If you are active, then you may have experienced or known of someone that has pulled their muscles. Heck, you may have pulled a muscle picking up a toy that your toddler left in the middle of the living room.
This is an article to help you understand how to make a good decision in what is your best next step. We have helped countless of active folks in Long Beach, from weekend warriors playing hockey, basketball, tennis, triathletes, with their rehabilitation and Physical Therapy needs, that we have heard this question all too many times.
A pulled muscle happens when the muscle is asked beyond its capacity.
There are two major ways of pulling a muscle: macro trauma and microtrauma.
A pulled groin is a myotendinous disruption of the hip adductors muscle. The most common muscle injured is the ADDUCTOR LONGUS . The adductor longus muscle helps to bring your thigh bone, the femur, inwards with a slight external rotation. Your adductor longus does help to bring your leg closer to your chest (flexion) and eccentrically controls your femur from trailing too far back (extension). There is a role in the adductor longus to resist and control the eccentric (excessive stretching) force of when the femur moves laterally outwards, with an inward rotation moment.
The most overlooked pulled groin muscle is the Pectineus muscle.
The pectineus muscle helps with hip flexion (picking up your leg) first, then preventing bring the thigh into a cross legged maneuver. Like the Adductor Longus muscle, this means that the Pectineus muscle role is to control the opposite movement of abduction. This is why it is common to pull this muscle too when you quickly have to do a cutting motion, spread the legs in gymnastics, or prevent yourself from falling while ice skating.
There is a internal rotation motion that is the opposite trend of the Adductor Longus.
Functional Anatomy.
Fascia is the connective tissues that connects muscles to work BEST together via force transfer. Imagine kinetic chain force moving from muscles to muscles like car moving along a highway. Each muscle is a freeway. A movement pattern is driving from route A to B.
The pectineus connects to the External Oblique Abdominals muscles. The External Oblique Abdominals are important as a rotational stabilizer. This means that it helps with giving your the ability to be strong during twisting motion.
The Pectineus muscle connects to the hip joint capsule to help reinforce hip stability and control.
In front of the Pectineus is one of the major hip flexors. If you do not have good control in picking up your leg and knee during walking, sprinting, or jumping, then the Pectineus muscle will attempt to do something it is not designed to do. You strain the Pectineus muscle because it is working more than its capacity.
There is an important foramen called the Obturator foramen that is located behind the Pectineus muscle. The important thing to know is there are many important tissue structures like nerves, arteries, and veins that run through and near this foramen.
Why is this important?
Your body will sacrifice your adductor and pectineus muscles to make sure your body automatically protect this foramen from further tension.
This is why you see more groin pull in ice skaters and hockey players. “Pulling your groin” is known as an adductor strain. You can get a groin pull with sports that require lateral cutting and explosive movements like tennis, football, basketball, rugby, and soccer. Other sports where you may not think about having an inner thigh force include horseback riding, breaststroke in swimming, and bowling.
Macro trauma, in the context of a pulled groin, is through a forceful and sudden event where the femur is moved lateral or inwards quickly. The adductor muscle groups need to react faster than what you are trained in doing, and you pull your groin.
Here are a few examples.
- Catching a fall
- Accelerating quickly
- Changing directions quickly
- Legs moving into a split position abruptly
Microtrauma is trickier to pinpoint and needs an extra set of eyes from a Specialist Sports Medicine Physical Therapist.
The definition of microtrauma is that is in small in nature and does not disrupt the tendon until multiple days, months, or years of the same improper movement habits. A small shift of imbalance between multiple muscle groups or the muscle’s interaction with the joint causes the hip and pelvis to work sub-optimal.
Rarely are you requiring your hips to function at 100% of its capacity. You will not feel any discomfort. If you are working at 90% of capacity with every cutting maneuver but done 1000’s of times, there will be a slow decline in muscular function. Now we are talking about an eventual 60-70% capacity.
The decline happens in four major ways.
- Lack of sufficient break from the activity. Example. Playing soccer year-round.
- Lack of lower body warm-up, cool-down, or proper muscle care from a Specialist.
- Recent illness or immune-compromised event that does not allow your musculoskeletal system to perform at a level you need. Example. Returning back to playing too soon after having a gut-related illness.
- Improper aging. Actually, age is not the issue. This is to say that if you do not take time to eat well, have good sleep hygiene, or have an outlet to handle life stress, your muscles cannot function when and at the intensity you need your adductor muscles. Can you play at 100% if you have a year of only 3-4 hours of sleep. The answer is NO. Many people are emotionally cranky and so will your muscles.
If you are in immediate attention for your pulled groin.
Grading System for severity
Orthopedist and Sports Medicine Specialist communicate to each other via the muscle strain classification system. This helps to communicate the severity of the groin pull.
There are three degrees of groin strains:
Grade 1
A grade 1 groin strain occurs it hurts to touch or palpate the adductor muscle(s), tendon, and/or the attachment of it to the pelvis bone. There is no pain with muscle resistance by the doctor. You can demonstrate strength during the resistance test. You may be able to walk without pain, but running, jumping, kicking, or stretching may be painful.
Grade 2
A grade 2 groin strain is a tear that damages a significant percentage of the muscle fibers. Touching the adductor muscle is painful now and you are demonstrating weakness during the strength test.
This might be painful enough to make walking difficult. It will be painful to bring your thighs together.
Grade 3
A grade 3 groin strain is a tear that goes through most or all of the muscle or tendon. This usually causes a sudden, severe pain at the time when it happens. Using the injured muscle at all will be painful.
You may feel no pain upon palpation as there is no connection of the tendon to the bone. Common complaints are feeling of weakness, swelling, and possible, ecchymosis (bruising). You may be able to feel a gap in the muscle when you touch the injury.
What else could it be?
A groin strain can be confused with other problems. You might experience similar symptoms with:
- Hip bursitis
- Inguinal hernia
- “Sports hernia”
- a stress fracture (a hairline break in your pubic bone or femur)
- Hip osteoarthritis
- Hip labral tear
- Pubic symphysis dysfunction
- L2 or L3 nerve root impingement
- ilioinguinal nerve entrapment
- Tumor or cyst
Your doctor will often start with an x-ray to make sure it is nothing serious at the skeletal or medical health matter. They will follow up with an MRI to confirm the diagnosis and rule out other injuries.
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If you need further medical assistance, go to your local Sports Medicine Physical Therapist. We specialize in looking a Sports Medicine from a deep knowledge of functional anatomy and holistic movement.