Adductor Muscle Strain, Groin Pain
Conditions
Keywords
Core Stability Training, Adductor Muscle Strain, Hip Adduction Abduction Ratio, Gymnastics Injuries
Brief summary
Adductor muscle strain is a common cause of groin pain in young athletes, particularly in gymnasts who frequently perform movements that require extreme hip flexibility and strength. Muscle imbalance around the hip joint and reduced core stability may increase the risk of adductor injuries. This randomized clinical trial aims to investigate the effect of adding core stability training to a traditional physiotherapy rehabilitation program on the hip adduction-abduction strength ratio in young gymnasts with adductor muscle strain. Thirty-six young gymnasts aged 7-10 years with Grade I or II adductor strain will be randomly assigned to two groups. Both groups will receive a traditional physiotherapy rehabilitation program for eight weeks, while the study group will also perform additional core stability exercises. Outcomes will include hip adductor and abductor strength measured using a hand-held dynamometer, pain intensity assessed using the Visual Analog Scale (VAS), and hip and groin function evaluated using the Copenhagen Hip and Groin Outcome Score (HAGOS). The findings of this study may help determine whether adding core stability training improves rehabilitation outcomes in young gymnasts with adductor muscle strain.
Detailed description
Adductor muscle strain is one of the most common causes of groin pain in athletes and is frequently reported in sports that involve rapid directional changes, high-impact landings, and extreme hip ranges of motion. Young gymnasts are particularly vulnerable to such injuries due to the repetitive mechanical loading placed on the hip and groin region during training and performance. Muscle imbalance around the hip joint, particularly an altered hip adduction to abduction (ADD:ABD) strength ratio, has been identified as a key intrinsic risk factor associated with groin injuries. Core stability plays an essential role in maintaining lumbopelvic control and providing proximal stability for efficient movement of the lower extremities. Deficits in core stability may increase compensatory movements at the hip joint and contribute to excessive loading on the adductor muscles. Consequently, incorporating core stability exercises into rehabilitation programs may improve neuromuscular control and optimize hip muscle function. The aim of this randomized clinical trial is to investigate the effect of adding core stability training to a traditional physiotherapy rehabilitation program on hip adduction-abduction strength ratio, pain intensity, and hip and groin function in young gymnasts diagnosed with adductor muscle strain. Thirty-six young gymnasts aged 7-10 years with Grade I or Grade II adductor muscle strain will be randomly assigned to either a study group or a control group. Both groups will receive a traditional physiotherapy program three times per week for eight weeks. The study group will additionally perform a structured core stability training program. Outcome measures will include hip adductor and abductor muscle strength assessed using a hand-held dynamometer, pain intensity measured using the Visual Analog Scale (VAS), and functional outcomes evaluated using the Copenhagen Hip and Groin Outcome Score (HAGOS). Assessments will be conducted before and after the intervention period. The results of this study may contribute to improving rehabilitation strategies for young athletes with adductor-related groin injuries and may help determine whether core stability training provides additional benefits beyond traditional physiotherapy.
Interventions
OTHERcore stability training + traditional physio therapy for study group
Core stability training (CST) was implemented to improve trunk control and lumbopelvic stability in young gymnasts with adductor muscle strain. The program was performed three times per week for eight consecutive weeks and was provided in addition to the traditional physiotherapy program. Each session included approximately 30 minutes of CST exercises focusing on neuromuscular control of the trunk and pelvis. The training protocol consisted of progressive exercises including abdominal hollowing, abdominal bracing, dissociation of the shoulder and pelvic girdles, cat-camel exercise, quadruped stance, front bridge, side bridge (both sides), and supine bridge. The program was delivered in three progressive phases with gradual increases in training difficulty to enhance trunk muscle activation, improve lumbopelvic stability, and optimize force transmission through the kinetic chain during lower limb movements.
OTHERtraditional physiotherapy for control group
The traditional physiotherapy program was designed for the rehabilitation of adductor muscle strain and was conducted three times per week for eight weeks, with each session lasting approximately 70 minutes. The program included a 10-minute warm-up using a cycle ergometer followed by pain-free strengthening exercises targeting hip flexion, extension, abduction, and adduction performed in side-lying and standing positions. Isometric adductor strengthening exercises were performed in the supine position using a small roll placed between the knees or feet. Balance and proprioceptive training were incorporated using balance boards and functional tasks. Stretching exercises for the hamstrings, gluteal muscles, hip flexors, and iliotibial band were performed during the cool-down period. In addition, low-level laser therapy was applied for 10 minutes over the symptomatic adductor tendon insertion sites to reduce pain and local tenderness.
Sponsors
Aya Mohamed Elsheikh
Faculty of Physical Therapy, Cairo University, Egypt is not a recognized organization name.
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
TREATMENT
Masking
NONE
Masking description
Due to the nature of the exercise-based rehabilitation interventions, blinding of participants and treating therapists was not feasible. Participants were aware of the type of treatment they received (traditional physiotherapy alone or traditional physiotherapy combined with core stability training). No additional parties were masked during the trial. Outcome assessments were performed using standardized procedures to minimize measurement bias
Intervention model description
This study followed a parallel-group randomized controlled interventional design. Eligible participants were randomly assigned in a 1:1 allocation ratio to either the study group or the control group using a computer-generated randomization sequence. The control group received a traditional physiotherapy program, while the study group received the same traditional physiotherapy program with the addition of a structured core stability training (CST) program. The intervention period lasted eight weeks, with treatment sessions conducted three times per week. Outcome measures were assessed at two time points: baseline (pre-intervention) and after completion of the intervention (post-intervention). The primary outcome was the hip adduction to abduction (ADD:ABD) strength ratio, while secondary outcomes included pain intensity measured using the Visual Analog Scale (VAS) and hip and groin functional status assessed using the Hip and Groin Outcome Score (HAGOS). The study employed a repeate
Eligibility
Sex/Gender
ALL
Age
7 Years to 10 Years
Healthy volunteers
No
Inclusion criteria
* Young gymnastic athletes aged 7-10 years. * Male or female participants who are actively practicing gymnastics. * Clinically diagnosed with Grade I or Grade II adductor muscle strain by an orthopedic physician. * Presence of groin pain reproduced during resisted hip adduction test. * Positive adductor squeeze test indicating adductor-related groin pain.
Exclusion criteria
* Presence of radiological evidence of hip joint pathology or fracture. * Neurological disorders affecting motor control or balance. * History of previous hip or pelvic surgery. * Presence of spinal pain involving the thoracolumbar region. * Any medical condition that could interfere with participation in the rehabilitation program or outcome assessments.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Hip Adduction-Abduction Strength Ratio (ADD:ABD ratio) | Baseline and after 8 weeks of intervention. | Hip adduction and abduction muscle strength were measured using a hand-held dynamometer, and the ratio between adduction and abduction strength was calculated to evaluate hip muscle balance. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| pain intensity | Baseline and after 8 weeks of intervention. | Pain intensity related to adductor strain was assessed using the Visual Analog Scale (VAS), where higher scores indicate greater pain. |
| hip and groin function | Baseline and after 8 weeks of intervention. | Functional status was evaluated using the Hip and Groin Outcome Score (HAGOS), a questionnaire assessing symptoms, pain, daily activities, sport and recreation, participation in physical activities, and quality of life. |
Countries
Egypt
Contacts
STUDY_DIRECTORNanees Essam Mohamed, physiotherapy Professor
Institutional Review Board of the Faculty of Physical Therapy, Cairo University, Egypt
Outcome results
None listed