Adductor Tendinopathy

What is it? 

Adductor tendinopathy describes a number of conditions that develop in and around the tendon in response to chronic overuse.  Adductor tendinopathy is characterised by pain in the upper inner thigh and groin area. The role of inflammation is still debated as research has demonstrated that there is usually an absence of inflammatory cells around the lesion hence the terminology 'tendonitis' is outdated. The good news is it can be treated effectively with physiotherapy intervention.

What is the cause? 

The adductors are active in many sports such as, running, football, horse riding, gymnastics and swimming. The repetitive nature of the movements in some of these sports and the constant change of direction in others heavily stresses the adductor tendon which makes athletes more prevalent to adductor tendinopathy and also groin injuries.  Other causes can be over stretching of the adductor tendons or a sudden increase in training or the type of training, such as intensity.  A 2015 study found that when playing the same sport, males were more likely to sustain adductor injuries when compared to females. 

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People are more likely to sustain an adductor injury in sport if they have had a previous groin injury, have weak adductors (inner thigh) muscles, play a higher level of field sports or have low levels of sports specific training.

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In the non-sporting population, poor movement patterns during exercise can also stress the adductor tendons.  Muscle length imbalance, strength differences or weak adductors in the lower limb or abdominals can influence the development of groin tendinopathy.  Some other factors that can contribute include lack of warm-up, obesity, age-related weakness, degeneration or genetics.

 Adductor tendonitis/tendinopathy typically occurs slowly over time due to increased loading of the adductor muscles and subsequent overloading of the tendon. This can start to produce adductor-related groin pain once the tendon starts to undergo physical and chemical changes.

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Tendinopathies can be thought to be on a continuum that moves through different phases. Initially, the tendons start to change shape and become thicker, due to chemical and structural changes in the tendon.  

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The tendon thickens in order to reduce the stress so it can cope with more loading. While the tendon continues to thicken the tendon fibres become disorganised, leaving the tendon with reduced capacity to cope with the force from the muscle contraction.  

Over time due to long term overloading and poor general health, the tendon can move into the degenerative phase, where the death of tendon cells occurs and further disorganisation of the collagen fibres of the tendon. Changes in this phase are irreversible and generally means the tendon is less tolerant to load. 

However, all is not lost, as there are likely portions of the tendon that aren’t in  the degenerative phase whose capacity to tolerate load can be improved.

Signs & Symptoms

• Groin pain on palpation of the adductor tendons,

• Pain on bringing your legs together and stretching such as getting in and out of a car may be painful 

• Pain can develop gradually or appear an acute, sharp pain

• A swelling or a lump may also be felt affected in the adductor muscles

• Stiffness in the groin area, worse the following morning after activity 

• An inability to contract or stretch the adductors.

What can we do about it? 

Physiotherapy treatment for adductor tendinopathy varies depending on the severity and the stage the tendinopathy is in. Our physiotherapists at Sports and Spine Physiotherapy will be able to assess and diagnose which stage the tendinopathy is in and in the acute stages, provide some manual therapy as soft tissue massage in the adductor muscles can help reduce pain and improve your confidence and mobility.  

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The evidence shows physiotherapy is extremely effective at managing adductor tendinopathy. Our physiotherapists will advise you on load management and provide you with a progressive strengthening program targeting the inner thigh muscles. Strength exercises help promote new tendon fibre growth and therefore help the healing of the tendon, as well as increasing the load tolerance of the tendon.

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Our therapists at Sports and Spine can help prescribe the best exercises for you, depending on your symptoms and what stage your tendinopathy is in and your current fitness levels.  Exercises will start basic and slowly increase in difficulty as pain and function improve. This translates into less pain day today, greater ease of performing day to day activities and your preferred type of exercise. Your exercises will progress to sports specific exercises to ensure your tendons are exposed to similar loads to that of your sport so that their tolerance improves. Your physiotherapist can provide education and advice on how to relatively rest your tendon and avoid aggravation to allow healing in the early stages.