Adductor tendinopathy: the groin pain that gradually stops you playing football
Adductor-related groin pain is common in footballers and in sports involving sprinting, kicking and rapid changes of direction. It can begin suddenly, but quite often it develops gradually and follows a surprisingly predictable pattern.
The mistake many people make is waiting until they can no longer play before doing anything about it.
How does adductor pain start?
There are two presentations I see regularly.
The first starts with a sudden pain or pop in the groin while sprinting, kicking, reaching for the ball or changing direction. This may initially be an adductor muscle or tendon strain rather than tendinopathy. The player rests, the pain settles and after a week or two they return to training.
They can usually play again, but the area does not feel completely right. It may be sore when striking a ball, accelerating or stretching for a tackle. After another short rest it improves again, so they carry on.
The second presentation is less dramatic. There is no obvious injury. The groin simply becomes a little sore after training or playing. Initially it settles by the following morning and does not seem particularly important.
Over time, however, it takes longer to recover.
The player may feel sore for a day after football, then two days and eventually most of the week. They begin training less, stop sprinting at full pace or avoid striking the ball firmly. Saturday’s match becomes possible, but only if they miss training during the week.
Eventually, even this stops working and they decide they need to take two weeks off.
The familiar rest, test and aggravate cycle
Rest often reduces the pain because it removes the activity aggravating the area. The problem is that rest alone does not necessarily restore the adductors’ strength or their ability to tolerate sprinting, kicking and changes of direction.
When the player returns at the same level, the symptoms come back.
This creates a familiar cycle:
Play until the groin becomes sore
Rest for a few days
Test it at training
Aggravate it again
Take a longer period off
Return and repeat the process
By this stage, what started as a manageable problem may have been present for several months.
Why does it gradually become more limiting?
The adductors are the muscles running along the inside of the thigh. They help control the hip and pelvis and are heavily loaded during running, accelerating, kicking and changing direction.
If the demands of training repeatedly exceed what the area can currently tolerate, symptoms can become increasingly irritable. The amount of football that causes pain gets smaller, while the recovery period becomes longer.
This does not mean the tendon is permanently damaged or that sport must be stopped indefinitely. It usually means the balance between load, strength and recovery needs addressing.
Why come in earlier?
You do not need to wait until you are unable to play.
An assessment is often more useful when you first notice that:
Groin pain is returning each time you train or play
It takes more than a day or two to settle
You are changing how you run, kick or move
You are regularly missing training to be available for matches
Rest helps, but the pain returns at the same point
Your playing or training volume is gradually decreasing
At this stage, it may be possible to keep you involved in some training while beginning rehabilitation. Waiting until every activity is painful can mean that more modification is needed before useful loading can begin.
Is all groin pain adductor tendinopathy?
No. Groin pain can arise from several structures, including the adductor muscles and tendons, the hip joint, iliopsoas, abdominal or inguinal region and the pubic area.
A sudden pop may represent an acute muscle or tendon injury, while longer-standing pain may involve more than one structure. This is why an accurate assessment matters, particularly if symptoms are severe, there is bruising or weakness, or the pain is not behaving as expected.
Imaging is not always required. In many cases, the history and physical examination provide enough information to begin treatment. Ultrasound or MRI may be considered if the diagnosis is unclear, a more significant injury is suspected or progress is not as expected.
What does rehabilitation involve?
Treatment is not simply a matter of stretching the groin or resting until it feels better.
Rehabilitation will usually include:
Managing football and training load
Progressive adductor strengthening
Strengthening the hips, trunk and wider lower limb
Gradually reintroducing running and acceleration
Building tolerance to changes of direction
Progressing kicking and sports-specific movements
Monitoring symptoms during exercise and over the following day or two
The starting point depends on how irritable the symptoms are. Someone who has mild discomfort after football will need a different programme from someone who is sore with walking or everyday movements.
As strength and tolerance improve, rehabilitation should become increasingly specific to the demands of the sport. Being comfortable during a basic exercise is useful, but it is not the same as being ready to sprint, cut, tackle or strike a ball at full pace.
Can I continue playing?
Sometimes, yes.
Complete rest is not automatically required. If symptoms are mild, settle reasonably quickly and are not progressively worsening, it may be possible to continue with an adjusted level of training.
If each session leaves you more painful for several days, however, repeatedly testing it through full training is unlikely to move things forward. A temporary reduction in the most provocative activities may be needed while strength and capacity are rebuilt.
The aim is not simply to get through one match. It is to restore enough capacity to train, play and recover consistently.
Do not wait for the groin pain to make the decision for you
The clearest warning sign is often not the pain itself, but the gradual reduction in what you can do.
If you are training less, avoiding certain movements or needing several days to recover after every match, the problem is already affecting your sport.
Getting it assessed earlier does not necessarily mean being told to stop. It gives you the opportunity to understand what is driving the symptoms, make sensible changes and begin rebuilding strength before two weeks off becomes two months of interrupted football.
If recurring groin pain is beginning to affect your training or match availability, you can book a physiotherapy assessment at Fit by Physio in Tooting.