A groin injury could mean a variety of different injuries to a hockey player and at times it seems the groin is a “catch all” for reasons a player may be kept out of the lineup.
A groin strain or groin pull is one of the most common and least severe injuries that can occur at the groin. Part of the reason for such a variety of injuries to the groin is the wide variety of structures that comprise the groin.
The groin consists of the area where the abdomen meets the legs, the inner thigh, the pubic area including the genitalia and even the scrotum in males. Groin pain is often difficult to diagnose, because there is often trouble describing the area of pain and most times athletes can’t really pinpoint the problem. If any of you remember when Danny Briere went through his “groin issues” (I say that because he had more than one in a small amount of time), he seemed to have a hard time describing where he felt his pain and how it was different from the other issues he dealt with.
Groin strain can involve any of the group of muscles called the adductor muscles. Adductor, these muscles pull the leg toward the midline of the body, they “add” or bring the legs together. The strain, you may recall, is a stretching or tearing of the muscle fibers and can range from mild to moderate to severe. Sometimes the tearing of the muscle can cause a hematoma, or pocket of blood, that may delay healing.
Areas that have been strained previously may heal, but scar tissue may make them susceptible to subsequent injuries. Players that have had prior groin strains, have a higher risk or re-injury than players that have never had a groin injury. Veteran players are especially susceptible and they more often occur in training
In very severe cases, the force of the muscle contraction is so great that it not only damages muscle fibers, but it can actually pull a piece of bone away, causing an avulsion fracture. These avulsion fractures are usually managed surgically. Most strains respond to non surgical treatment. The groin strain usually occurs as a result of overstressing the muscles (sometimes due to poor conditioning, hence the large proportion that happen in training camp) but they may also be injured from a sudden force of a hit or being tripped.
The player usually has pain with motion and/or stretching of the hip joint that is usually felt in the inner thigh, sometimes very close to the pubic bone. Muscle strains may cause spasm of the involved muscles in the abdomen, the groin or the thigh.
With mild or grade 1 strains, there is usually discomfort that may not be noticed until the player is resting after training or practice. The player often will complain of “tightness” and it may be tender. Walking may not be affected, but running and skating and changes in direction may be bothersome. Grade 2 or moderate strains usually present with a sudden and sharp pain in the groin or thigh. The muscles will usually tighten and there may be spasms. Bruising and swelling may be noticed a few days after the injury. Walking may be uncomfortable and The muscles are weakened due to the damage. Grade 3 or severe strains cause severe pain, severe weakness and inability to contract the muscles involved. Substantial bruising and swelling within 24 hours and there may be a “gap” felt in the muscle where the tear occurred.
R.I.C.E. is usually used for the first 48 hours. With mild strains, rest may only involve avoiding activities that produce pain. A player may be held out of practice for a few weeks. Compression shorts or a wrap may be used to support the muscles and reduce swelling. Crutches may be needed for a couple of days for a moderate strain. For a severe strain, the athlete should use crutches for 5-7 days. Recovery will progress to stretches and strengthening exercises and as with other injuries; return to play should occur when the athlete has full range of motion, full strength and no pain.
Mild strains can take 1-4 weeks to heal. Moderate strains may take 4-8 weeks and sever strains may take up to 12 weeks.
Sports massage is very useful in recovery from a groin strain and is usually started about a week after the injury occurred to allow swelling and bleeding to stop. This type of massage can increase blood flow and promote healing as well as manually breaking up any scar tissue that may have formed.
Groin strains are just one of many injuries that can occur to the groin and are often seen in the early part of an NHL season or even training camps. They can also result from sudden force, so while the number of new groin issues decreases as the season moves on, there are still a few injuries that will happen later in the season. Most off-season strengthening and training programs are designed to strengthen the groin and hopefully reduce the frequency of this injury.
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