Adductor tendinopathy

The term “adductor tendinopathy” is an amalgam of conditions that affect your adductor muscle group. When the adductor tendons are palpated, adductor tendinopathy typically manifests as groin pain, leg adduction, and pain in the affected leg, which may appear gradually or suddenly.

You have five muscles that make up the hip adductors: the pectineus, adductor brevis, and adductor longus, referred to as the “short adductors.” In contrast, the gracilis and adductor magnus are the “long adductors” running from the pelvis to your knee joint. These adductor muscles are the inward rotators of your thigh. They are also heavily utilized in hurdling, horseback riding, football, and running.

Tendinopathies, or tendon injuries, are relatively prevalent and develop due to degenerative changes in collagen that make up your tendons. They frequently cause groin pain and can be brought on by overuse or past trauma, such as a groin injury. The pubic symphysis and superior pubic ramus extend into the adductor longus, which attaches to the Linea Aspera. A significant, flat, fan-shaped muscle is secured to the medial femoral triangle boundary. At its anterior attachment, it also develops a fascia that connects to the enormous medialunas muscle. It medially rotates and adducts the thigh. Adductor From the inferior pubic ramus to the back of the linea Aspera, the brevis sits beneath the longus—thigh adduction by the brevis.

The only muscle with two joints is the gracilis, which extends from the medial side of your tibia to the inferior border of the pubic symphysis, integrating into a bursa between the tendons of the sartorius and semitendinosus. It acts to adduct the thigh and flex the leg at the knee and is the most superficial movement.

In this article, you will learn about adductor tendinopathy and what you can do about it if you have this condition.

Causes of adductor tendinopathy

• Tendon disrepair: Chronic overloading and overuse of the tendon results in degeneration and thickening. Due to the inadequate blood supply of overloaded tendon soft tissue, the body struggles to heal the micro tears produced as a result of exercise, which, over time, causes fibre deterioration.
• Muscle tears: A tendon tear develops when the muscle’s ability to produce contractile force surpasses the muscle or tendon’s capacity to withstand this force (1). This leads to the longitudinal splits in your adductor tendon, which develop inflammation in the long run.

• Previous adductor injury: If you have torn the adductor muscle previously, chances are excellent that you will suffer from adductor tendinopathy in future. This is because repetitive injury to your tendon develops fibrosis in your tendon, which develops tendinopathy in the long term.
• Stress forces: The combination of these forces and improper abdominal strength or lack of flexibility can result in stress fractures or avulsion of the pubic symphysis, tendon, and adductor muscles.

• Poor sports techniques: Adductor muscle strains are common in ice hockey and soccer. Suppose you are not guided with proper techniques; you can be exposed to adductor tendinopathy(2).
• Hip stiffness: Adductor tendinopathy, commonly known as poor hip joint stability from weak or tight adductors or iliopsoas, can cause imbalance and impingement of your adductor muscles. It frequently results from flexing a tendon while aggressively stretching, such as during a football tackle or side-to-side motion.
• Osteitis pubis: Osteitis pubis or pubic bone inflammation frequently coexists and may be present simultaneously as adductor-related disorders. The fibrocartilaginous symphyseal disc may be immediately disrupted by adductor muscle traction on the pubic ramus.
• Sports hernia: Many athletes get groin pain from sports hernias and rectus abdominis tears and may develop hip or groin muscle pain.

Signs and symptoms of adductor tendinopathy

Symptoms usually include groin pain and stiffness at the beginning of an activity or in the morning. The initial pain is intense and soon followed by a dull ache.

• Lumbar disc or facet joint abnormalities result in radicular symptoms pointed to the pelvis or groin pain, limiting the range of motion.
• You feel pain in the resisted hip flexor and resistance towards doing some activities, such as walking and climbing stairs.
• If you are in an activity, you can not continue that activity after the initial onset of pain.
• You will feel a sharp pain in the lower limb muscles and the groin area.
•  When you press your legs together against resistance, you will feel irritation and popping in the inner thigh.
• Difficulty will be there in running, jumping, and doing any sports.
• You may develop bursitis, redness or limping in specific areas (3).

At your initial consultation, your physiotherapist (physio) can confirm your diagnosis and start the appropriate course of treatment.

Care and treatment

Most of the time, you can begin tendon damage treatment at home. Start these steps off right for the best results.

To be pain-free, you should spend the first 48 hours of recovery resting from activities that will make it worse. To assist in reducing swelling and inflammation caused by any unexpected trauma, perform the R.I.C.E. therapy three to ten to twenty minutes a day. Blood flow stimulation therapy may be initiated to speed up the healing process once the swelling has subsided.

To enhance the recovery process, you need to execute active treatment. For that matter, you need to start anti-inflammatory medications such as ibuprofen and naproxen(4). These medications are essential to prevent acute inflammation from becoming chronic. This will be an excellent benefit for your adductor tendinitis, especially if you have an injury to your adductor tendon. However, you must be aware of the side effects of the anti-inflammatory medications before starting the medication.

Strength training(5) benefits the tendon structure, muscle characteristics, and limb biomechanics to rehabilitate muscle and tendon qualities. Recent research indicates that exercise programmes are most beneficial for reducing tendon pain and enhancing your tendon’s function while exercising or doing sports.

If the adductor tendinopathy doesn’t respond to the conservative treatment, you may need to undergo surgical treatment for the permanent treatment of your tendon illness. However, it would be best to undergo diagnostic tests like X-rays or MRIs (magnetic resonance imaging) before surgical treatment.

Contact your orthopaedic doctor or physiotherapist for a complete evaluation of your tendon disease if you are a sports person. Because the disease may affect your professional career if left untreated.

Prolotherapy

In recent years, Prolotherapy has built its reputation within the medical community for its clinically proven ability to treat adductor tendinopathy.

Published research has proven its pain-relieving, anti-inflammatory and regenerative benefits.

Prolotherapy involves injecting a natural regenerative solution with tiny needles. This has been shown to stimulate the production of collagen cells, the small cells needed to help with adductor tendinopathy.

As prolotherapy is helping to treat the root cause of adductor tendinopathy, it is deemed to be a permanent fix, preventing the symptoms from returning.

Prevention of adductor tendinopathy

To prevent sports injuries, an athlete should ideally follow a strength and conditioning programme that focuses on the elements above, such as improving muscle strength and coordination, while giving enough time for recovery and adaptation between training sessions(6).

The athlete must develop muscular strengthening workouts and stability around the groin and pelvic areas by engaging in specific exercises relevant to the demands of their activity or sport and range in difficulty, such as training for speed and jumping. Proper warm-up is necessary before an active workout. Another important consideration is the adductor muscles’ flexibility. Stretching frequently is encouraged.

Suppose you are an athlete or a professional gymnast and keep doing strenuous exercise all day. In that case, you must massage your lower thigh region to avoid adductor strain. Continuous exercise develops microtears in your tendons; if not given proper care, it may lead to chronic tendinopathy and osteoarthritis. However, massaging your muscles and tendons before you sleep positively impacts replenishing your muscle tendons.

Products like mobility and muscular support may be beneficial by decreasing high impacts. Rest, adjustment of sports activities, cryotherapy, oral medications such as non-steroidal anti-inflammatory drugs, manual therapy, and physiotherapy exercises are some of the therapies that have been suggested and are now used in clinical practice.

Bottom line

Effective treatment and the long-term management of symptoms depend on understanding the pathologies’ stage. Early on, there is a potential that symptoms will go away, but a degenerating tendon needs long-term care to prevent rupture or the need to discontinue all activities. Since everyone responds differently to treatment, no one method for managing tendinopathy exists. While physical therapy is failing to relieve pain, you can use medical treatments, although caution must be exercised when using steroids. You may need to stick to the program for several weeks before seeing a real change. If you continue to have pain, you should consult your doctor or a physiotherapist to get additional help.

You may strengthen these muscles with workouts and strengthening exercises. Before you notice a significant change or risk factor, you might need to follow the regimen for a few weeks. We suggest avoiding activities that hurt you is crucial while following the regimen. Make sure that you continue to engage in other physical activities and exercises. Swimming and cycling, for instance, are acceptable.

If you don’t take care of your health despite being diagnosed with adductor tendinopathy, it can lead to severe complications that may affect your gait and your daily activities. So, seek your doctor’s advice in the first place if you feel like you are having this condition.

Because adductor tendonitis may not manifest as discomfort until the tendon has been overused, it can be challenging to treat. The good news is that with the proper treatment plan, you can find relief while reducing your risk factor of re-injury and avoiding more intrusive procedures like surgery.

References

1. 1. Pesquer, L., Reboul, G., Silvestre, A., Poussange, N., Meyer, P., & Dallaudière, B. (2015). Imaging of adductor-related groin pain. Diagnostic and Interventional Imaging, 96(9), 861–869. https://doi.org/10.1016/j.diii.2014.12.008
   2. Zhang, B., Yuan, Y., Zhang, H.-J., Luo, H., & Yang, C. (2019). [Comparison of two different arthroscopic techniques for long head of biceps tendinitis]. Zhongguo Gu Shang = China Journal of Orthopaedics and Traumatology, 32(8), 701–706. https://doi.org/10.3969/j.issn.1003-0034.2019.08.005
   3. The Weekend Warrior: Common Foot and Ankle Injuries in Recreational Athletes – ProQuest. (n.d.). Www.proquest.com. Retrieved June 24, 2022, from https://www.proquest.com/openview/edac7eddaf32256a36d536b3b55aa986/1?pq-origsite=gscholar&cbl=24126
   4. Ghasemian, M., Owlia, S., & Owlia, M. B. (2016). Review of Anti-Inflammatory Herbal Medicines. Advances in Pharmacological Sciences, 2016, 1–11. https://doi.org/10.1155/2016/9130979
   5. Carpinelli, R. N., & Otto, R. M. (1998). Strength Training. Sports Medicine, 26(2), 73–84. https://doi.org/10.2165/00007256-199826020-00002
   6. Peters, J. A., Zwerver, J., Diercks, R. L., Elferink-Gemser, M. T., & van den Akker-Scheek, I. (2016). Preventive interventions for tendinopathy: A systematic review. Journal of Science and Medicine in Sport, 19(3), 205–211. https://doi.org/10.1016/j.jsams.2015.03.008