When Inner Thigh Pain Isn't a Groin Injury...

 

Inner thigh or groin pain can cause discomfort on the inside of your leg that can be felt from the groin and all the way down to the knee. This type of injury is common in sports involving rapid acceleration, deceleration, and with rapid change in direction such as soccer, basketball, football, tennis, ice hockey, and martial arts. Often these injuries involve strains (tearing or stretching) of the adductor muscles or chronic damage to the adductor tendons.

The adductor muscles (adductor longus, brevis, magnus, and the gracilis) are responsible for bringing your legs together towards the midline, crossing your legs across the midline, play a part in internal and external hip rotation, hip flexion and extension, and assists with stability. These muscles are located on both inner thighs stretching from the groin and down to the inner part of the knees.

The symptoms associated with adductor muscle strain includes tenderness, stiffness, and pain at the origin of the muscle. The pain can be characterized as sharp, stabbing, or a constant dull ache that can make it difficult to perform daily activities. Pain and stiffness often resolve after a period of warming up but often recur after athletic activities have seized. 

Muscle and tendon tear are graded based on the severity of the injury.

-Grade 1: tear of a small number of muscles and/or tendon fibers causing pain with minimal or no loss of strength or motion

-Grade 2: tear of a significant number of muscles and/or tendons causing pain, swelling, decreased motion, and decreased strength but not complete loss of function.

-Grade 3: complete disruption of the muscle-tendon unit with loss of function

Treatment includes RICE (rest, ice, compress, elevate), activity restrictions, physiotherapy (PT), platelet rich plasma (PRP)/steroid injection and surgery (for complete avulsions).

Other considerations includes…

Muscle and tendon injury

-Sports hernia or athletic pubalgia (has the same presentation but increased intra-abdominal pressure from valsava maneuver or sit-ups makes the pain worse)

-Osteitis pubis refers to an inflamed pubic symphysis which is the joint that connects the two-halves of your pelvic bone.

-Lower abdominal muscle strain

Bone conditions

-Stress fractures of the pelvis or the thigh bone (femur)

Nerve injury

-Inguinal (groin) nerve pain causes lower abdominal pain that can radiate to the groin and thigh

-Obturator nerve entrapment can cause sensory loss, paresthesia, inner thigh pain especially in sports that involves kicking or twisting

Hip pathology

-Labral tear involves the ring of cartilage that follows outside rim of the socket of the hip joint

-Osteoarthritis

References

Brody, F. J., & Harr, J. (2017). Sports hernia with adductor tendonitis. In B. P. Jacob, D. C. Chen, B. Ramshaw, & S. Towfig (Eds.), The SAGES manual of groin pain, (pp. 453-461). Nyw York, NY: Springer.

Charlton, P. C., Drew, M. K., Mentiplay, B. F., Grimaldi, A., & Clark, R. A. (2017). Exercise interventions for the prevention and treatment of groin pain and injury in athletes: A critical and systematic review. Sports Medicine, 1-16. DOI 10.1007/s40279-017-0742-y

Gaudino, F., Spira, D., Bangert, Y., Ott, H., Zobel, B. B., Kauczor, H., & Weber, M. (2017). Osteitis pubis in professional football players: MRI findings and correlation with clinical outcome. European Journal of Radiology, 94, 46-52. doi: https://doi.org/10.1016/j.ejrad.2017.07.009

Patricios J. (2017). Adductor muscle and tendon injury. Retrieved from https://www-uptodate-com.ezproxy2.library.arizona.edu/contents/adductor-...

Serner. A., Weir, A., Tol., J. L., Thorborg, K., Roemer, F., Guermazi, A., … Holmich, P. (2017). Characteristic of acute groin injuries in the adductor muscles: A detailed MRI study in athletes. Scandinavian Journal of Medicine & Science in Sports, 1-10. doi: 10.1111/sms.12936

Whittaker, J. L., Small., C., Maffey, L., & Emery, C. A. (2015). Risk factors for groin injury in sport: An updated systematic review. British Journal of Sports Medicine, 49(12), 1-8. doi:10.1136/bjsports-2014-094287