Groin Strains: Treatment and Return to Sport

Kathy Ryan-Ceisel, PT MHS | Algonquin Sports PT

Overhead Throwing Expert-Athletic Edge and Wellness Edge

Groin strains are common injuries in athletes—particularly in sports that require

sprinting, acceleration, deceleration, cutting, kicking, jumping, lateral movement and rapid changes of direction. They can be particularly frustrating because an athlete may feel relatively good during everyday activities but still be unable to tolerate the high-speed, high-force demands of sport.

An athlete may be able to walk, jog or perform basic strengthening exercises without significant pain but still experience pain when sprinting, cutting, kicking or changing direction at full speed. This is one reason groin injuries can linger or recur when an athlete returns to sport before restoring adequate strength and tissue capacity.

At Athletic Edge and Wellness, addressing groin strains, treatment, and return to sport emphasizes not just alleviating pain, but also restoring mobility, strength, hip and pelvic control, neuromuscular coordination, running mechanics, and the capacity to handle the specific demands of the athlete's sport.

What Is a Groin Strain?

A groin strain most commonly involves injury to the adductor muscles, which are located along the inside of the thigh.

The primary adductor muscles include:

• Adductor longus

• Adductor brevis

• Adductor magnus

• Gracilis

• Pectineus

These muscles help bring the leg toward the midline of the body, but their role goes far beyond simply "squeezing the legs together."

The adductors contribute to:

• Hip stabilization

• Pelvic control

• Deceleration

• Change of direction

• Acceleration

• Running mechanics

• Kicking

• Lateral movement

• Force transfer between the lower extremities and trunk

A groin strain occurs when the muscle or musculotendinous tissue is exposed to forces that exceed its current capacity.

This commonly occurs when the adductors are required to produce high levels of force while being rapidly lengthened—for example, during sprinting, cutting, kicking or a sudden change of direction.

The adductor longus is one of the most frequently injured structures in athletes with acute groin injuries. Importantly, not all groin pain is an adductor strain. Pain in the groin can also originate from the hip joint, abdominal wall, iliopsoas, pubic region or other structures. An accurate diagnosis is therefore important.

Who Is Most Likely to Suffer a Groin Strain?

Groin injuries can occur in athletes of almost any age, but they are particularly common in sports involving high-speed running, cutting, kicking and multidirectional movement.

Common sports include:

• Soccer

• Hockey

• Football

• Basketball

• Baseball

• Softball

• Lacrosse

• Tennis

• Rugby

• Track and field

• Martial arts

• Dance

Sports that combine high-speed movement with rapid acceleration, deceleration and changes of direction place particularly high demands on the adductor muscles. For example, soccer and hockey players repeatedly accelerate, decelerate and change direction while competing for the ball or puck.

In baseball and softball, groin injuries can occur during:

• Sprinting out of the batter's box

• Stealing bases

• Sliding

• Sudden acceleration

• Sudden deceleration

• Defensive lateral movements

• Chasing down balls

• Changing direction

• Throwing-related lower-body movements

The demands may be different from soccer or hockey, but the underlying requirement is similar: the athlete must be able to rapidly produce and absorb force through the hip, pelvis and lower extremity.

When During the Season Do Groin Injuries Happen?

Groin injuries can occur at any point during a season, but they may become more common when athletes experience a rapid increase in high-intensity activity.

This can occur during:

• Preseason

• The beginning of a new season

• Return from an extended break

• Tournament play

• Increased practice intensity

• Increased sprinting

• Increased cutting

• Increased game volume

An athlete may spend several weeks participating in relatively low-intensity training and then suddenly be expected to perform repeated sprints, cutting drills and competitive movements.

The problem isn't necessarily that the athlete is "out of shape." The problem may be that the athlete's adductors, hips and overall kinetic chain have not been adequately exposed to the specific intensity and volume required for competition.

Common Causes of Groin Strains

Groin injuries are rarely caused by one isolated factor.

They often occur when several factors combine.

1. High-Speed Sprinting

Sprinting places substantial demands on the muscles surrounding the hip and pelvis. The adductors contribute to hip stabilization and force production during running. At higher speeds, the forces placed on the lower extremity increase significantly. An athlete who has not been adequately prepared for high-speed running may not have the capacity necessary to tolerate repeated sprinting.

2. Cutting and Change of Direction

Rapid changes of direction can create large forces through the hip and adductor muscles.

The athlete must:

• Decelerate

• Stabilize the pelvis

• Absorb force

• Redirect the center of mass

• Produce force in a new direction

If the athlete cannot efficiently absorb and redirect these forces, excessive stress may be placed on the groin.

3. Sudden Increase in Training Load

Rapidly increasing:

• Sprint volume

• Running distance

• Practice intensity

• Games

• Cutting

• Conditioning

• Tournament participation

• Kicking volume

can exceed the athlete's current tissue capacity.

The issue isn't necessarily that the athlete is doing "too much."

The issue may be that they are doing too much, too soon, relative to what their body is prepared to tolerate.

4. Previous Groin Injury

A previous groin injury can increase the risk of another injury. This is one reason simply allowing pain to disappear isn't enough. The goal should be to restore the athlete's ability to tolerate the demands that caused the injury in the first place.

5. Adductor Strength Deficits

The adductors need to be strong enough to produce and absorb force.

Weakness may affect the athlete's ability to:

• Stabilize the pelvis

• Decelerate

• Change direction

• Sprint

• Kick

• Control the leg during single-leg activities

Adductor strength should therefore be an important part of both rehabilitation and injury prevention.

6. Hip and Glute Weakness

The adductors do not work alone. The gluteal muscles, hip rotators, quadriceps, hamstrings and trunk all contribute to lower-extremity force production and control. A deficit in one part of the system can change how forces are distributed throughout the kinetic chain.

7. Poor Lumbopelvic Control

The pelvis is the foundation connecting the lower extremities to the trunk.

Poor pelvic control can influence how the hip moves and how forces are transferred through the groin.

This is why treating only the painful area may not fully address the problem.

8. Fatigue

Fatigue can affect strength, coordination and movement mechanics.

This becomes especially important late in:

• Practices

• Games

• Tournaments

• Conditioning sessions

An athlete may demonstrate good movement when fresh but lose control as fatigue increases.

9. Inadequate Preparation for Sprinting and Cutting

An athlete who has not recently sprinted, cut or performed high-intensity multidirectional movement should not immediately be expected to tolerate full-speed competition. These demands should be progressively reintroduced.

10. Inadequate Warm-Up

Going directly into maximal sprinting, cutting or kicking without progressively preparing the muscles and nervous system may increase the risk of injury.

A dynamic warm-up that progressively increases movement intensity is generally more appropriate before explosive activity than simply performing static stretching and immediately going full speed.

11. Limited Hip Mobility

Mobility deficits can influence how an athlete moves and compensates during running, cutting and other athletic movements. However, limited mobility is not automatically the cause of every groin injury. The goal should be to identify whether a mobility limitation is actually affecting the athlete's movement or ability to perform.

Where Does a Groin Strain Usually Occur?

A groin injury can occur in the muscle belly, musculotendinous junction or tendon.

The adductor longus is a particularly common site of acute groin injury.

Pain may also occur near the pubic attachment of the adductor muscles.

Location matters because the specific tissue involved can influence:

• Diagnosis

• Treatment

• Rehabilitation

• Prognosis

• Return-to-sport progression

Importantly, pain in the groin does not automatically mean an adductor muscle strain.

Other conditions can produce similar symptoms, including:

• Adductor tendinopathy

• Hip joint pathology

• Iliopsoas-related pain

• Athletic pubalgia

• Abdominal wall injury

• Pubic bone-related conditions

• Hip flexor injury

• Hernia

A proper clinical evaluation is therefore important when groin pain persists or significantly limits athletic activity.

What Does a Groin Strain Feel Like?

Athletes may describe:

• Sudden sharp pain in the groin

• Pain along the inside of the thigh

• A pulling or tearing sensation

• Pain during sprinting

• Pain with cutting

• Pain with kicking

• Pain when changing direction

• Pain when squeezing the legs together

• Pain with stretching the groin

• Pain with resisted hip adduction

• Localized tenderness

• Weakness

• Tightness

• Difficulty accelerating

• Difficulty changing direction

Some athletes experience an immediate sharp pain that stops activity.

Others may develop progressively increasing groin pain over several days or weeks. The severity and symptoms can vary considerably depending on the tissue involved and the degree of injury.

How Is a Groin Strain Diagnosed?

Diagnosis begins with a detailed history and physical examination.

A sports physical therapist or sports medicine physician may evaluate:

• Mechanism of injury

• Location of pain

• Palpation

• Hip range of motion

• Hip strength

• Adductor strength

• Pain with resisted hip adduction

• Pain with muscle lengthening

• Single-leg control

• Squatting

• Lunging

• Running mechanics

• Acceleration

• Deceleration

• Cutting

• Sport-specific movements

The combination of localized groin pain, tenderness, pain with resisted adduction and pain with stretching or athletic movements can be consistent with an adductor injury. However, the clinical examination must also consider other possible sources of groin pain.

Is an MRI Necessary?

Not every groin strain requires an MRI.

Many adductor injuries can be diagnosed clinically.

MRI may be useful when:

• The diagnosis is uncertain

• The injury appears significant

• There is concern for a high-grade tear

• There is significant weakness

• There is concern for tendon involvement

• Symptoms are persistent

• The athlete is not progressing as expected

• Another source of groin pain is suspected

• Additional information is needed for treatment planning

Imaging can provide useful information about the location and extent of tissue injury. However, imaging should not be used by itself to determine when an athlete is ready to return to sport. Clinical function, strength and sport-specific performance remain extremely important.

What Are the Grades of Groin Strains?

Groin strains are commonly described as:

Grade I – Mild

A small amount of tissue involvement.

Symptoms may include:

• Mild pain

• Minimal strength loss

• Mild tenderness

• Little functional limitation

An athlete may still be able to walk and perform some athletic activity, although higher-intensity movements may produce symptoms.

Grade II – Moderate

A partial muscle injury with more significant pain and functional impairment.

The athlete may have:

• Significant tenderness

• Weakness

• Pain with running

• Pain with cutting

• Reduced range of motion

• Difficulty accelerating

• Difficulty changing direction

• Difficulty kicking

Grade III – Severe

A severe or complete muscle/tendon disruption.

These injuries may involve:

• Significant weakness

• Difficulty walking

• Significant bruising or swelling

• Major loss of function

• Significant pain

• Possible tendon disruption

A suspected complete tendon injury or avulsion requires appropriate medical evaluation and may require consultation with a sports medicine physician or orthopedic specialist.

Treatment for Groin Strains

Treatment should be individualized based on the severity, location, tissue involved and functional demands of the athlete.

Early Phase

The initial goals are to:

• Protect the injured tissue

• Control pain

• Minimize excessive irritation

• Maintain appropriate movement

• Maintain overall fitness when appropriate

• Begin progressive loading when tolerated

Complete rest for an extended period is generally not the goal.

Instead, rehabilitation should transition toward progressive loading as soon as the tissue can tolerate it. The amount and type of loading should depend on the injury and the athlete's symptoms.

Physical Therapy

Physical therapy is an important component of groin rehabilitation.

A comprehensive program may include:

Early strengthening

• Adductor isometrics

• Gentle hip adduction

• Bridge variations

• Controlled hip strengthening

• Core exercises

• Low-load single-leg exercises

Progressive strengthening

• Side-lying adduction

• Standing cable/band adduction

• Copenhagen plank progressions

• Split squats

• Lunges

• Single-leg strengthening

• Hip extension exercises

• Multi-directional strengthening

Progressive adductor loading

The adductors need to regain the ability to tolerate increasing amounts of force.

Exercises such as Copenhagen adduction progressions can be valuable components of a comprehensive groin rehabilitation program. However, one exercise should not be viewed as a complete solution. The goal is to progressively develop the athlete's overall capacity, not simply check a particular exercise off a list.

Neuromuscular Training

The athlete also needs to regain control of:

• Pelvis

• Hip

• Knee

• Trunk

• Single-leg mechanics

• Deceleration

• Change of direction

This becomes particularly important as rehabilitation progresses from isolated strengthening to athletic movement.

Running and Change-of-Direction Progression

One of the most important parts of groin rehabilitation is progressive exposure to the movements required by sport.

An athlete cannot be considered fully rehabilitated simply because they can:

• Walk without pain

• Jog

• Perform strengthening exercises

• Stretch without discomfort

They eventually need to demonstrate the ability to tolerate progressively higher levels of:

• Running speed

• Acceleration

• Deceleration

• Lateral movement

• Cutting

• Reactive movement

• Sport-specific activity

A typical progression may include:

Phase 1 Walking → light jogging

Phase 2 Jogging → running

Phase 3 Running → acceleration

Phase 4 Acceleration → higher-speed running + deceleration

Phase 5 Straight-line running → controlled lateral movement

Phase 6 Lateral movement → planned change of direction

Phase 7 Planned cutting → reactive cutting

Phase 8 Sport-specific movement

Phase 9 Return to practice

Phase 10 Return to competition

The exact progression should be individualized. A soccer player, hockey player, basketball player and baseball player do not have identical groin demands.

The rehabilitation program should eventually reproduce the speed, direction, intensity and fatigue demands of the athlete's actual sport.

How Long Does a Groin Strain Take to Heal?

There is no single timeline for every groin injury. A mild injury may allow an athlete to return relatively quickly, while a more significant injury can require several weeks or longer.

Recovery depends on:

• Severity

• Tissue involved

• Location

• Strength deficits

• Athlete's age

• Previous injury history

• Sport

• Training demands

• Rehabilitation progression

• Response to loading

For that reason, "two weeks" or "four weeks" should not automatically be used as a return-to-play deadline.

The better question is:

Is the athlete ready to tolerate the demands of their sport?

Return to Play: What Should Be Tested?

Returning an athlete simply because they are pain-free is not enough.

Before unrestricted return, the athlete should demonstrate:

Full or Near-Full Range of Motion

The athlete should have appropriate hip mobility without significant pain or asymmetry.

Adductor Strength

Adductor strength should be evaluated objectively whenever possible.

Testing may include:

• Hand-held dynamometry

• Isometric strength testing

• Side-to-side comparison

• Functional strength testing

• Progressive Copenhagen testing

Hip and Lower-Extremity Strength

The athlete should also demonstrate adequate strength through the:

• Glutes

• Hamstrings

• Quadriceps

• Hip rotators

• Core

Running

The athlete should progressively demonstrate the ability to run at the speeds required by their sport.

Acceleration and Deceleration

The athlete should tolerate repeated acceleration and deceleration without:

• Pain

• Apprehension

• Weakness

• Compensatory movement

Cutting and Change of Direction

For sports requiring multidirectional movement, rehabilitation must progress beyond straight-line running.

The athlete should demonstrate the ability to cut and change direction with increasing speed and intensity.

Lateral Movement

This is particularly important for athletes participating in:

• Soccer

• Hockey

• Basketball

• Lacrosse

• Tennis

• Baseball

• Softball

Sport-Specific Drills

A soccer player, hockey player, football athlete and baseball player do not have identical groin demands.

Return-to-play testing should reflect the athlete's actual sport.

Fatigue Testing

This is often overlooked.

An athlete may perform perfectly when fresh but demonstrate weakness, altered mechanics or pain after repeated high-intensity movements.

The goal is not simply to determine whether the athlete can perform one good sprint or one good cutting maneuver. The goal is to determine whether they can repeatedly tolerate the demands of competition.

Why Do Groin Injuries Keep Coming Back?

This is one of the biggest problems with groin injuries.

An athlete may feel normal during daily activities long before the groin has regained its previous strength and capacity.

Common reasons for recurrence include:

• Returning too quickly

• Inadequate adductor strength

• Inadequate hip strength

• Inadequate sprint exposure

• Inadequate change-of-direction exposure

• Poor lumbopelvic control

• Incomplete rehabilitation

• Sudden increase in workload

• Returning to competition before restoring capacity

• Failure to address contributing factors

The goal of rehabilitation should not simply be to make the athlete feel better.

The goal should be to make the athlete prepared for what comes next.

Preventing Groin Injuries

Prevention should begin before the athlete gets hurt.

Important components include:

• Progressive sprint training

• Adductor strengthening

• Copenhagen progression exercises

• Hip and glute strengthening

• Single-leg strength

• Core and pelvic control

• Appropriate mobility work

• Progressive change-of-direction training

• Appropriate workload management

• Adequate recovery

• Sport-specific conditioning

Research has demonstrated that structured exercise programs can reduce the risk of groin problems in athletic populations, particularly programs incorporating adductor strengthening and progressive sport-specific preparation. A well-designed program should prepare the athlete for the actual demands of their sport—not simply the demands of the rehabilitation exercises.

The Bottom Line

A groin strain isn't simply a "pulled muscle."

It is an injury that can affect an athlete's ability to sprint, accelerate, decelerate, cut, kick, change direction and perform at full speed. The most successful rehabilitation programs don't stop when the athlete becomes pain-free.

They progressively restore:

Mobility → Strength → Adductor Capacity → Hip & Pelvic Control → Running → Acceleration → Deceleration → Cutting → Sport-Specific Performance → Full Competition

At Athletic Edge and Wellness, our goal is to help athletes not only recover from groin injuries but return with the strength, mobility, confidence and physical capacity necessary to perform at their previous level—and reduce the risk of future injury.

Don't let "feeling better" be the only measure of recovery.

Make sure your groin is ready for what your sport demands.

Call Athletic Edge and Wellness at 224-505-3343 today to schedule your evaluation.

Sports Medicine References

1. Serner A, Weir A, Tol JL, et al. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study. Orthopaedic Journal of Sports Medicine. 2020;8(1). .

2. Serner A, et al. Acute Adductor Muscle Injury: A Systematic Review on Diagnostic Imaging, Treatment, and Prevention. American Journal of Sports Medicine.

3. Cuniberti M, et al. Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts. Sports Medicine - Open. 2022. .

4. Estévez Rodríguez JL, et al. Consensus of Return-to-Play Criteria After Adductor Longus Injury in Professional Soccer. Sports. 2025;13(5):134.

5. Kekelekis A, Perna P, Beato M. Which Criteria Determine Return-to-Play Decisions Following Hip and Groin Injuries in Soccer Players: A Scoping Review. Journal of Sport Rehabilitation. 2026;35(6):459-473.

6. Thorborg K, et al. Research on adductor strengthening and Copenhagen adduction exercise.

7. Ardern CL, et al. 2016 Consensus statement on return to sport from the First World Congress in Sports Physical Therapy, Bern. British Journal of Sports Medicine.