How to Prevent Groin Injuries

Previously, I have written about that groin injury we hear so much about in professional soccer, ice hockey and with some football players a curious injury that may lead to surgery and an extended rehabilitation period.

Sure sounds like more than a pulled muscle. If there was one saving grace in this injury, it is that it's mostly isolated to professional athletes. Still, the more typical "groin pull" (the proper term is "strain") is a pretty common injury in soccer, and we see teams stretching these muscles as a part of their pre-game routine.

Groin injuries are pretty common in ice hockey because the diagonal stride used in skating puts the groin (adductor) muscles under strain. In soccer players, groin strains are a result of rapid changes of speed/direction or from reaching to the side to make a tackle. In football, the "speed" players can strain groin muscles when changing directions.

While treatment of injuries is a major focus of sports medicine, prevention of injuries is also an important goal. So, has anyone tried to prevent these injuries?

The doctors at the Lennox Hill Hospital in New York City studied these injuries for a number of years. Before one can start to prevent injuries, it is important to know how the injury occurs, and then to know how general factors of the muscles and joints differ between injured and uninjured players.

On a large group of professional hockey players, they measured flexibility and strength of the hip. Then they followed groin injuries over two seasons and went back to their data to see if there were any differences between the injured and uninjured players. There was no difference between groups when comparing flexibility, but the injured players had remarkably lower adduction strength (i.e. the groin muscles).

Does that mean all that time spent stretching the groin is ineffective? I wouldn't go that far. It is probably a combination of strength and flexibility, but professional ice hockey seems to have the flexibility aspect covered. However, it appeared that poor groin strength was a major factor is predicting groin injuries.

The next step the Lennox Hill folks did was to devise a training program to improve groin strength. Here is what they came up with:

Warmup: stationary cycling, groin stretching, sumo squats, side lunges, kneeling pelvic tilts

Strengthening: ball squeezes with different-size balls, concentric adduction against gravity, cable/elastic standing adduction, seated adduction machine, slide board forward, slide board with simultaneous adduction (spread legs and bring both together at the same time), one-legged lunges.

Ice hockey specific: on-ice kneeling adductor pull-togethers, cable cross-over pulls, slide skating, cable-resisted striding.

So did it work? Over the next two years, 58 players followed the program. Based on pre-training tests, 33 were classified as being "at risk" of a groin injury due to low adductor (groin) strength. This (mostly game) injury rate fell from 3.2 per 1,000 game-exposures during the two years before to 0.7 per 1,000 game-exposures during the prevention phase. That is a huge reduction in groin injuries.

So what can we take home from this? Most coaches are pretty good about encouraging flexibility work on the groin area, but need to add in some adductor strengthening to their work. And players must take some responsibility in this by preparing for the season by strengthening these muscles using some of the exercises listed above.

Having had strained groin muscles during my playing days, there is no injury that creates more problems in most all aspects of the day. You have no clue just how much these muscles are used until one is injured. It can keep players out for weeks while it heals.

Wouldn't you rather put in some time preventing this injury rather than time on the pine waiting for it to heal?

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