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.


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Trochanteric Bursa, Adductor
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Hi,

I was diagnosed in Oct/Nov last year with an imflammed illitibal band. I was given stretches and told to ease off with the running.

It's now February and I have give myself several periods of RICE. I was told that this is really stubborn and could take a long time to settle. And even when it settles I go for a long run and it just starts again. The last time this happen on my other hip it just went of its own accord.

My question is does anyone else suffer with this and if so how have then gone about solving this?. I'm running in my first half marathon in March (Bath) and I want to try and improve my pain levels!!

Can anyone give me some advice

Thanks

Alison Fisher
Posted: 04/02/2003 at 11:09

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 at 11:31

Alison

I get this when I go mountaineering but not very offten when I run. I wear the same orthotics in both my running shoes and my boots so I don't know why it happens, it must be the way I walk. Me I'm just a lawnmower etc...
It usually goes away of its own account but it was only when I started running last year that I found out what it was!
Posted: 04/02/2003 at 12:02

Not sure if this is ITband problem? Pinpoint stabbing pain in hip every time my heel strikes ground. Just happened during recent fast 10 mile road race. Ran through it but it felt as if someone was hitting my hip with a hammer.
Been running for a very long time and never any biomechanical problems.
Suggestions welcome.
Posted: 04/08/2003 at 22:42

I am going through my worst nightmare at the moment - I am fit as a fiddle and raring to go but my knee is, well, agon-knee. ITB, apparently, and I am icing it, resting it, stretching it and drugging it up and I am still sore. SO frustrating. I'm about to read Swerve's website on treatment and I would literally do anything. My doc said she would give me a cortezone injection to get me through the marathon (London) but to be honest I want to get there on my own, safely and without pain.
Posted: 12/02/2004 at 09:13

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 at 11:34

Thanks for the advice, Swerve. I have thrown more money at my knee than the national debt, including physio, osteopathy and have made an appointmnet at a podiatrist. Today my knee is feeling a lot better. I bought a 'patela strap' - not for my patela, but it has really helped reduce the 'rubbing' and I am feeling no pain at all at the moment, either when I walk or with sudden movement. My week off ends tomorrow so I will try a gentle jog up the road to see what it's like. This week has been the longest in my life!

I have to focus on this year's FLM because I'm raising money for my charity, SeeAbility (check out www.justgiving.com/marathonfi) but if I think longterm damage is on the cards I'll defer, certainly.

Dr Swerve, I can't thank you enough.
Posted: 16/02/2004 at 11:46

Not "Dr" - just an amateur who's been through the injury and done some research! Please assume I'm incompetent!

Best of luck with the strap - a lot of people swear by it (though a lot don't). And a podiatrist is an excellent plan. You're obviously going about this the right way, and it is beatable.

By the way, in this context, "long-term damage" might mean several months off running and much greater difficulty getting back into full training (ITB issues can be a pig, and some people do give up on them entirely - you would be increasing the risk of being in that category) - happily it doesn't seem to mean mobility issues in later life or anything nasty like that (unless a medic can tell me different?). But this is a pessimistic view, and some people apparently run their marathons with ITBS then get fixed, and are moving happily in a relatively short time.
Posted: 16/02/2004 at 12:21

Dr was flattery not etiquette.

Thank you for your support, though. I'll let you know how it goes.

M
Posted: 16/02/2004 at 12:24

Hi all could anyone help with a problem I've got with my hip. I've just reached 3hours for my marathon training and on sunday I had to walk (hobble)the last mile home with severe pain in my right hip,just on the hip bone itself. The rest of sunday was spent trying to move around in great pain,sitting down was ok and walking was eventually ok it was the painful bit in between that killed.

If you have any advice I would be very very grateful. Ta Pete.
Posted: 08/03/2004 at 09:31


bow
hi, i suffer with hip,how are you doing now with your hip, did you find a cure.i'm coming up for a run in lincoln, and i,m starting to step the mile's up. now me hip is starting to acre.
Posted: 17/03/2004 at 14:28

Which stretch is everyone doing for ITB pain. I get a lot of problems with hip/ITB pain and find that the standing ITB stretches don't seem to help. However, this one does seem to help.

Lie on back, lift leg as if doing hamstring stretch.
Wrap scarf/rope around foot, turn foot in slightly and take leg across body.
You should be able to feel stretch down the side of your leg and at the outer side of you knee.

On the subject of biomechanics, LF mentioned he/she(?) got pain every time his/her heel striked the ground. Hate to be contraversial (not sure if my spelling is write here) but maybe forefoot striking may eliminate the problem - see very long thread on pose running.
Hope some of this helps.
Posted: 17/03/2004 at 15:16

My chiropractor told me a long time ago I have an adductor muscle problem. Symptoms now are aching all along the back of the upper leg, particularly towrds the top, and a feeling of tightness when running. It doesn't stop me running but it feels uncomfortable as I can't stretch out. i have tried every stretch i can think of as well as hot baths,rest,massage but it always seems to hit me as soon as I start running. It is now getting depressing as it has been around for many months so I wonder if anyone has any ideas/experiences of something similar.
Posted: 26/03/2004 at 09:30

I am fairly sure I have a bursa problem on my left hip for 2.5 months and am unsure what to do. I have been building my running up slowly, successfully for the first time in years so am deeply frustrated as when I felt the problem I decided 'to hell' and continued until the pain made it impossible to run further. I have been having treatment for a shoulder problem from the Middx CCC physio (well, he should know about shoulders!) and he said absolutely not to run on it. The hip tolerates cycling and cycling fairly hard as long as the resistance/hills are not too great - I don't want to cut out all aerobics. I have just got back from a 4 day hol in Prague, very slow ambling with wife around city, and the hip did not like that either! Any suggestions as to a quick cure or a less quick cure but at least a cure? Between my right shoulder and my left hip I feel imprisoned and frustrated. Thanks in advance for any help and advice given.
David Freedman
Posted: 22/07/2004 at 23:32

DD, I have something of the same problem over seven months now which is really annoying. watch your posture, my new chair at work has helped loads, though the niggly pain is still there. ITB stretches seem to help as well. Since you are seeing a chirorator, i assume he/she has ruled ot trapped nerves, piriformis syndrom etc but if he/she hasn't might want to ask.
Posted: 23/07/2004 at 11:21

Due to the spell of wet windy weather lately I decided to take my training indoors and hit the treadmill. I did several days of about 7 or 8 miles on it and noticed slight niggling pain in my hip sockets. Last Wednesday I was forced to stop after 4 miles in agony. The pain was so bad I didn't think I would even make it to the car. Now 9 days later i could no more run than I could fly. Even walking is painful, with pain all around my hip joints and down the front of my thighs it is so bad it actually makes me wince in pain at times. I am off to see the doctor in a couple of days, ( I know I probably should have gone sooner) but just wondered if anyone has had the same sort of thing? I have never had any sort of injury before, and am finding this really frustrating. I long to get back on the road! Could it have been the treadmill that caused the damage?
The pain is in both legs, and often alternates in severity between the two of them. Walking downhill is almost impossible, and running...well I can't imagine ever being able to do it again. Help, please!!!!
Posted: 22/10/2004 at 10:05

I too am sufering with an acute pain in my right hip. This happened last year in the marathon and after rest it went away. I'm now training again for the marathon and it's happened again. I iced and stretched it last night and I'm off for a sports massage to see if this helps. Any other suggestions?
Posted: 11/02/2005 at 15:34

Hi all
Thought I would join this thread as I have been having issues since a half marathon in September- it was on heavy dunes, sand tracks and beach in Netherlands (live across the pond) I fell bad over a tree root. My pain in the top of my leg /right groin has steadily got worse to the point I have seen a sports Dr & had my hips x-rayed all is ok. He said I have damaged a very deep muscle but said it in dutch so I have no clue what muscle it is!
I have been told to ease off the running - I have Thames Meander in oopss one day and counting - my issues are when I try to add my speed drills into my runs as soon as i open my stride bang the pain starts.... I am training for IM France and can't afford for this to continue.
Can anyone offer help? Thanks
Julie

Posted: 17/02/2005 at 11:30

I went for a sports massage which helped a lot. I thought it was my IT band, but it turned out to be a pull in my glutes. Spent an hour with her elbow pushed in my behind. Could have scrapped me off the ceiling at the time, but have to say it feels much better now. She said taht the area gets so conjested that the pain can transfer. Still aches a bit after a run, but going again for treatment. Hope this helps!!!!
Posted: 17/02/2005 at 11:50


JRM
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 at 15:33

Margot no wonder you are having probs if you're chucking money at your knee. Try to use notes instead of coppers.
Posted: 17/02/2005 at 15:45

I developed a pain on the outside of my knee just where it hinges towards the end of a 5 mile run on road after over a week of no running. It feels fine when walking and cycling and I can run for several miles before it twinges again (at which point I have stopped). Does this sound like ITBS?

I am doing the ITBS stretches standing up but am not suer if I am doing them right as I don't 'feel' anything!
Posted: 17/02/2005 at 16:15

How I finally solved my hip problem (there have been fascinating pieces of advice and experience here)REST. I did not run, I stopped cycling around London even on the flatish bits. The rest was enforced and not planned - we were decorating a large room and living in chaos and squalor with all the stuff out of the room, when my mother-in-law was taken seriously ill and a month later died. This meant that any thoughts of serious exercise went out the window for a couple of months. I started back at square one with a bit of stiffness in the hip but I took things very gently, never pushing the hip when it felt stiff, and gradually I was able to increase my running and other forms of aerobic activity. I would not have taken so much time off by choice and would probably still be grumbling here about the hip, but sometimes we have to take the frustration and just rest an injury until it is fully better and be patient (all the sorts of things I am incapable of). As for the shoulder....don't ask, I'm in denial.
Posted: 17/02/2005 at 23:26

I agree with a lot of the feedback on this Forum. When I originally posted this discussion, I was in a lot of pain and the only way to treat this was to rest until the pain eased. After a couple of months of light exercise and cross training (no running) my injury was healed. I did find using an ice pack before and after runs helped a lot though in pain management.

Every once in a while now I still get twinges and stop my runs immediately to ensure that I don't have serious problems again.

Touch wood, this strategy is working!
Posted: 18/02/2005 at 09:14

I was due to run the New York Marathon last year but I had a terrible hip pain in my left hip about two weeks before the race. It was so bad I couldn't walk without pain for a few days after. I thought I had some serious artheritis problem as the pain seemed to be in the hip joint itself. I went to my doctor who sent me to a sports specialist doc and they took some X-rays and a bone scan and there was no indication of any bone problems so it was more than likely ITBS.

Well, I pretty much gave running up completely since then and only now have I started training again for the Freiburg Marathon here in germany (I live here) next April 2006. So that's about 10 months I had off. I do get little 'twinges' now and again in the hip and I'm hoping that it won't return.

However, this will sound strange, but it seems to work for me. For some reason I have found the best way to get rid of the 'twinge' pain is if I go dancing at the local disco after a long run, my hip feels great. It's weird I know but it seems to work! So, if any of you lot still have hip problems then get on the dancefloor and give it all you have and see if it helps.
Posted: 15/12/2005 at 18:40

Hi, Just got back from a training run for my first 10K next weekend. Unfortunately whilst stepping sideways off a pavement I felt a sharp pain just below the pubic bone and was unable to continue running through dis-comfort. After invesigating the injury section of the website I suspect I have strained or ruptured an adductor muscle. Has anyone got any experience of this type of injury and could give me any idea of treatment and timescale for recovery. Many thanks Stephen
Posted: 03/11/2006 at 20:01


So much pain!

I think I'll take up swimming instead.
Posted: 04/11/2006 at 11:21

third way - where do you live? we are on the Deutsche Weinstrasse near Bad Duerkheim.
Posted: 04/11/2006 at 12:11

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