Adductor Strain

Lower Limb

Overview

Adductor strain is an acute or chronic injury to the adductor muscle group (longus, brevis, magnus, gracilis, pectineus) of the medial thigh, commonly occurring in athletes due to rapid changes in direction, overload, or muscle imbalance. The condition presents with pain in the medial thigh that may radiate toward the groin and can significantly limit hip adduction and functional activities. Early recognition and appropriate management are crucial to prevent chronic groin pain and return to optimal function.

Pathophysiology

Adductor strain results from excessive eccentric loading, rapid lengthening under tension, or direct trauma to the adductor muscle group. Microtrauma or macroscopic tears occur within the musculotendinous unit, triggering an inflammatory response with edema, hemorrhage, and disruption of muscle fibers. Chronic strains may develop due to inadequate initial rehabilitation, persistent biomechanical dysfunction, or premature return to activity.

Patient Education

Gradual return to activity with progressive strengthening and flexibility work is essential; avoid aggressive stretching in acute phase and address underlying hip and core weakness to prevent recurrence.

Typical Presentation

Site

Medial aspect of proximal thigh, may extend toward groin, pubic bone insertion, or along medial thigh toward knee depending on which adductor is affected

Quality

Sharp, aching, or stinging pain; may feel like a muscle pull or cramping sensation

Intensity

Variable: acute strains present with moderate to severe pain (5-8/10) limiting function; chronic strains may be mild to moderate (2-5/10) with activity-related flare-ups

Aggravating

Hip adduction, crossing legs, side-stepping, rapid direction changes, kicking motions, prolonged sitting, resisted hip adduction, sprinting, pivoting, activities requiring explosive movement

Relieving

Rest, ice application, gentle passive stretching (after acute phase), anti-inflammatory medication, support/compression, reduced activity level, heat (chronic phase)

Associated

Hip flexor tightness, buttock pain, groin discomfort, limping gait, hip muscle weakness (gluteal and core), stiffness in medial hip, possible referred pain to anterior knee or lower abdomen

Orthopaedic Tests

Test descriptions are written with AI assistance from standard clinical texts. Where a test lists Sources, its description has been checked against them; those sources are independent and do not endorse OsteoKit. Accuracy figures and grades (A–D) appear only when checked against the published study; tests without one are marked “No accuracy study”.

Further reading: full test procedures are described in standard clinical examination texts, e.g. Magee & Manske, Orthopedic Physical Assessment (7th ed.), and Cook & Hegedus, Orthopedic Physical Examination Tests: An Evidence-Based Approach (2nd ed.).

Grade A
A+ABCDStrong clinical value: substantially changes the diagnosis (LR ≥10 or ≤0.1)
best for ruling OUT (screening).

Adductor Longus Palpation Test

Procedure

Patient supine with the hip slightly abducted and externally rotated. Palpate the adductor longus from its tendon at the pubic bone down along the muscle, and compare with the other side. Note where the tenderness is and how far it extends.

Positive Finding

Tenderness that reproduces the patient's own pain, at the tendon near the pubic bone or in the muscle.

Sensitivity / Specificity

96% (46 athletes with an adductor injury)/57% (35 injured athletes without one)

Reference: Serner A, Weir A, Tol JL, Thorborg K, Roemer F, Guermazi A, et al. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?. Br J Sports Med. 2016;50(24):1541-1547.

Interpretation

No tenderness makes an adductor injury unlikely. A palpable gap or defect near the pubic bone suggests a complete avulsion of the adductor longus tendon; refer for imaging and a sports medicine opinion. From one study of 81 male athletes seen within 7 days of an acute groin injury, with MRI as the reference (Serner 2016). 46 had an adductor injury on MRI; the comparison group was the 35 athletes with another groin injury or a normal MRI, so specificity was measured against other injured athletes, not healthy people. A test counted as positive only if it reproduced the athlete's own injury pain. Figures apply to acute injuries, not long-standing groin pain. No pain on adductor palpation made an adductor injury on MRI unlikely.

Sources

Grade C
A+ABCDModest value: a small but usable shift in probability (LR 2–5 or 0.2–0.5)
modest, supportive value.

Resisted Outer Range Adduction

Procedure

Patient supine with the legs straight. Move the affected leg out into abduction, then ask the patient to pull it back in against your hand placed on the inside of the ankle or knee.

Positive Finding

Reproduction of the patient's own adductor pain.

Sensitivity / Specificity

85% (46 athletes with an adductor injury)/74% (35 injured athletes without one)

Reference: Serner A, Weir A, Tol JL, Thorborg K, Roemer F, Guermazi A, et al. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?. Br J Sports Med. 2016;50(24):1541-1547.

Interpretation

Loads the adductors in a lengthened position and was one of the most useful adductor tests in acute groin injuries. A positive test supports an adductor injury. From one study of 81 male athletes seen within 7 days of an acute groin injury, with MRI as the reference (Serner 2016). 46 had an adductor injury on MRI; the comparison group was the 35 athletes with another groin injury or a normal MRI, so specificity was measured against other injured athletes, not healthy people. A test counted as positive only if it reproduced the athlete's own injury pain. Figures apply to acute injuries, not long-standing groin pain.

Sources

Grade C
A+ABCDModest value: a small but usable shift in probability (LR 2–5 or 0.2–0.5)
modest, supportive value.

Passive Adductor Stretch

Procedure

Patient supine with the legs straight. Hold the pelvis steady and move the affected leg passively out into abduction to end of range, comparing with the other side.

Positive Finding

Reproduction of the patient's own adductor pain at end of range, or less range than on the other side.

Sensitivity / Specificity

61% (46 athletes with an adductor injury)/80% (35 injured athletes without one)

Reference: Serner A, Weir A, Tol JL, Thorborg K, Roemer F, Guermazi A, et al. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?. Br J Sports Med. 2016;50(24):1541-1547.

Interpretation

Supports an adductor injury. Pain on the stretch is also linked to a more severe injury grade. Combine with palpation and resisted tests. From one study of 81 male athletes seen within 7 days of an acute groin injury, with MRI as the reference (Serner 2016). 46 had an adductor injury on MRI; the comparison group was the 35 athletes with another groin injury or a normal MRI, so specificity was measured against other injured athletes, not healthy people. A test counted as positive only if it reproduced the athlete's own injury pain. Figures apply to acute injuries, not long-standing groin pain.

Further reading

Grade D
A+ABCDLimited value: little effect on the diagnosis on its own
limited standalone value.

Adductor Squeeze Test

Procedure

Patient supine with hips bent to 45° and knees to 90°, feet flat. Place your fist (or a ball or pressure cuff) between the knees and ask the patient to squeeze as hard as they can for a few seconds. The test can also be done with the legs straight (hips at 0°), holding the ankles apart with your forearm.

Positive Finding

The patient's own groin pain is reproduced, in the adductor region.

Sensitivity / Specificity

67% (46 athletes with an adductor injury)/63% (35 injured athletes without one)

Reference: Serner A, Weir A, Tol JL, Thorborg K, Roemer F, Guermazi A, et al. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings?. Br J Sports Med. 2016;50(24):1541-1547.

Interpretation

Supports an adductor injury. Only count the athlete's own injury pain as positive. Weakness compared with the other side (or a low reading on a pressure cuff) is useful to track recovery and guide return to sport. From one study of 81 male athletes seen within 7 days of an acute groin injury, with MRI as the reference (Serner 2016). 46 had an adductor injury on MRI; the comparison group was the 35 athletes with another groin injury or a normal MRI, so specificity was measured against other injured athletes, not healthy people. A test counted as positive only if it reproduced the athlete's own injury pain. Figures apply to acute injuries, not long-standing groin pain. This is the squeeze with hips bent to 45° and knees to 90°. The squeeze with the legs straight (hips at 0°) performed better in the same study: 80% / 74%.

Sources

No accuracy study

Side-Lying Adduction (Bottom Leg Lift)

Procedure

Patient lies on the affected side with the top leg bent forward and resting on the plinth. Ask the patient to lift the straight bottom leg up off the plinth (adduction against gravity), then against light resistance.

Positive Finding

Pain in the adductors, or clearly less strength or control than on the other side.

Interpretation

A loading test that helps grade the injury and progress rehabilitation.

Sources

Not a diagnostic test

Dynamic Adduction Test (Standing or Half-Kneeling)

Procedure

Ask the patient to do sport-like movements that load the adductors, such as side lunges, a side-step, changing direction, or kicking a ball if appropriate. Progress only if pain-free.

Positive Finding

The patient's groin pain returns with the movement, or the movement is guarded.

Interpretation

A functional check used to guide return to sport. Not a diagnostic test.

Further reading

⚠ Red Flags

  • •Severe sudden onset with inability to weight-bear suggesting complete muscle rupture
  • •Signs of deep vein thrombosis (DVT): calf swelling, warmth, discoloration despite medial thigh injury
  • •Acute severe groin pain with fever suggesting hernia with strangulation or infection
  • •Progressive neurological symptoms (numbness, tingling in distribution of obturator nerve) suggesting nerve compression
  • •Mechanism involving direct trauma with signs of compartment syndrome (severe swelling, severe pain with passive stretch, paresthesia)
  • •History of cancer with new groin mass or unexplained lymphadenopathy
  • •Groin pain associated with systemic symptoms (fever, weight loss, night sweats) suggesting infection or malignancy

⚡ Yellow Flags

  • •High fear-avoidance beliefs limiting rehabilitation participation despite clinical improvement
  • •Chronic strain with poor response to treatment suggesting underlying psychosocial barriers
  • •Athletes with perfectionism or excessive training focus at risk for overuse patterns
  • •Job or sport demands creating persistent biomechanical stress without adequate recovery
  • •Poor compliance with rehabilitation exercises due to lack of understanding of injury mechanism
  • •Anxiety about re-injury preventing confident return to sport or normal function
  • •Secondary gains (continued attention or modified duties) reinforcing pain behavior

Osteopathic Techniques

Partial adductor tears are managed without surgery, with physiotherapy, and return to play takes about 1–7 weeks depending on the grade. Care is built on specific exercise and load management. No trials of osteopathic techniques for acute adductor strain were found.

Region

Adductors (longus, brevis, magnus, gracilis)

Technique

Soft tissue, hip and thigh
Grade D
Low evidence: expert consensus or could not be verified against literature
No trials in acute adductor strain. In long-standing adductor-related groin pain, a manual therapy package sped return to sport but active training beat passive physiotherapy.

Rationale

Hands-on work to the hip and thigh muscles to ease tension and pain, given alongside exercise.

How it's done & evidence

How it's done

Hands-on kneading, stretching and sustained pressure to the muscles around the hip and thigh: the hip flexors, adductors and hamstrings, and tensor fasciae latae with the iliotibial band.

Evidence in Adductor Strain

Searched 24 Oct 2026: no trials of soft tissue technique in acute adductor strain. Indirect, long-standing adductor-related groin pain: Weir 2011 found heat, manual therapy and stretching sped return to sport compared with exercise therapy, with no difference in pain; Hölmich 1999 found active training far beat physiotherapy without active training.

Region

Adductors

Technique

Muscle energy, hip and thigh musclesNo trials found

Rationale

Low-force, patient-powered stretch for tight hip and thigh muscles.

How it's done, cautions & evidence

How it's done

The muscle (for example the hamstrings, adductors or rectus femoris) is taken to its barrier. The patient pushes gently, at about 10–20% effort, against resistance for 5–10 seconds, relaxes for 3–5 seconds, and the new barrier is taken up.

Cautions

Not used with an acute fracture, a joint infection or a bone malignancy; take care with severe osteoporosis or after surgery that limits muscle contraction. Use the least force needed: too much can tear a muscle or pull off a tendon, especially in older patients.

Evidence in Adductor Strain

Searched 24 Oct 2026: no trials of adductor MET in adductor strain.

Region

Hip flexors (iliopsoas)

Technique

Muscle energy, psoasNo trials found

Rationale

Low-force, patient-powered stretch for a tight psoas and iliacus.

How it's done, cautions & evidence

How it's done

The hip is taken into extension to the barrier (prone, or supine with the leg off the table). The patient pulls the hip toward flexion for 3–5 seconds against equal resistance, relaxes, and the hip is taken further into extension. Repeat 3–5 times, then re-check.

Cautions

Do not use with a fracture in the area, an unstable pelvis or hip, recent surgery, or a patient who cannot contract on request or follow directions.

Evidence in Adductor Strain

Searched 24 Oct 2026: no trials of hip flexor MET in adductor strain.

Region

Hip joint

Technique

Articulation, hipNo trials found

Rationale

Gentle, rhythmic movement of the hip within its range to ease pain and stiffness.

How it's done, cautions & evidence

How it's done

Rhythmic, low-velocity passive movement of the hip joint within its range, with no thrust, usually with the patient supine. In hip osteoarthritis trials it was given as a course of about 9–10 sessions over 5–12 weeks.

Cautions

Side effects are usually mild and short-lived. In one hip osteoarthritis trial, 41% of the active group (manual therapy plus exercise) reported mild side effects, against 14% with sham.

Evidence in Adductor Strain

Searched 24 Oct 2026: no trials of hip mobilisation in adductor strain.

Region

Pelvis (innominate)

Technique

Muscle energy, pelvis (innominate and pubis)No trials found

Rationale

Gentle patient-powered contractions to restore pelvic (innominate or pubic) movement.

How it's done, cautions & evidence

How it's done

The innominate (or pubis) is taken to its restricted barrier. The patient makes a short, gentle contraction against equal resistance (a few seconds), relaxes, and the new barrier is taken up. Repeat, then re-check pelvic landmarks. Check for pubic dysfunction first, with consent.

Cautions

Do not use if the contraction causes severe pain, with a fracture or unstable joint in the area, or after recent surgery.

Evidence in Adductor Strain

Searched 24 Oct 2026: no trials of pelvic MET in adductor strain.

Sources

Region

Gluteal muscles, hip extensors and abductors

Technique

Soft tissue, lumbar and glutealNo trials found

Rationale

Hands-on work to the gluteal and lower back muscles to ease tension around the hip.

How it's done, cautions & evidence

How it's done

Hands-on soft-tissue work (kneading, stretching and sustained pressure) to the lumbar paraspinals, quadratus lumborum and gluteal muscles, usually prone or side-lying.

Cautions

Only minor side effects have been reported in trials.

Evidence in Adductor Strain

Searched 24 Oct 2026: no trials of gluteal soft tissue technique in adductor strain.

Sources

Rehabilitation Exercises

Supine Adductor Stretch (Modified Butterfly)

StretchingBeginner

Standing Adductor Stretch with Hip Flexion

StretchingBeginner

Sidelying Hip Abduction with Adductor Lengthening

Range of MotionBeginner

Sidelying Hip Adduction

StrengtheningBeginner

Supine Hip Adduction with Ball Squeeze

StrengtheningIntermediate

Standing Hip Abduction (for gluteal activation and adductor balance)

StrengtheningIntermediate

Clamshells (Hip External Rotation and Abduction)

StrengtheningIntermediate

Supine Bridge with Hip Abduction Focus

PosturalIntermediate

Eccentric Adductor Strengthening (Standing with Theraband)

StrengtheningAdvanced

Single Leg Stance with Hip Control

BalanceAdvanced

Copenhagen Adductor Exercise (Sidelying with Ball Between Knees)

StrengtheningIntermediate

Gradual Return to Sport-Specific Movement (Lateral Stepping, Directional Changes)

CardiovascularAdvanced

Referral Criteria

  • •Severe pain with complete inability to weight-bear or ambulate suggesting complete muscle rupture; refer for ultrasound or MRI imaging and possible surgical assessment
  • •Clinical signs suggestive of DVT (unilateral leg swelling, calf or thigh warmth, deep-vein tenderness) - refer urgently to vascular medicine or the emergency department. Homan's sign is unreliable (sensitivity roughly 10-54%, specificity roughly 39-89%) and must not be used to include or exclude DVT
  • •Suspected inguinal or femoral hernia presenting with palpable mass, vomiting, or signs of obstruction; refer to general surgery
  • •Neurological symptoms (numbness, tingling, weakness in obturator nerve distribution) persisting beyond expected timeline; refer to neurology for nerve assessment
  • •Chronic adductor pain unresponsive to conservative treatment after 6-8 weeks; refer for imaging (ultrasound, MRI) or specialist orthopaedic assessment
  • •Recurrent strains preventing return to function despite appropriate rehabilitation; refer for advanced imaging, biomechanical assessment, or sports medicine consultation
  • •Signs of infection or abscess (fever, localized warmth, fluctuance, lymphadenopathy); refer for infection assessment and possible imaging
  • •Groin pain associated with constitutional symptoms or unexplained weight loss; refer for systemic investigation
  • •Suspected osteitis pubis or pubic symphysis dysfunction; refer to sports medicine or orthopaedics for imaging and specialized management
  • •Inadequate progress after 4 weeks of conservative treatment; refer for physiotherapy assessment, imaging, or specialist consultation to rule out underlying pathology