This is part 3 of a series on groin pain. If you missed the beginning go back to Part 1 .
Here is a simplified arrangement of the muscles to help you better understand your groin pain.
Three adductors bring the thighs together:
Adductor brevis and longus (means short and long) are right at the top between the bones of the pelvis and the thigh. Adductor magnus (large) fills the whole inner thigh from deep in the crotch to the inner knee.
The pectineus (a comb) is a short muscle up in the same area with the small adductors. You use it to cross your legs.
Two long inner thigh muscles cross both the hip and knee joints: Gracilis (slender), primarily an adductor, is long and thin stretching from below the inner knee straight up to the pubic bone. Sartorius (tailor) starts with the gracilis at the knee but goes across the thigh to the front angle of the hip bone. It helps flex and externally rotate the thigh in a sitting position like a tailor (from which it gets it’s name).
Flexing the hip are the iliopsoas (means hip and loin) and the tensor fasciae latae (tightens the broad fascia). Iliopsoas connects the inner top of the thigh bone to the inner side of the hip bone (iliacus portion) and also to the lowest five vertebrae (psoas portion). TFL works on the opposite side of the hip bone to the iliacus and connects the front of the outer hip bone to the outside of the thigh.
Quadriceps (means four heads) Three of them affect the groin. The vastus medialis goes from inner knee to just below the groin at the inner thigh and the rectus femoris crosses the front of the hip. The vastus intermedius lies deep in the middle beneath the rectus. It is the most important one because of it’s Trigger Point pattern.
The next post is on Trigger Points that refer pain to the groin.
Hello Christina!
I am emailing from Vancouver BC Canada – Olympic city 2010! I loved your site. I wondered if you might not mind an inquiry. I had arthroscopic hip surgery (labral tear) in Sept’08. I had a slow recovery due to hysterectomy surgery 3 months prior..I started doing really well once doing Active Release Therapy with my chiropractor ..think it’s called Mayofascial Release )?). Had a set back in mid May in my groin area and can’t get a handle on it..my hip surgeon is fully booked and my family doctor..is in over is head with this one. I am considering an MRI but am unsure of what should be ordered..so is the doctor lOL!
Your descriptions of the groin injury are really good. I find though that I have pain also on my mons pubis area just on the rite side (so tender), crease in groin and find lateral adduction (spreading my leg laterally) super painful. I was wondering if my pubic/pelvis area would be considered part of the femoral triangle? My doctor is considering this for the MRI..but would that explain my pubic pain/tenderness?
I figure what the heck..you sound very knowledgable.
thanks for blog and any insite that you might have..wish I could come to Boston!
Hi Tara,
Sounds like your pelvis has been through a tough time! This pain could be leftover from your surgery, less likely for you it could be due to a fracture, but most likely caused by tension in the adductors. Locally, the adductor longus and gracilis muscles attach to the pubic bone and could be causing irritation at those attachments from muscle tension. If the pubic symphysis between the two sides of the pubic bone has become inflamed (called symphysitis) the add. longus and pectineus are involved. If it’s Trigger Point referral pain, then it is most likely the adductor magnus which can refer pain to the pubic bone. I have treated vulvoynia successfully by treating that muscle. It refers to the inner pelvis and can refer to the vagina, rectum and bladder as well as the pubic bone. Pain from the hip joint can be described as groin pain but because you have pain spreading your knees apart, it sounds like an adductor muscle problem.
In answer to your question about where the groin is, it is medically considered to be the inguinal area but can refer to the area lower than that around the crease of the thigh. The upper border of the femoral triangle is at that part of the groin.
Treatment I would recommend is Active Isolated Stretching and muscle treatment of all the adductors by a knowledgeable deep tissue massage therapist or a Neuromuscular Therapist if you can find one in your area. My next posts will be on treatment of Enrique. That should give you some ideas. After that I will be posting on self-treatment tips and corrective actions. So keep tuned and feel free to ask more!
Christina
Hi Christina,
I’m in my forties and just recently started working out again. Almost five years ago I had an epidural during the birth of my youngest. The procedure along with my lack of muscle tone in my thighs during the pregnancy seemed to have led to a continuing loss of muscle tone, capability and fatty cellulose. My first day at work out I worked an adductor machine for just a few minutes on very light weights. I drank water and used consistent breathing techniques.
I didn’t think I’d overdone anything when I first became sore from the adductor workout. I figured it to be lactic acid deposits and continued a lighter version of the 5 minute work out the next day followed up with a “body pump” work out of dumbell lifting aerobics.
Being very sore a little later I assumed from not drinking enough water after the workout, I noted very restricted movement in lifting my knees while seated due to pain in my inner thigh around the minor adductor and pectineus to about midway of my inner thigh. I suffered hobbling around the remainder of the day and tried to relieve the pain and gain greater mobility by soaking in hot water with baking soda and bath salts.
Still not feeling much better I retired to sleep only to be woken a few hours later with serious cramping enough to make me scream out in pain. It was the exact same area I continue to have pain and restricted range of motion in. Am I just sore or have I caused some sort of muscle damage? I’m still hobbling, guzzling water (my urine was quite colored this morning and not clear as I thought it would be) and taking hot baths and jacuzzi soaks.
I’m sure I’m not doing all that I would do for clients in similar situations. For the cramping pains I administered a hot towel which GREATLY reduced the pain. It’s funny that I know this stuff when dealing with aches and pains for clients who utilize my bodywork services, but seem to not be able to interpret my own, lol! Maybe you can help shed some light on what may be going on.
Sincerely,
Nicole
Hi Nicole,
Nice to hear from a fellow bodyworker! I doubt you’ve caused an injury. You’re covering most of the bases in your self-treatment, but there are three things I think you’re missing:
1) Treat the adductors manually. Part 10 of this series is on self-treatment. I have done two entries so far, so keep tuned and try what I’m suggesting.
2) What about stretching? Gentle Active Isolated Stretching is best for muscles in spasm. Actively stretch using the power of your own muscles, assist the stretch for two seconds with your hand or a rope wrapped around your foot and leg. Release the stretch to let the blood and lymph flow, then repeat 10 times. This will help pump the waste products out that are being released by your new workouts and causing the soreness.
In the beginning of starting a workout regime, it’s best to exercise different muscles on consecutive days rather than doing the same workout twice in a row. Your muscles need time to recover from the increased demand.
3) I think your iliopsoas is involved. It attaches deep in the top of the thigh, cramps when you flex at the hip when it’s tight, and responds to abdominal heat because of the reflex area in the skin there. Hip extension stretches help to lengthen it.
Let me know if these suggestions help.
Christina
Yay Christina! Like magic, the pain’s gone. A bit of stiffness lingers but I’m working through it. Thanks bunches as this type of thoroughly professional and absorbable information is what makes me love neuromuscular therapy so intensely. Yes, I was reminded of quite a bit for my own self care. I felt much better today and my oldest son (whose grand idea it was for me to focus more on the re-disciplining of my physical reality and get a move on to get back in shape) bet me it was not injury but as he put it, “the price you have to pay”.
I thought it an evil penalty (the pain, loved the work out), but once you informed me of the variation I should work with the picture is much clearer. Think I’ll follow your method as point well taken of one area per day on a routine track rotating over several days being the trick versus continuously working the same area. Ignorance of HOW to work out was more the faux pas versus the work out itself.
As well I was informed by the trainer the second day is the worst on a new work out so I appreciate and will pay attention to my soft stretching and evacuating the area manually with progressive stretching techniques as you suggested in your response. I used many yoga moves along with breath work (these always help my body feel so much better) in hydro environment to absorb the gravitational impact of the stretch and warm the muscle, increase blood flow, etc. This always seems to be the cinch for me as the water and steam act as natural detoxifier; while H2o creates a bouyancy barrier when submerged so injury is less likely, at the same time giving a greater and less pain stimulated range of motion.
Both my son (the 21 year old not the 4 year old, lol!) and the trainer were surprised I was doing GREAT today. They agree it normally takes a week to two weeks for most people to work through their soreness. Though miserable, mine lasted only two days! When writing yesterday, I felt desperate thinking I felt no relief at all. Nor was it thought I’d last the two weeks if the same level of pain continued (I admit, I’m a woose when it comes to pain)! Now that I have the rope technique I doubt I’ll suffer as much (I noted my body felt like I should be doing more I just didn’t know what to do or where to turn).
If your institute teaches classes please send me your 2010 schedule via email when it’s designed as it’d be good for my CEU’s and I need an NMT refresher course as it’s been maaaaany years (15 to be exact) since my modules 6 and 7 were complete. Hmmm, we shall see as I am greatly inspired by your thorough knowledge and would love to learn the manual self-evacuation techniques for use in my work. You are correct, it is nice to speak with a fellow therapist and a joy when a co-professional takes the time to treat you as a patient/client not giving you the “physician-heal-thyself” speech. I humbly thank you.
So Christina, while I am developing “The New Me” I will be watching your blog to “e”-learn more about caring for my body. Had it not been for my son (actually I have them both to thank at this point, lol!) I dare say I’d have given a second thought to my own health.
The journey to focus on self after focusing on others for so long can be quite scarey because you, yourself know not who to turn to for YOUR professional advice and guidance. After reading your lessons and instructions here, knowledge of my own body processes, interactions and new techniques learned will help me to overcome fear of the unkown and the “if-it-hurts-I-don’t-want-to-do-it” (which I’ve dubbed the “Owie Complex” after my 4 year old, lol)! Now there is no excuse left, I simply won’t be afraid to do the work! Thank you so much!
Namaste,
Nicole
Hiya Christina, I wonder if you could help at all, I had a hysterectomy 7 weeks ago and all has been well, but for a couple of things. Most days I have this burning pain in my right groin area. It hurts more if I sit down for long periods and also if I walk for too long (over 1/2 hour) each day. I do have days where it doesn’t feel very painful and days where it feels like an elastic band stretched to its limit and about to snap! When I sleep at night I am getting upper stomach spasms whenever I move even a millimetre and they go down my sides and into the top of my legs and I spasm like this throughout the night until I get out of bed. I don’t have this in the day time, but am aware of my tender and tight stomach and am worried the spasms might have caused some neurological injury by pulling on the internal stitches. I would appreciate your professional opinion on this please. I used to be very active before my hysterectomy and am wondering if my inactivity is causing the spasms, also I am very good at muscle isolation and think maybe I am overusing my upper stomach and isolating my lower area so that I don’t injure my operation site!!?? Many many thanks for reading this. Yours kindly, Nicola (England)
Hi Nicola,
It sounds to me like the iliopsoas. It is often affected by a hysterectomy surgery, especially if retractors are used. Your symptoms sound typical of Trigger Points from that muscle. At night, if you are sleeping with your knees drawn up, it shortens the muscle and can cause cramping. Since you’re past 14 days of your surgery, the stitches should be just fine and opening your abdomen and stretching your hip flexors would be therapeutic. Don’t be afraid of movement. Your body needs to move to have the muscles and soft tissue heal normally. It may feel a little uncomfortable at first, but won’t harm you unless there’s been a surgical error. If you have concerns about that after you have been moving about for a week or more, it would be advisable to check with your surgeon. As for neurological damage, there are 9 nerves that go through the psoas. Chances are there was no physical damage to that muscle, so it is probably just reacting to the trauma created by the surgery. My recommendation is to get back to the movement you are accustomed to and let me know if you don’t feel better. You may want to find a knowledgeable therapist to treat the iliopsoas to release the Trigger Points and scar tissue or go to Westminster College and consult with Dr. Leon Chaitow and his staff if you are still concerned.
Hiya Christina,
Thank-you for your prompt reply it has been very helpful to me. I have been putting my knees up in bed to stop the cramps, I won’t do that now, and I will start to move about more normally again. It is difficult to know what to do for the best sometimes, so thank-you for putting my mind at ease, I will probably try some yoga or pilates as well to stretch out some of the nerves and muscles. Kind regards, Nicola.
Hello,
I had a hysterectomy, just shy of a year ago. Before this I had cronic pain in my groin area. My OBGYN felt it was due to possible Endometriosis. He did a complete hysterectomy. I didn’t have endometriosis but I did have a cyst on my ovary. After the surgery I had the groin pain for about two days and it was gone. What a RELIEF right? Wrong, about 8 days ago, my groin pain returned. Almost one year exactly. Just when life seemed to be getting better. This happens. I need help. Don’t think I can do this whole groin pain thing again. Any suggestions?
There are lots of things you can do. Sorry the surgery didn’t work. Sometimes the scar tissue can make things worse. I can’t go into detail here, but read my posts on groin pain. You should understand it better and find ways to self-treat. I would highly recommend that you find a Neuromuscular Therapist or knowledgeable deep tissue therapist who can manually treat the muscles. It’s really the fastest and most effective treatment. Good luck and let me know if you have specific questions.