Inner Thigh Groin Pain in Soccer with Iyad Salloum

Mark: Hi, it's Mark from Remarkable Speaking. I'm here with Iyad Salloum of Insync Physio in North Burnaby, British Columbia, Canada, and one of the top physiotherapy clinics in North Burnaby. We were talking about inner thigh groin pain. How you doing Iyad? 

Iyad: Good, Mark. How are you today? 

Mark: Good. So I know we're gonna label this as inner thigh groin pain from soccer, but this really bridges a lot of different sports that have a lot of cutting and moving in different directions. Does it not? 

Iyad: Yeah, basically, the inner thigh muscles, they're called the adductors. So you know, we can have adductor related groin pain from multiple different, let's say exposures. Typically we see it in like, let's say the more sprinty type sports where you have a lot of change of direction because you are putting lots of tension and strain through those musculatures, especially when you're trying to cut and change direction really quick.

You need to kind of put a high amount of force in a short period of time and then pivot and continue going at that same speed. So that's kind of where we see this a lot in hockey potentially, or soccer. And then in other times we'll see it, let's say more traumatic reasons.

So we had a skier who, as you were talking earlier, caught an edge and thigh got pulled up to the side, so suffered an injury to the inner thigh, and that caused quite a bit of groin pain from him. So you could have that as well. It could happen over, let's say a repetitive pattern where you're just doing too much all at once and, you know, maybe not adequately recovering from it, or maybe you're overloading your current capacity. So if your tolerance level is this arbitrary number here and we're doing this a bit too much without adequate recovery, that could do it too. 

Or you have the big force all at once case, which, you know, those tend to be pretty hard to miss for most people, and they don't kind of sneak up on you. They come in all at once. And then we kind of would look at addressing that in as many ways as we can. 

Mark: So let's just define this adductor. What movement does the adductor actually do? 

Iyad: So that's a really good question because I think the muscle suffers from a bad name because it's called the adductor. And adduction is usually when your thigh is, let's say, in your thigh coming towards midline, it's called adduction. So that's basically it, so basically moving inwards it's either left or right. So that inwards movement is one of the things that the adductors will do, but the adductors also can help us rotate our hips so they can actually help us twist.

They can also help us if most of you know, like the time when you haven't done squats in a while and you do a bunch of squats and next morning your inner thigh is really sore. So the adductors can also extend the hip. So they can push us up basically. They can work with the glutes, and then there's some abductors that also will help the hamstring do their job.

So we're looking at quite a big repertoire. And then in our front, we have some abductors that also can flex the hip. So some of them are hip flexors too. So this is where I think the challenge comes in. You have people who can try to do, let's say abduction based exercise only, and you know, just trying to do a lot of squeezing type exercises and where you're missing out, basically. Yeah the thigh master. And it's not a bad exercise to do sometimes. It could be quite useful, actually. Quite neglected muscle group. But, you're not probably addressing the total function of the muscle.

Like, you know, you think about the muscle that it has multiple fibres that go in different planes, in different directions, and then it's really key for us to try and address the function instead of just specifically training the tissue only. So there's some theories out there that because the muscle does so much of the different tasks that maybe you can have a deficit, for example, in your hip flexors, and your adductor starts to potentially try to help out because when we move, we don't think of specific muscles. We think of global movements. 

So whatever's available, we'll try to help out sometimes. And then we can kind of build these, let's say patterns that strain one area a bit more than the other. And then that's kind of where, for example, if we're treating an adductor, we wouldn't just treat the adductor or we'll just see where's there a deficit in those surrounding musculature and try to kind of address that too. Because the last thing we'd want is somebody to rehab their adductor, feel really good, and then go back into play and then pull up with another injury somewhere else, for example. 

Mark: So, as always complicated to diagnose. What are you looking for? You mentioned this a little bit, but I'd like to emphasize it. What are you actually looking for? 

Iyad: So, in cases where there's trauma, we wanna look to see if there's potentially any like major injury to the structure. So the muscle or the tendon attachment to see if there's like any, you know, big injury there. So we would look at from bruising to strength to range. We can do palpation, it's a good test too. It's not the most comfortable area to have someone poking around for sure. But it can have some clinical use to do that because in the latest criteria to diagnose it, we'd look at those three things. 

So you'd have to have pain in that region, and then you'd have to have like tenderness to touch and then some kind of, let's say, weakness in one of the tests that we would use to assess the strength of it. And then you'd probably lose a bit of range just because that's typically what tends to happen.

I can't move my hip too much when I'm really, really sore there. So it could be protective, let's say restriction of movement or it could be that sometimes the swelling could be there and it kind of limits my movement and sometimes it could be just weakness that I just feel like I can't move because I just don't have that ability to leverage properly, you know, to push off of things properly.

So I feel like I'm stiff, when reality I just don't have the ability to move, full stop. So that's how we would try to, you know, see that. We would try to see if it's the only thing we're dealing with too. And there's really been a lot of recent studies on this where we look at not just rehabbing the local area, but we also look at rehabbing the trunk.

So for example, how you control your low back, your pelvis in conjunction with the adductors because control issues there can also spill downstream. There's a big study cohort out of Ireland that looked at this and they did some really cool stuff with like, even 3D measurements and stuff, and they found that, yeah, an intervention even to the, to the like, you know, to what we classify as the core musculature, especially in running and sprinting can also help the adductor related groin pain.

Mark: Hip bones connected to the thighbone , in other words.

Iyad: Yeah, like that song says, exactly. 

Mark: So how much has it changed the course of treatment, depending on what you actually see and which adductor positioning or fibres are causing the issue? 

Iyad: Yeah. So I wanna just clarify. The abductors themselves, it's a group of muscle, it's not a singular muscle. So I have a couple in the front, couple in the back. They're quite big as a group. 

Yeah obviously like the more widespread, like if you have a very focal injury, it's gonna be a little easier potentially to come back from than if you have multiple little things all over the place.

The good news is, a lot of the times, our clients are surprised by how much we get them to do right off the bat. They think we have to rest and avoid, and avoid, and actually we can push in like a loading program without affecting them negatively.

If anything, like we speed up the recovery a bit more cuz they're able to kind of get started on something a bit more meaningful for them. And you know, the toughest thing on athletes is when you tell 'em, Hey, you're gonna sit down and do nothing, for example, right? And this is anywhere from like a university level varsity athlete you know, to a pro all the way to the weekend warrior. Sports can be a nice outlet for a lot of people and just having them completely withdraw from that could be, you know, negative in other areas beyond the hip pain and the groin pain. 

So yeah, we would get people started quite early and it's really just about tolerance. Is it appropriate to get this person started more aggressively? We wanna make sure that they're safe to do that, obviously. Like, so this is where, I guess it depends on is it just a single spot? Is it multiple things that we're dealing with? You know, multiple different things. Because sometimes, like, you know, there's nothing that says you can't have your low back and your adductor hurting at the same time. And maybe that's more limiting to them than the adductor injury. So it just depends on what you're dealing with.

And then obviously, the timeline depends on your target. What are you trying to get back to? What's the level of like, what's the capacity, what's the max? Let's say torture you should be able to handle with your hip muscles and with your leg and with movement. Because a lot of the times you'll see people who test normally on the bed because the load's not the same as sprinting for 90 minutes in the soccer game. So that's where you'd wanna kind of match the intervention to the level that they're trying to get back to. 

Mark: If you've got some kind of inner thigh groin pain happening. You wanna see the experts at Insync Physio in North Burnaby. They will diagnose exactly what's going on so that your recovery will happen more efficiently and effectively. And you can book online at There's two locations, one in Vancouver, one in North Burnaby. Of course you can call the North Burnaby office, (604) 298-4878 to book. You have to call and book ahead. They're always busy. And thank you so much for watching and listening. Thanks Iyad. 

Iyad: Thank you.