Etiology — what causes it

Eccentric overload of quadriceps (often rectus femoris during sprinting or kicking) or adductors (often during cutting, change of direction). Risk factors include reduced eccentric strength, fatigue, prior injury.

Epidemiology — who gets it

Common in football, AFL, rugby, hockey. Adductor strain is a major contributor to groin pain in athletes (Doha consensus).

Clinical signs

Tenderness localized to the injured muscle, pain with resisted contraction and stretch, weakness asymmetry. Palpable defect in higher-grade injuries.

Symptoms

Sudden pain in the anterior thigh (quad) or medial thigh/groin (adductor) during high-effort activity. Pain with sprinting, kicking, cutting, and stairs.

Best evidence for chiropractic treatment

Progressive loading from isometric → concentric → eccentric → energy-storage. The Hölmich protocol (Hölmich et al., Lancet) for adductor-related groin pain. Copenhagen Adductor Strengthening (Harøy et al., BJSM) for prevention. RTS based on strength symmetry, sport-specific testing.

Subtypes

  • Quad strain (rectus femoris most common). Sprinting and kicking mechanism.
  • Adductor strain. Cutting and change of direction mechanism.

When to seek emergency care

Some symptoms need urgent medical attention — not a chiropractic visit. Call 911 or go to the nearest emergency department for: progressive limb weakness, loss of bowel or bladder control, saddle anesthesia (numbness in the groin/inner thighs), severe unrelenting pain unrelieved by position, signs of fracture after significant trauma, chest pain, stroke-like symptoms (face drooping, arm weakness, speech changes), or any rapidly worsening or unusual symptom.

Bottom line

Progressive loading and criteria-based RTS reduce recurrence. Calendar-only returns drive the recurrence rate up.