Bodyworks: Adductor Injuries
How to recognise them, how to overcome them
Posted: 5 June 2000
by Patrick Milroy
Although the quadriceps and hamstring muscles mainly move the knee joint, the hamstring group arise above the hip, too, and play a small part in the movement of that joint. Other tissues also incorporate the pelvis as well as the upper leg, with the result that pelvic and upper leg injuries may sometimes be indistinguishable and may often become confused. By virtue of their anatomy, hip joints allow a wide range of movement, not only forwards and backwards, outwards and inwards, but also rotational, and each of these movements requires appropriately placed muscle contractions. Some muscles even perform two functions, depending on the position of the hip. The function of the adductor muscles is to pull the thighs together and rotate the upper leg inwards, as well as stabilising the hip.
These muscles may be torn at their origin from the pelvis or in their bulk on the inside of the thigh.
Symptoms
In an acute tear there is sudden pain over these areas, which probably occurred as your foot slipped sideways or outwards, as when crossing a steeplechase hurdle. Because the muscles stabilise the hip, continued running will be painful.
Signs
There may be a tender swelling where the muscle was injured, and any action which holds the knees together will be painful. Outward movement of the hip will be restricted by spasm and pain. Complete ruptures are uncommon.
Medical investigation
The simple test of the doctor trying to part the knees while the patient is lying flat is usually the only investigation required, unless further damage is suspected in an elite sportsperson, when an ultrasound or muscle scan might be applicable.
What else could it be?
This is where the difficulties start, as the symptoms may be very similar to those experienced where the pubic bones meet at the front of the groin, or where you have suffered a so-called sports hernia. Osteoarthritis of the hip joint may also refer pain to the inner thigh.
Self-treatment
There are only so many ways in which one can write RICE, but it is by far the most appropriate treatment in the early stages. You should not deviate from its use, continuing the treatment during rehabilitation. The most effective exercise to stretch the muscles safely resembles the yogic lotus position.
Medical treatment
A doctor and a physiotherapist will be able to guide appropriate stretching while electrical treatments are used, and advise on the use of optimum stretching required before strength is gained, using exercises which pull the knees together.
Can you run through it?/Recovery time
My personal experience of attempting to run through an adductor injury was to lose six months of youthful running, thanks to inexperience. These injuries are slow to heal and over-enthusiasm may again risk scar tissue changing to bone. It is far better to write off two months during which you rehabilitate properly, than to risk many more with inappropriate treatment.
Trochanteric Bursa
Runners’ pain over and below the bony outer part of the hip joint is frequently diagnosed as a bursa forming with discomfort in the outer buttock and thigh. Some of the discomfort may well be due to tautness of the iliotibial band, whose other end we met on the outer side of the knee. All this muscle is contained within the inelastic stocking-like fascia lata – the reason that our thigh muscles don’t sag like those in the belly!
Symptoms
There is an increasing ache over the bony trochanter of the hip, which becomes painful with extra mileage. Pain may radiate down the thigh at night, while rolling the straight-kneed leg inwards will increase the pain.
Signs
The doctor should be able to put his finger on the pain over the bone, but a simple test, whereby you lie on your good side and attempt to lift the affected side upwards against resistance (abduction) will undoubtedly worsen the pain. Sometimes the irritation gives rise to crepitus, the crackling sensation that occurs with movement.
What else could it be?
It is necessary to rule out hip arthritis, back and nerve conditions, as well as muscle injuries to the gluteals within the buttock, to confirm the diagnosis. However, little else in the area will actually be sore to touch.
Self-treatment
If it’s bad enough to stop you running, RICE will only have a marginal effect upon treatment.
Medical treatment
Depending on the severity of the condition, treatment with ultrasound may be effective. However, if the condition shows any signs of becoming chronic, a steroid injection will have the greatest chance of producing a cure.
Can you run through it?/Recovery time
Limping through an injury like this may well be forerunner of secondary injuries and should be avoided. Running may well be possible within two weeks of a steroid injection, but you should always follow the advice of your medical professional.
Discuss this story
Hi Alison.
No experience with the hip, but for ITB problems at the knee (and I think it's just as valid at the hip), I always (and frequently!) say address the biomechanical issues first - i.e. find out what it is about your running style that causes it. Stretching on its own won't do any good - it'll come back ad infinitum. It could be as simple as getting the right pair of shoes, or you may need to strengthen the adductor muscles, or a combination of both.
For now, RICE is OK, and some anit-inflammatories such as ibuprofen may help (don't take these long-term).
And don't run through the pain!
The best reference on the web I've discovered up til now is this one.
Best of luck with it.
Posted: 04/02/2003 11:31
Blimey, I've been on these forums a long time!
Margot, a couple of things - firstly, don't be impatient. It heals really slowly because of the limited blood supply, and for every brief thing you do that makes it hurt (quite possibly including stretching) causes damage, and every little bit of damage equals a long recovery time. Secondly, the biomechanical aspect is what made the difference when I had my problems - I found this out only when the third incidence started off and I went to a running shop with video gait analysis. They sorted me out with a shoe with much more stability than I'd had before. I then went to a physio who got me estretching, strengthening and (possibly more importantly) tried an experiment with a home-made wedge (Yellow Pages and tape!) under the insole to make a bit of an adjustment to the toe-off phase of my gait. All of this ISN'T on the website above, which is a proper, measured and systematic approach to healing (long term it's way better to fix the biomechanics than to apply a 'crutch').
So, all in all, unless your doc's a running specialist, you really need to get to a qualified sports physio (a runner!) as a first step, and discuss strengthening and particularly biomechanics and shoe stability (possibly getting some custom-made orthotics if the Yellow Pages approach is a bit basic!) - that's your best bet for a quick fix. Long term, the website is the right approach.
On the subject of cortisone, I'm sure you know that it'll just mask the pain and allow you to damage yourself. It'd be your call, but I'd personally defer if it came to that, and go for an autumn marathon before FLM '05. But hopefully a physio can ease you through. Best of luck!
Posted: 12/02/2004 11:34
Alison, Pete Davies 2, David Freedman, Baking Runner, Bow and Hilly F - I might be able to offer some help on hip pain which may be of interest.
Last September I developed a pain in my left hip just to the underside of the outermost part of the hip bone and it is only in the last two weeks that I have made a complete recovery.
My condition was called Trochanteric Bursitis. If you put this into the Google search engine it will give you lots of commentary about the symptoms, diagnosis and treatment.
I switched from exclusively running to triathlon training last summer and in September I bought an indoor turbo cycle trainer. I think the trochanteric bursitis was triggered by over-using the trainer combined with a couple of longish runs.
Most of the time the hip pain was only really noticeable when I pressed my hip bone with my fingers and I could even run and cycle without it hardly hurting but the pain would be more acute when pressed the next day. At its worst, the pain would make lying on my side to sleep uncomfortable, I would feel the pain getting out of bed and moving around for the first half an hour, and there would be a little pain getting up from a chair or sofa after being still for a while. Because of this I cut my running and cycling back to almost nothing until late November/early December to the point where I could wake up and get out of bed without any pain.
Then I started cycling again in December without any pain. I even managed a 95 mile cycle just after Christmas and didn't have any pain the day afterwards so I knew that things were looking up. However, I also did a 6 mile run that next day and in the evening my hip was a little sore to the touch.
Since then I have been doing a couple of runs and a couple of cycles each week and I've managed to keep the pain at bay using ice each evening and easy stretching. Although one hard cycle with a lot of hills did make my hip a bit sore. There were quite a few times when the pain was a sort of vague ache and I began to wonder if I was just imagining it.
About a fortnight ago I did quite a hard run and noticed that there was no pain on touching my hip and since then the pain has not returned. This has been surprising because there were moments even as late as mid January when the pain felt as acute as in September.
I think the icing was very important in reducing inflammation and keeping the pain under control. I think that keeping the training going without aggravating the injury may have helped me recover.
I also think that the stretching helped my recovery, and not just the usual IT band stretch but also stretching surrounding tissue and muscles in the hip area - and possibly stretching the injured tissue in a different direction.
I've had a number of lower leg injuries as a runner - which is the main reason why I switched to triathlon - but those injuries were different to this one in that those hurt whilst I was running. The hip pain didn't and so allowed me to continue training to some extent - which was novel to me.
One point that may be worth mentioning is that the recent disappearance of the pain followed a weekend triathlon workshop where I did lots of new running and swimming drills which worked my hips in completely new ways. The day after I could feel a little bit of vague soreness together with a bit of muscle ache from the new exercises, but a few days later the pain went and as I said above I did a hard run and haven't felt any hip pain since. Even pressing the area with my fingers doesn't hurt.
I hope there is something in this which may be of interest and which hastens your recoveries.
Julian
Posted: 17/02/2005 15:33
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