gradually and provided there is no increase in symptoms.
Begin this exercise lying on your back (figure 2). Keeping your knee straight, take your leg to the side as far as you can go without pain and provided you feel no more than a mild to moderate stretch, then return to the starting position. Keep your knee cap and toes facing the ceiling throughout the exercise. Repeat 10 – 20 times provided there is no increase in symptoms.
Figure 2 – Hip Abduction (right leg)
Hip External Rotation
Begin this exercise lying on your back with your knee bent and foot flat on the floor (figure 3). Take your knee to the side as far as you can go without pain and provided you feel no more than a mild to moderate stretch, then return to the starting position. Repeat 10 – 20 times provided there is no increase in symptoms.
Figure 3 – Hip External Rotation (right leg)
Begin this exercise lying in the position demonstrated with a rolled towel or ball between your knees (figure 4). Slowly squeeze the ball between your knees tightening your inner thigh muscles (adductors). Hold for 5 seconds and repeat 10 times as hard as possible and comfortable pain free.
Figure 4 – Adductor Squeeze
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Rehabilitation Protocol for adductor tendonitis
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Find a Physio
Find a physiotherapist in your local area who can treat adductor tendonitis.
Physiotherapy products for adductor tendonitis
The most commonly recommended products by physiotherapists to hasten healing and speed recovery in patients with this condition include:
- Ice Packs or Heat Packs
- Foam Rollers (for self massage)
- Spikey Massage Balls (for self massage)
- Resistance Band (for strengthening exercises)
- Wobble boards or dura discs for balance exercises
To purchase physiotherapy products for adductor tendonitis click on one of the above links or visit the PhysioAdvisor Shop.
- View more Groin Stretches.
- View more Hip Strengthening Exercises.
- View more Leg Stretches
- View more Leg Strengthening Exercises
- View Balance Exercises
- View Beginner Pilates Exercises to improve core stability and posture.
- View detailed information on How to Use Crutches
- View detailed information on when to use Ice or Heat
- View detailed information on initial injury management and the R.I.C.E. Regime.
- View detailed information on Do I Need Orthotics?
- View detailed information on a Return to Running Program.
- View detailed information on Returning to Sport.
- Read our Hip & Groin Diagnosis Guide.
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