Recovery Insights Blog | Foundational Rehab

The Stubborn Injury

Groin strains are notorious for two things: they hurt, and they come back. The adductor muscles (inner thigh) are involved in nearly every lower body movement, making them hard to rest and easy to re-injure.

But with proper rehabilitation, you can recover fully and significantly reduce your risk of recurrence.

Anatomy: What Gets Injured

The "groin" includes several muscles that adduct (pull together) and stabilize the hip:

**Adductor longus** — most commonly strained

**Adductor brevis**

**Adductor magnus**

**Gracilis**

**Pectineus**

These muscles work during running, cutting, kicking, skating, and any lateral movement. The adductor longus, which attaches to the pubic bone, is injured most often.

How Groin Strains Happen

Acute strain:

Sudden overstretching (splits, slide tackle, fall)

Quick change of direction

Forceful kicking

Overstride while running

Chronic/overuse:

Repeated stress without adequate recovery

Muscle imbalances (weak adductors relative to abductors)

Poor hip mobility

Inadequate warm-up

High training loads

Risk factors:

Previous groin injury (biggest risk factor)

Weak adductors

Hip flexor tightness

Poor core stability

Sports with cutting/kicking (soccer, hockey, football)

Severity Grades

Grade 1 (mild):

Tightness or mild pain

No significant strength loss

Can usually continue activity

1-2 weeks recovery

Grade 2 (moderate):

More significant pain

Some loss of strength

Pain with walking or running

3-6 weeks recovery

Grade 3 (severe):

Severe pain, possible "pop"

Significant weakness

May see bruising

2-4 months recovery

May require imaging

Immediate Management

First 48-72 hours:

Relative rest (avoid activities that cause pain)

Ice: 15-20 minutes several times daily

Compression: elastic bandage if swelling

Avoid stretching initially (can worsen injury)

Walking as tolerated

See a doctor if:

Severe pain or inability to walk

Significant bruising or swelling

"Popping" sensation at time of injury

No improvement after 1-2 weeks

Rehabilitation

Phase 1: Protection and Gentle Activation (Days 1-7)

Goals: Reduce pain, begin gentle muscle activation.

Isometric adduction:

1. Lie on back, ball or pillow between knees

2. Gently squeeze (20-30% effort)

3. Hold 10 seconds

4. No pain during exercise

5. 3 sets of 10, multiple times daily

Supine hip flexion:

1. Lie on back

2. Slowly slide heel toward buttock

3. Return to start

4. 15-20 reps

Walking:

As tolerated, pain-free or minimal pain.

Phase 2: Progressive Loading (Weeks 1-3)

Goals: Restore strength through inner and mid-range.

Side-lying adduction:

1. Lie on injured side, bottom leg straight

2. Top leg bent, foot on floor in front

3. Lift bottom leg toward ceiling

4. 3 sets of 15

Seated ball squeeze:

1. Sit with ball between knees

2. Squeeze and hold 5 seconds

3. 3 sets of 12-15

4. Progress resistance as tolerated

Standing adduction with band:

1. Band around injured ankle, anchored to side

2. Pull leg across body against resistance

3. Control the return

4. 3 sets of 15

Sumo/wide stance squats:

1. Wide stance, toes turned out

2. Squat down, knees tracking over toes

3. Challenges adductors in a stretched position

4. Start with bodyweight, progress load

Phase 3: Strengthening Through Range (Weeks 3-6)

Goals: Build strength in outer ranges, sport-specific preparation.

Copenhagen adduction (supported):

1. Side plank position

2. Top leg supported on bench, bottom leg underneath

3. Lift bottom leg to meet top leg

4. 3 sets of 8-10 each side

5. Progress to unsupported (top leg on bench, no support for bottom)

The Copenhagen exercise is the gold standard for adductor strengthening and injury prevention.

Lateral lunges:

1. Step wide to one side

2. Bend that knee, keep other leg straight

3. Push back to start

4. 3 sets of 10 each side

5. Add weight as tolerated

Slider adduction:

1. Stand on one leg, other foot on slider

2. Slide foot out to side

3. Pull back using adductors

4. 3 sets of 8-10 each side

Romanian deadlifts:

1. Build posterior chain

2. Supports overall hip function

3. 3 sets of 10-12

Phase 4: Return to Sport (Weeks 6+)

Progressive running:

1. Straight-line jogging

2. Gradual speed increases

3. Add curves and turns

4. Add cutting and change of direction

5. Sport-specific drills

Kicking/striking progression:

1. Light, controlled kicks

2. Gradually increase intensity

3. Match-intensity only when pain-free

Criteria for full return:

Full pain-free range of motion

Equal strength to uninjured side

Sport-specific movements without pain or apprehension

Completed progressive return-to-sport program

Prevention: The Copenhagen Protocol

Research shows the Copenhagen adductor exercise dramatically reduces groin injury rates (up to 41% reduction).

In-season protocol:

Week 1: 1 set of 5 reps each side

Week 2: 2 sets of 6-8 reps

Week 3: 3 sets of 8-10 reps

Maintenance: 1-2 sets of 8-10 reps, 2-3x per week

Add this to your regular training for prevention.

Other Prevention Strategies

Adequate warm-up before activity

Address hip flexibility limitations

Maintain hip and core strength

Don't ignore warning signs (tightness, minor strains)

Gradual progression of training loads

Include lateral movement in training

Common Mistakes

Returning too soon:

The biggest mistake. Groin muscles don't feel that painful to walk on, so athletes rush back. Re-injury rates are high.

Stretching acutely:

Avoid aggressive stretching in the first 1-2 weeks. It can worsen the injury.

Ignoring the Copenhagen:

This exercise has the best evidence for prevention and rehab. Don't skip it.

Not addressing root causes:

If you don't fix weakness, inflexibility, or training errors, the injury will return.

The Bottom Line

Groin strains require patient, progressive rehabilitation. The keys:

1. Allow acute healing (1-2 weeks of relative rest)

2. Progressive strengthening through full range

3. Copenhagen exercises for rehab and prevention

4. Gradual return to sport with clear criteria

5. Ongoing maintenance to prevent recurrence

Take the time to rehab properly. A few extra weeks now prevents months of dealing with a chronic, recurring problem.

Groin Strain: Recovery, Exercises, and Preventing Re-Injury