Adductor Tendinopathy

Adductor Tendinopathy

Article by John Miller

What is Hip Adductor Tendinopathy?

A common source of groin pain is adductor tendinopathy. There are five hip adductor muscles: pectineus, adductor brevis, and adductor longus (called short adductors) that go from the pelvis to the thigh bone, and the gracilis and adductor magnus (long adductors) go from the pelvis to the knee.

The primary function of these adductor muscles is to pull the legs together. They are also used quite a lot in sprinting, playing football, horse riding and hurdling.

Tendon injuries (tendinopathies) are common. They can occur through overuse or previous trauma such as a groin strain and often result in groin pain.

What are the Symptoms of a Hip Adductor Tendinopathy?

  • Pain in the groin at the top of the adductor muscles can radiate down the leg.
  • Pain on resisted hip flexion.
  • Pain at a specific point on the bone in the groin.
  • Pain when you press your legs in together against resistance.
  • Have difficulty in running, especially sprinting.

Your physiotherapist can confirm your diagnosis and commence corrective treatment at your initial consultation.

Typically, tendon injuries occur in three areas:

  • musculotendinous junction (where the tendon joins the muscle)
  • mid-tendon (non-insertional tendinopathy)
  • tendon insertion (e.g. into bone)

Non-insertional tendinopathies tend to be caused by cumulative microtrauma. This microtrauma is from repetitive overloading, e.g. overtraining.

What is a Tendon Injury?

Tendons are the tough fibres that connect muscle to bone. Most tendon injuries occur near joints, such as the shoulder, elbow, knee, and ankle. A tendon injury may seem to happen suddenly, but usually, it is the result of repetitive tendon overloading. Health professionals may use different terms to describe a tendon injury. You may hear:

Tendinitis (or Tendonitis): This means “inflammation of the tendon,” but inflammation is only an infrequent cause of tendon pain. But many doctors may still use the term tendinitis out of habit.

The most common form of tendinopathy is tendinosis—degeneration due to repetitive overloading. Tendinosis is a noninflammatory degenerative condition characterised by tendon collagen degeneration. These tendinopathies, therefore, do not respond well to anti-inflammatory treatments and are best treated with functional rehabilitation. The best results occur with early diagnosis and intervention.

What Causes a Tendon Injury?

Most tendon injuries are the result of gradual wear and tear to the tendon from overuse or ageing. Anyone can have a tendon injury, but people who make the same motions repeatedly in their jobs, sports, or daily activities are more likely to damage a tendon.

Your tendons design is to withstand high, repetitive loading. However, when the tendon’s applied load is too high to endure, the tendon becomes stressed.

When tendons become stressed, they sustain small micro-tears, which encourage inflammatory chemicals and swelling, quickly healing if managed appropriately.

However, if you continually apply load to the tendon, these lesions occurring in the tendon can exceed the repair rate. The damage will progressively become worse, causing pain and dysfunction. The result is tendinopathy or tendinosis.

Researchers current opinion implicates the cumulative microtrauma associated with high tensile and compressive forces. These forces generated during sport or activity causes tendinopathy. Cumulative microtrauma appears to exceed the tendon’s capacity to heal and remodel.

What are the Symptoms of Tendinopathy?

Tendinopathy usually causes pain, stiffness, and loss of strength in the affected area.

  • The pain may get worse when you use the tendon.
  • You may have more pain and stiffness during the night or when you get up in the morning.
  • The area may be tender, red, warm, or swollen if there is inflammation.
  • You may notice a crunchy sound or feeling when you use the tendon.

The symptoms of a tendon injury can be a lot like those caused by bursitis.

Tendinopathy Phases

Your tendon’s inability to adapt to the load quickly enough causes the tendon to progress through four phases of tendon injury. While it is healthy for normal tissue adaptation during phase one, further progression can lead to tendon cell death and subsequent tendon rupture.

1. Reactive Tendinopathy

  • Normal tissue adaptation phase
  • Prognosis: Excellent. Normal Recovery!

2. Tendon Dysrepair

  • Injury rate > Repair rate
  • Prognosis: Good. The tissue is attempting to heal.
  • You must prevent deterioration and progression to permanent cell death (phase 3).

3. Degenerative Tendinopathy

  • Cell death occurs
  • Poor Prognosis – Tendon cells are giving up!

4. Tendon Tear or Rupture

  • Catastrophic tissue breakdown
  • Loss of function.
  • Prognosis: very poor.
  • Surgery is often the only option.

It is crucial to have your tendinopathy professionally assessed to identify its injury phase. Identifying your tendinopathy phase is vital to direct your most effective treatment since specific modalities or exercises should only be applied or undertaken in distinct tendon healing phases.

How is a Tendon Injury Diagnosed?

Your physiotherapist will ask questions about your past health, symptoms, and exercise regime to diagnose a tendon injury. They’ll then do a physical examination to confirm the diagnosis. If your symptoms are severe or do not improve with early treatment, specific diagnostic tests may be requested, such as an ultrasound scan or MRI.

Please consult your trusted physiotherapist who has a particular interest in tendinopathies.

How is Tendinopathy Treated?

In most cases, you can start treating a tendon injury at home. To get the best results, start these steps right away:

  • Rest the painful area, and avoid any activity that makes the pain worse.
  • Apply ice or cold packs for 20 minutes at a time, as often as two times an hour, for the first 72 hours. Keep using ice as long as it helps.
  • Do gentle range-of-motion exercises and stretching to prevent stiffness.
  • Have a physiotherapist assess your biomechanics.
  • Undertake an Eccentric Strengthen Program. Appropriate exercise is vital!

More information about tendinopathy.

For a thorough assessment and the quickest relief from your groin pain, please contact your physiotherapist.

Acute Injury Signs

Acute Injury Management.

Here are some warning signs that you have an injury. While some injuries are immediately evident, others can creep up slowly and progressively get worse. If you don't pay attention to both types of injuries, chronic problems can develop.

For detailed information on specific injuries, check out the injury by body part section.

Don't Ignore these Injury Warning Signs

Joint Pain

Joint pain, particularly in the knee, ankle, elbow, and wrist joints, should never be ignored. Because these joints are not covered by muscle, pain here is rarely of muscular origin. Joint pain that lasts more than 48 hours requires a professional diagnosis.

Tenderness

If you can elicit pain at a specific point in a bone, muscle, or joint, you may have a significant injury by pressing your finger into it. If the same spot on the other side of the body does not produce the same pain, you should probably see your health professional.  

Swelling

Nearly all sports or musculoskeletal injuries cause swelling. Swelling is usually quite obvious and can be seen, but occasionally you may feel as though something is swollen or "full" even though it looks normal. Swelling usually goes along with pain, redness and heat.

Reduced Range of Motion

If the swelling isn't obvious, you can usually find it by checking for a reduced range of motion in a joint. If there is significant swelling within a joint, you will lose range of motion. Compare one side of the body with the other to identify major differences. If there are any, you probably have an injury that needs attention.

Weakness

Compare sides for weakness by performing the same task. One way to tell is to lift the same weight with the right and left sides and look at the result. Or try to place body weight on one leg and then the other. A difference in your ability to support your weight is another suggestion of an injury that requires attention.

Immediate Injury Treatment: Step-by-Step Guidelines

  • Stop the activity immediately.
  • Wrap the injured part in a compression bandage.
  • Apply ice to the injured part (use a bag of crushed ice or a bag of frozen vegetables).
  • Elevate the injured part to reduce swelling.
  • Consult your health practitioner for a proper diagnosis of any serious injury.
  • Rehabilitate your injury under professional guidance.
  • Seek a second opinion if you are not improving.

Article by John Miller

Elite Sports Injury Management

You probably already know that a sports injury can affect not only your performance but also your lifestyle. The latest research continues to change sports injury management considerably.  Our challenge is to keep up to date with the latest research and put them to work for you.

How we treated you last year could vary significantly from how we treat you this year. The good news is that you can benefit considerably from our professional knowledge.

What Should You Do When You Suffer a Sports Injury?

Rest?

Rest from painful exercise or a movement is essential in the early injury stage. "No pain. No gain." does not apply in most cases.  The rule of thumb is - don't do anything that reproduces your pain for the initial two or three days.  After that, you need to get it moving, or other problems will develop.

Ice or Heat?

We usually recommend avoiding heat (and heat rubs) in the first 48 hours of injury. The heat encourages bleeding, which could be detrimental if used too early. In traumatic injuries, such as ligament sprains, mu