Groin strain: symptoms, self-care and recovery time

The groin is the area where the lower tummy meets the top of the thigh. Several muscles and tendons cross this area, mainly the group on the inside of the thigh that pulls the legs together (the adductors). A groin strain is an overstretched or torn fibre in one of them. The NHS describes a strain in general as an overstretched or torn muscle, also known as a pulled muscle, which differs from a sprain, where a ligament is twisted or torn.

Leeds Community Healthcare explains that the pain can come from different structures, including muscles and tendons, and that the most common form of the injury is a strain of the adductor longus muscle. Pressing on the sore spot gives a good clue to which structure is involved, which is why a clinician will often feel the area as part of an assessment.

Berkshire Healthcare describes the injury as pain in the inner thigh or hip from overuse or over-stretching the hip. The leaflets use the same everyday language that people use: a pulled groin, a pulled adductor, or simply groin pain after football.

Berkshire Healthcare NHS Foundation Trust and Leeds Community Healthcare NHS Trust list very similar features. Symptoms can come on at once during a sudden movement, or build up over a few days of activity.

• Pain and tenderness in the groin and inside of the thigh.

• Pain from quick or strong movements of the leg.

• Pain when you bring your legs together, such as squeezing your knees, or when you raise or bend your knee or climb stairs.

• The groin may feel warm to the touch.

• Some bruising or swelling in the groin or inside the thigh, which Leeds describes as minor.

• If the lower tummy muscles are involved, some discomfort when coughing or sneezing.

Berkshire Healthcare recommends the P.O.L.I.C.E. approach for the first 48 to 72 hours: protection, optimal loading, ice, compression and elevation. In practice that means resting the area while starting gentle movement as soon as it feels okay, using crutches for a short time if needed, and applying ice wrapped in a damp towel for 15 to 20 minutes every 2 to 3 hours, checking for ice burns. A snug, not tight, elastic bandage and raising the leg to hip height while resting complete the list.

Leeds Community Healthcare gives similar advice for the first 48 hours: avoid activities that make the pain worse, use ice in the same way, use compression such as old tights, sports leggings or a bandage, and speak to a GP or pharmacist about pain medication. The NHS general advice for sprains and strains adds that heat, alcohol and massage are best avoided for the first couple of days to help prevent swelling, and that a pharmacist can suggest painkillers such as paracetamol or ibuprofen gel.

It depends on how severe the strain is. Leeds Community Healthcare says minor strains may take only a couple of weeks to return to pre-injury function and more severe strains a few months, and that even the most severe groin strains would generally be back to a pre-injury level within 6 months with physiotherapy.

The NHS says severe sprains and strains can take months to get back to normal. If progress stalls, or each attempt to increase activity sets you back, that is a reason to seek assessment rather than push on.

Both services emphasise gradual loading. Berkshire Healthcare describes three starter exercises done little and often: an inner thigh squeeze with a ball between the knees, a bridge with a thigh squeeze, and a bottom leg lift lying on the affected side. They suggest 10 to 20 repetitions, twice a day, and say the exercises may be uncomfortable but should not significantly increase symptoms.

Leeds Community Healthcare suggests that after about 48 hours, if pain is improving, you try exercises as pain allows, building from 3 sets of 10 repetitions towards 3 sets of 20, around 4 times a week, with 1 to 2 minutes of rest between sets. Its rule of thumb is that if symptoms are aggravated for more than 15 minutes after the exercises, you are doing too many or pushing too hard, and that you should work into mild discomfort, not pain.

The NHS says that after 2 weeks most sprains and strains feel better, but that you should avoid strenuous exercise such as running for up to 8 weeks because of the risk of further damage. Groin strains are prone to recurrence if sport is resumed too early, so a staged return, guided by how the leg feels the next day, is more sensible than a fixed date.

Berkshire Healthcare says groin strains usually occur while playing sports that involve sudden changes of direction, twisting, turning and kicking, and that they can also occur by simply slipping on a wet surface. Leeds Community Healthcare names football as a good example and says the injury is more common in people who play sport that involves twisting, turning, changing direction quickly and kicking.

More generally, the NHS says sprains and strains happen when you overstretch or twist a muscle, and that not warming up before exercise, tired muscles and playing sport are common causes. That fits the usual pattern: a sudden push-off, a long stride or a slide tackle when the muscle is cold or fatigued.

Berkshire Healthcare advises contacting your GP if you have further pain, and says that if the exercises make symptoms worse you should take a break and speak to your GP; this does not mean it is anything too serious, only that you may need extra help and a physiotherapist referral.

The NHS advice for sprains and strains is to get help from NHS 111 if the injury is very painful or getting worse, there is a large amount of swelling or bruising, you cannot put any weight on it or walk more than a few steps, it feels very stiff, or it is not improving after treating it yourself. It says to call 999 or go to A&E if you heard a crack at the time of injury, the body part has changed shape, it is numb or tingling, or the skin has changed colour and is cold to touch, because you may have broken a bone.

Persistent groin pain that does not fit a simple strain can have other causes, such as a hernia or a hip problem, so it is worth having an unusual or lingering case examined.

The NHS says that in many areas you can refer yourself to community musculoskeletal (MSK) services for help such as physiotherapy without a GP referral, although NHS physiotherapy might not be available everywhere and waiting times can be long. It also notes that physiotherapy can be obtained privately, and points to the Chartered Society of Physiotherapy for finding a chartered physiotherapist.

In general terms, the difference between the routes is mostly speed of access and how many sessions are offered. The assessment and rehabilitation principles described above are the same in both.