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Preventing Adductor Strains in Hockey Players

Updated: Oct 9, 2023

Hockey Player
https://www.nhl.com/news/pittsburgh-penguins-sidney-crosby-ready-for-stanley-cup-playoffs-run-324634556

How to Fix the issue!


Hockey Athletes are highly exposed to adductor strains. 25% of muscle related injuries in hockey are adductor strains. Making sure that the athletes are well prepared for excessive stress on the legs is a key preventative measure we can take. However, accidents do happen. A specific exercise prescription set by a specialist in physical therapy or sports performance can help aide an athlete in their recovery.


Lets find out how one can rehabilitate an adductor strain.


Anatomy 101


The adductors of the leg perform adduction or moving the extremity closer to the midline of the body. https://www.physio-pedia.com/File:Adductor_magnus.png

Adductor muscles

6 muscles make up the adductor group:

1) adductor longus (most commonly injured)

2) adductor magnus

3) adductor brevis

4) obturator externus

5) gracilis

6) pectineus


These muscles are placed on heavy eccentric (lengthening of the muscle) load during ice hockey games. With that being said rapid acceleration and deceleration combined with twisting on an unstable surface put these muscles at risk of excessive tensile forces.


When these forces are applied to an untrained or weak muscle the fibers within the muscle belly can develop small tears (grade I), moderate tears (grade II), or complete ruptures (grade III)

Types of muscles strains
https://www.thornleighphysio.com.au/blog-2/2020/6/6/muscle-strain-grading-traditional-grading-versus-modern-approach

The approach one should take to rehabilitate this injury will ultimately depend on the grade of the tear.


Grade I: able to treat conservatively with a quicker recovery time (1-4 weeks)


Grade II: able to treat conservatively with a longer recovery time (4-8 weeks)


Grade III: not able to treat conservatively with good outcome: surgical repair is usually necessary and will need skilled physical therapy following.



With that being said lets take a deeper dive to how we can identify these tears.


TESTING TIME


Adductor squeeze test: lying on your back place a ball, bolster, or two fist between your knees with your legs straight, at 45 degrees hips bent feet touching the ground, and 90 degrees hip bent feet off the ground. If pain is experienced in the mid/inside thigh or front portion of the pelvis we may want to examine this further.


Athletic Rehab-Adductor squeeze test
Adductor Squeeze Test


Passive adductor stretch: lying on your back with a strap abduct (pull leg out to the side) as far as you can without pain. If pain is experienced in the inner thigh and full range of motion is limited we may want to examine this further.


Athletic Rehab- passive adductor stretch
Passive Adductor Stretch


Athletic Pubalgia


One thing we must look out for in hockey groin injuries is athletic pubalgia or sports hernia. This can result from weakening in the abdominals above the top of the thigh and excessive twisting or extending.



example of athletic pubalgia
Athletic Pubalgia


Now do not confuse this with inguinal hernias. Athletic pubalgia do not have any palpable identification but can be a precursor for bulging hernias. So if anterior (front of) groin pain is present at the top of the thigh and the test above are negative we may want to investigate this further.


Rehabilitation


With all this information its time to get down to rehabilitation for Grade I and II injuries


Top 7 exercises:


Weeks 1 and 2: Rest, Isometric exercises, stretching of other muscle groups


Athletic Rehab- Dr. Lohr demonstrating SL bridge on unstable surface
SL Bridge on unstable surface

Weeks 3 and 4: low grade eccentrics/concentrics. unilateral training, and stretches



Athletic Rehab: SL RDL exercise
SL RDL

Athletic Rehab: Resisted hip adduction
Resisted Hip Adduction




Weeks 5 and 6: loaded bilateral resistance, copenhagens


Athletic Rehab: Dr Jacob Lohr with Nomadic physical therapy demonstrating squat
Loaded Squat

Athletic Rehab: Dr Jacob Lohr with Nomadic physical therapy demonstrating Copenhagen plank
Copenhagen Plank

Weeks 7 and 8: sport specific training

Athletic Rehab: Dr Jacob Lohr with Nomadic physical therapy demonstrating dynamic hip strengthening
Dynamic Challenge for Hip Stability

Athletic Rehab: Dr Jacob Lohr with Nomadic physical therapy demonstrating skiers
Skiers

Want sport specific care for your groin injury and accelerate your return to the ice?

CLICK HERE for a free consultation with Nomadic Physical Therapy


Instagram: nomadic.physical.therapy

Phone: 865-935-9313

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