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Adductor Tendinitis

From Physiopedia

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Original Editors - Gaëlle Vertriest

Top Contributors -

Gaëlle Vertriest  

Contents

Search Strategy

Keywords:

Adductor tendinitis, adductor tendonitis, groin injuries, adductor injuries, adductor tenosynovitis, inflammation adductor muscles (tendons)

Databases searched:

Medscape, Pedro, Google Scholar, Pubmed, Cochrane library, Web of Knowledge, Library of the VUB

Description

Adductor tendinitis is the inflammation of the tendons in the adductor muscles. We can divide them into long and short adductors: the long adductors (Gracilis & Adductor Magnus) go from the pelvis to the knee and the short adductors (Pectineus, Adductor Brevis & Longus) go from the pelvis to the thigh bone.[1][2][3] These adductor muscles stabilize the pelvis and pull the legs together (= adduction).[4][1][3]

Clinically Relevant Anatomy

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Epidemiology /Etiology

We use the adductors a lot in sports like running, football, horse riding, gymnastics, swimming,… These are sports in which we repeat movements, change of direction or stress the adductor tendon quite heavily.[4][2] Adductor tendinitis and also groin injuries are more prevalence among athletes. [1]
Another cause is the overstretching of the adductor tendons.[4][2]

The development of adductor tendinitis is influenced by a lot of factors. Especially leg length difference has consequences: it affects the way you walk.[1] While performing wrong movements during physical activity, one may influence the tendinitis in a negative way. Also length and strength differences in the muscles or weakness can result in adductor tendinitis. Other factors can be lack of warming up, the absence of sport, fatigue, obesity, age-related weaknesses, degeneration and genetics.[4][1]

Characteristics/Symptoms

We can perceive adductor tendinitis with groin pain: this pain occurs by touching the adductor tendons on the pelvis, by closing the legs or effectuating abduction from the affected leg. The pain can grow gradually or sudden sharp pains may appear.[4][2]
The patient can notice swelling or lump in the adductor muscles, stiffness in the groin or inability to contract or stretch the adductors.[2] In severe cases the patient may be unable proceed with physical activities.[4][3]

Differential Diagnosis

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Diagnostic Procedures

We can make an objective diagnosis of adductor tendinitis by the examination from a physiotherapist. There is also the possibility to take an X-ray, Ultrasound, MRI- or CT-scan.[4][1]

Outcome Measures

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Prevention

To prevent the development of adductor tendinitis, the patient must work on most factors mentioned. But remember that they must avoid doing too much too soon![4]
The patient has to develop his muscles and stabilize his groin, pelvis and hip area by doing exercises with different levels of difficulty. These exercises train the balance, strength, speed, jumping…
Another important object is stretching: the muscles have to be flexible.
Tools like mobility and muscle supports also help by alleviating high impacts.[4][1]

Medical Management

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Physical Therapy Management

In order that the patient has a good rehabilitation, he must quickly have a good treatment of physiotherapy. Normally the patient will return to a normal health in a few weeks. With a more serious case, the rehabilitation will take a few months before the patient will come back to a normal function.[4]

Treatment

For treating the adductor tendinitis, the patient must rest. It’s important to rest until the patient is capable to do physical activities without pain! Apply cold therapy ‘RICE’: 3times a day 10-20minutes, during 3days. This cold therapy will help to reduce the swelling and inflammation.[4][1][2] When the swelling has decreased, blood flow stimulation therapy may start to increase the blood flow and accelerate the healing process.[1]
Another way to reduce the inflammation is by corticosteroid injections, steroid drugs, surgery, anti-inflammatory medication… As such pay attention to the risks for undesirable effects (e.g. rupture of tendon).[4]

When the patient is able to do his physical activities without pain, he may resume them gradually by being careful. Physiotherapy is necessary: flexibility and strengthening programs will influence the healing process and avoid the reappearance.
The stretching exercises should be executed 3 times daily, complementary to the physiotherapeutic sessions; and the patient may only execute them if they do not cause or increase symptoms. The patient can start with them from day 1, but only if they can be done without pain!
The strengthening exercises should be executed daily, and when the patient got back to full activity, he may do them 3times a week. These exercises can begin after the acute phase, when the pain has diminished in time: this may take 5days.
The stretching exercises must be done throughout the strengthening program: before and after the session.[4][3]

A few examples: stretching exercises:

  1. The short adductors:
  • sit down like the person on the picture.
  • The patient must quietly press the elbows onto the knees until he feels the stretch.
  • This may not be painful!
  • Hold for 20-30seconds[3]
    237.jpg
    237.jpg
  •  










[5][6][7][8]



  2. The long adductors:

  • stand and open the legs.
  • The patient must bend the non-stretching knee and lean to the side of this knee until he feels the stretch
  • This may not be painful!
  • Hold for 20-30seconds[4][3]

  







[5][6][7][8]




Strengthening exercises:

  1. Stand near a table with the blessed leg, with a resistance band around the ankle.
    He must keep his back and knee straight. Slowly move you leg away from the table.[4][3]
  2. A variant: the patient sits down on a chair with the resistance band above the knee.


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[5][6][7][8]

  

  

Resources

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Clinical Bottom Line

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Recent Related Research (from Pubmed)

see tutorial on Adding PubMed Feed

References

1. Tonsoline, P.A., chronic adductor tendinitis in a female swimmer, Buffalo Physical Therapy and Sports Care Services, Williamsville, NY 14221, J Orthop Sports Phys Ther. 1993 Nov;18(5):629-33.

(http://www.ncbi.nlm.nih.gov/pubmed/8268966)
(http://www.jospt.org/issues/articleID.1466/article_detail.asp)
Level of evidence: C


2. http://www.sportnetdoc.com/injury/09-06.htm; http://www.sportnetdoc.com/injury/09-03.htm

Level of evidence: D


see adding references tutorial.

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 1.7 1.8 http://www.aidyourtendon.com/tendinitis-injuries/adductor-tendinopathy.phpfckLRfckLRfckLRfckLR Level of evidence: D
  2. 2.0 2.1 2.2 2.3 2.4 2.5 http://www.itendonitis.com/adductor-tendonitis.htmlfckLRfckLRfckLRfckLR Level of evidence: D
  3. 3.0 3.1 3.2 3.3 3.4 3.5 3.6 http://www.sportsinjuryclinic.net/cybertherapist/front/frontthigh/adductorinflam.htmfckLRfckLRfckLRfckLR Level of evidence: D
  4. 4.00 4.01 4.02 4.03 4.04 4.05 4.06 4.07 4.08 4.09 4.10 4.11 4.12 4.13 4.14 http://www.physioadvisor.com.au/10426550/adductor-tendonitis-adductor-tendinopathy-phys.htmfckLRfckLRfckLRfckLR Level of evidence: D
  5. 5.0 5.1 5.2 Holmich P, Uhrskou P, Ulnits L, et al: Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: Randomised trial. Lancet 353: 439-443, 1999 Level of evidence: A2
  6. 6.0 6.1 6.2 Tyler TF, Nicholas SJ., Campbell RJ., Donellan S., McHugh MP.,The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players, American Journal of Sports Medicine, Sept-Oct, 2002 Level of evidence: B
  7. 7.0 7.1 7.2 Morelli V, Smith V.,Groin injuries in athletes.,Am Fam Physician. 2001 Oct 15;64(8):1405-14. Level of evidence: A1
  8. 8.0 8.1 8.2 http://www.mtchuizen.com/liespijn.php Level of evidence: D

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