Blog 2: Groin & Adductor Strains: The Injury Behind Your Hip and Knee Pain
Part 2: Why Your Groin Strain Keeps Coming Back
Welcome back! In Part 1 Dr. Keirstyn broke down what the adductor group actually is, why groin injuries so often masquerade as hip and knee pain, and how to tell a Grade 1 from a Grade 2 strain. Now let's talk about why these injuries happen in the first place and why the 'rest until it feels better' approach is exactly why so many athletes are back in the same situation three months later.
Who Gets Adductor Strains , And Why
Adductor strains show up across a wide range of sports, but two groups dominate my practice:
Hockey players:
And for good reason. The skating stride requires powerful hip abduction (pushing out) and then adduction (pulling back in) with every single push. The adductors are working eccentrically , under load while lengthening, which is exactly the condition that makes muscle strains most likely. Research shows groin injuries account for up to 10–11% of all ice hockey injuries, making them one of the sport's most common soft tissue problems.
Runners:
Especially those increasing mileage quickly, doing speed work, or running on cambered roads. The adductors play a significant stabilizing role during the stance phase of running. When they're fatigued or underprepared for the load, strain follows.
Other high-risk groups include soccer players, sprinters, and masters athletes returning to sport after time off, where the cardiovascular system comes back faster than the connective tissue does.
The Actual Mechanism — It's Not Just 'Doing Too Much'
Yes, load is a factor. But the underlying driver I see most consistently is a strength imbalance between the adductors and the muscles around them:
Weak adductors relative to abductors: when the glutes and hip abductors are significantly stronger than the adductors, the adductors get overwhelmed during explosive or repetitive lateral movements
Poor hip stability overall: the adductors compensate when the glutes and deep hip stabilizers aren't doing their job. Over time, a compensating muscle is a muscle heading toward injury
Insufficient eccentric strength: the adductors need to be able to control hip abduction under load, not just produce adduction force. Most athletes train the wrong direction
Tight hip flexors: hip flexor tightness alters pelvis position and forces the adductors into a mechanically disadvantaged length, making them more vulnerable under load
Inadequate warm-up: cold adductors asked to perform explosive movements are at dramatically higher risk, particularly in cold arena environments
Warning Signs You Shouldn't Ignore
These are the signals that tell me something needs proper attention, not just rest:
Pain that returns every time you resume training — the tissue never fully recovers between sessions
Inner knee aching that developed alongside groin tightness — gracilis involvement is being missed
A pulling sensation in the lower abdomen during hip flexion — potential athletic pubalgia developing
Groin 'tightness' that never fully releases no matter how much you stretch — this is an injured muscle, not a tight one
Pain with resisted adduction testing — squeezing your knees together against resistance — a reliable clinical indicator of adductor strain
Clicking or sharp pain deep in the groin with hip rotation — warrants ruling out hip joint involvement
Why It Keeps Coming Back
This is the most important part of this post. Adductor strains recur at some of the highest rates of any soft tissue injury in sport. Research puts recurrence risk at 15–30% within the first year for athletes who return without proper rehabilitation.
The reason is almost always the same: the muscle healed, but the underlying weakness, imbalance, and loading pattern that caused it didn't change. Rest eliminates the pain. It does not fix the problem. The moment you return to the demands that caused the injury, you're working with the same vulnerable system.
This is why I rarely treat adductor strains in isolation. The hip stabilizers, the glutes, the pelvis, they all need to be part of the picture.
Up Next — Treatment, Recovery, and Keeping It Away for Good
Part 3 wraps it up with what a proper recovery actually looks like, what I do in practice to address these injuries, and most importantly, the specific habits that prevent adductor strains from becoming a recurring theme in your athletic life. See you there.
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Recurring groin pain that keeps sidelining you? There's a reason it keeps coming back, and it's fixable. Book an assessment with Dr. Keirstyn at Endurance Therapeutics and let's find the pattern driving it.
📍 Endurance Therapeutics | Oakville, Ontario
📞 905-288-7161
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