Context
Adductor-related groin pain (ARGP) is the most common cause of groin pain in athletes, particularly in kicking and multidirectional sports such as AFL and soccer.
Prevalence rates are high (~30% in AFL squads; Weir et al., 2015; Mosler et al., 2017). Thorborg (2023) highlights the crucial role of adductor strength and its balance with hip abduction.
Key Insights
- Adductor weakness and poor hip adduction/abduction (ADD/ABD) strength ratio are strong risk factors for ARGP.
- Normative values suggest an optimal ADD:ABD strength ratio of ~1.0–1.2. Ratios <1.0 (weaker adductors relative to abductors) are linked to higher injury risk and poor rehabilitation outcomes.
- The Copenhagen Adduction Exercise (CAE) is the gold-standard prevention and rehabilitation exercise. When performed regularly, CAE reduces groin injury risk by up to 41% (Harøy et al., 2019).
- Secondary prevention strategies (ongoing monitoring of hip/adductor strength, load management, and early rehab interventions) are effective in reducing time-loss injuries (Wollin et al., 2018; Adams et al., 2024).
Clinical Relevance
- Screening adductor strength and ADD:ABD ratio should be routine in high-risk athletes.
- Rehabilitation should prioritise restoring adductor strength symmetry and achieving an ADD:ABD ratio of at least 1.0.
- Implementing CAE and progressive adductor loading throughout preseason and in-season reduces recurrence and supports safe return-to-play.
Take Home Message
Adductor-related groin pain is highly prevalent in football codes. Monitoring and restoring adductor strength, and maintaining a balanced ADD:ABD ratio, are central to effective prevention, rehabilitation, and performance in athletes.
References
- Adams, S. R., Wollin, M., Drew, M. K., et al. (2024). Secondary injury prevention reduces hamstring strain and time-loss groin injury burdens in male professional football. Physical Therapy in Sport, 70, 15–21. https://doi.org/10.1016/j.ptsp.2024.08.003
- Harøy, J., Clarsen, B., Wiger, E. G., et al. (2019). The Adductor Strengthening Programme prevents groin problems among male football players: A cluster-randomised controlled trial. British Journal of Sports Medicine, 53(3), 150–157. https://doi.org/10.1136/bjsports-2017-098937
- Mosler, A. B., Agricola, R., Weir, A., Hölmich, P., & Crossley, K. M. (2015). Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis. British Journal of Sports Medicine, 49(12), 810. https://doi.org/10.1136/bjsports-2015-094602
- Thorborg, K. (2023). Current clinical concepts: Exercise and load management of adductor strains, adductor ruptures, and long-standing adductor-related groin pain. Journal of Athletic Training, 58(7–8), 589–601. https://doi.org/10.4085/1062-6050-0496.21
- Weir, A., Brukner, P., Delahunt, E., Ekstrand, J., Griffin, D., Khan, K. M., et al. (2015). Doha agreement meeting on terminology and definitions in groin pain in athletes. British Journal of Sports Medicine, 49(12), 768–774. https://doi.org/10.1136/bjsports-2015-094869
- Wollin, M., Thorborg, K., Welvaert, M., & Pizzari, T. (2018). In-season monitoring of hip and groin strength, health and function in elite youth soccer: Implementing an early detection and management strategy over two consecutive seasons. Journal of Science and Medicine in Sport, 21(10), 988–993. https://doi.org/10.1016/j.jsams.2018.03.004