Adductor-Related Groin Pain in Footballers : A Practical Approach
Updated: 6 days ago
From initial assessment and progressive strengthening to kicking, change of direction and return to football. This article outlines a practical framework for approaching adductor-related groin pain in Footballers, from the initial management of symptoms through to return to performance.
Groin pain can be frustrating for footballers. A player may walk comfortably, complete gym exercises and even jog without difficulty, yet experience pain when striking the ball, accelerating or changing direction at speed.
These demands place considerable stress on the adductor muscles, particularly the adductor longus, which is frequently involved in acute adductor injuries.
Rehabilitation should therefore do more than settle symptoms. It needs to restore the player's ability to tolerate increasing loads and prepare them for the specific demands of football.
1. First, establish the diagnosis
Not all groin pain is an adductor injury. Symptoms can arise from the hip, pubic region, iliopsoas or inguinal region, and more than one condition may be present.
Assessment should include :-
the history of the injury
the location of symptoms
palpation of the adductor muscles
resisted adduction and appropriate hip movement tests.
The clinician should also consider the mechanism of injury, such as sudden pain during a powerful kick, sprint or change of direction.
For an acute injury, the assessment should establish the likely muscle involved, injury severity and whether further investigation is needed. Imaging may be appropriate when a significant injury or tendon involvement is suspected.
Rehabilitation should follow the clinical findings—not simply the label of “groin pain.”
2. Early rehabilitation : maintain capacity while managing symptoms
The initial aim is to reduce aggravating loads without unnecessarily stopping all physical activity.
Depending on the injury, this may mean -
temporarily reducing forceful kicking
sprinting
sharp changes of direction and
painful adductor exercises.
Other strength and conditioning work may continue if it can be performed safely and does not aggravate the injury.
Exercise selection and loading should reflect the player's symptoms, injury severity and response to activity. A player with a more substantial injury may require a different starting point from someone with a less severe muscle injury.
Complete rest is not automatically necessary, but continuing to train through significant or worsening pain is not a suitable rehabilitation strategy.
3. Progress adductor loading
Restoring adductor strength is a central part of rehabilitation. The starting exercise should match the player's current capacity, rather than automatically beginning with demanding exercises.
A progressive programme may include:
Initial loading: controlled hip adduction and other tolerable exercises to reintroduce muscle loading.
Progressive resistance: resisted hip adduction with increasing load and range of movement.
Higher-load strengthening: more demanding adductor exercises, including appropriate progressions towards Copenhagen adduction.
High-speed and functional loading: exercises that challenge the adductors under greater speed, force and movement demands.
These are examples of loading options, not mandatory stages that every player must complete in the same order.
Progression should be based on exercise performance, symptoms and recovery between sessions. A player may tolerate some training components before others, so rehabilitation does not always need to progress as one single block.
4. Running and change of direction: progress according to capacity
Running should be progressed alongside strengthening, according to the player's presentation and tolerance.
A suitable progression may move from
Controlled running → Faster running → Acceleration → Deceleration → Planned changes of direction → Reactive changes of direction, with speed, intensity, volume and recovery progressively adjusted to the player’s response.
Football also requires braking, turning off either leg, reacting to opponents and changing direction under pressure. Completing straight-line running comfortably does not automatically establish readiness for these demands.
The aim is to progressively expose the player to the movements and loads that were previously difficult, without introducing a sudden increase in total workload.
5. Reintroduce kicking and football-specific drills
Kicking and change of direction deserve particular attention because they are important mechanisms of groin injury in football.
Kicking can be progressed from controlled ball contact and short passing towards longer passes, more forceful striking and repeated kicking. Change-of-direction work can progress from planned movements to sharper, faster and eventually reactive drills.
The exact sequence will depend on the injury, the player's symptoms and the demands of their position. A player who regularly strikes long passes or takes powerful shots may need a different kicking progression from one whose role involves more short passing and repeated changes of direction.
Football-specific exposure should build progressively towards training demands, rather than jumping from isolated rehabilitation exercises straight into unrestricted team training.
6. Use criteria—not a fixed calendar—to guide progression
The Aspetar acute adductor injury protocol uses a criteria-based approach. Its clinical pain-free criteria include:
No pain on palpation of the injured adductor region.
No pain during maximal isometric adduction in an outer range.
No pain during maximal passive adductor stretch.
No pain during the prescribed resisted hip-adduction exercise.
No pain during the prescribed Copenhagen adduction exercise.
No pain during a maximal-intensity T-test.
These are specific criteria from the Aspetar protocol, not a substitute for a complete assessment or a guarantee of readiness for a football match. The clinician must decide how they apply to the individual injury and combine them with appropriate running, kicking, change-of-direction and football-specific progression.
The rehabilitation components may progress at different rates. Passing a strength exercise does not automatically mean the player is ready for maximal sprinting or full football training.
7. Return to training is not the same as return to performance
Before unrestricted return, the player should demonstrate that they can tolerate the relevant demands of football—not merely walk, jog or perform isolated strength exercises without pain.
Depending on the injury and level of play, this may include:
Appropriate clinical recovery and adductor loading capacity.
High-speed running and acceleration/deceleration.
Planned and reactive changes of direction.
Kicking at the required intensity and volume.
Repeated high-intensity actions and football-specific training.
Confidence in performing these tasks at match-relevant intensity.
The clinician should also consider the player's response after training and whether workload can be increased without an adverse reaction.
Return-to-play decisions should be shared appropriately between the player, physiotherapist, medical team and coaching staff.
8. The key clinical message
Acute adductor rehabilitation is a progressive process of restoring muscle capacity and exposing the player to the demands of football.
As the Aspetar protocol provides a useful criteria-based reference, but the diagnosis, injury severity, clinical findings and response to loading must guide its application. Players with persistent or recurrent groin pain, or symptoms that do not fit a straightforward acute adductor injury, need reassessment rather than automatic progression through the same protocol.
The goal is not only to return the player to the pitch, but to prepare them for the repeated kicking, sprinting and changes of direction that football requires.
Nidhi Nadar (PT)
Sports Physiotherapist | Sports Rehabilitation & Performance
Clinical note: This article is an educational overview, not an individual treatment prescription. Adductor-related groin pain should be assessed appropriately, and rehabilitation progression should be tailored to the player's diagnosis, presentation and response. The acute injury criteria referenced above are drawn from the Aspetar Acute Adductor Injuries Treatment Protocol.
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