Groin Strain (Pulled Groin or Hip Adductor Tear)

Introduction

A groin strain, also called a pulled groin or a tear of the hip adductor muscles (Figure 1), is a common injury involving the muscles on the inside of the thigh. These muscles, known as the hip adductors, include the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus. Their main job is to pull the leg toward the body’s midline and help stabilize the hip during walking, running, cutting, and kicking. A groin strain occurs when one or more of these muscles or their tendons are stretched beyond their normal limits, causing small or large tears. This results in pain, swelling, weakness, and difficulty performing activities that require quick movements of the legs.

How Groin Strains Occur

Groin strains most commonly occur during sports that involve sudden acceleration, rapid changes in direction, forceful kicking, or side-to-side movements. Soccer, hockey, football, basketball, tennis, rugby, and track and field athletes are particularly susceptible. The injury often occurs when the leg is suddenly forced outward while the adductor muscles are contracting, or during a powerful kicking motion. Risk factors include inadequate warm-up, tight groin muscles, muscle weakness, fatigue, previous groin injuries, and poor conditioning. Athletes who return to sports too quickly after a previous groin strain are at increased risk of reinjury.

Diagnosing a Pulled Groin

Doctors usually diagnose a groin strain by asking how the injury occurred and performing a physical examination. Patients typically have pain and tenderness along the inner thigh or where the adductor tendons attach to the pelvis (Figure 10. Pain is often reproduced when the patient squeezes their legs together against resistance or stretches the injured muscles. Imaging studies are not always necessary for mild injuries but may be helpful if the diagnosis is uncertain or a more serious injury is suspected. X-rays may be ordered to rule out fractures or avulsion injuries where a piece of bone is pulled away by the tendon. Ultrasound can identify muscle tears and bleeding within the muscle, while MRI provides the most detailed images of the muscles, tendons, and surrounding soft tissues. MRI is particularly useful when a complete tendon tear or another hip injury is suspected.

Classifying a Groin Strain

Groin strains are commonly classified into three grades based on the severity of the injury.

• A Grade 1 (mild) strain involves stretching or very small tears of the muscle fibers. Patients have mild pain but can usually continue walking and may even continue playing, although with discomfort.
• A Grade 2 (moderate) strain involves a partial tear of the muscle or tendon. Patients experience more significant pain, swelling, bruising, weakness, and difficulty running or changing direction.
• A Grade 3 (severe) strain is a complete tear of the muscle or tendon. Patients often feel or hear a sudden “pop,” followed by severe pain, significant weakness, bruising, and an inability to continue the activity. In some cases, a complete tendon tear may pull away from its attachment on the pelvis.

Conservative Treatment of a Groin Strain

Most groin strains heal successfully without surgery. During the first few days after the injury, treatment focuses on protecting the muscle while reducing pain and swelling with rest, ice, compression, and elevation (the RICE principles). Anti-inflammatory medications may help relieve pain if appropriate. As symptoms improve, physical therapy becomes the most important part of recovery. Rehabilitation focuses on gradually restoring hip range of motion, improving flexibility, strengthening the hip adductor muscles as well as the surrounding hip and core muscles, and improving balance and movement control before returning to sports. Recovery time depends on the severity of the injury. Grade 1 strains often recover within 2 to 4 weeks, Grade 2 strains usually require 4 to 8 weeks, and Grade 3 strains treated without surgery may take 3 months or longer before returning to full activity.

Surgical Treatment of a Severe Hip Adductor Tendon Injury

Surgery is rarely needed for a groin strain but may be recommended when there is a complete tear or avulsion (pulling off) of the adductor tendon from the pelvis, particularly in competitive athletes or patients who continue to have significant weakness despite rehabilitation. During surgery, the torn tendon is reattached to the pelvis using strong sutures that are secured with small anchors placed into the bone. Following surgery, patients usually use crutches for a short period while the repair heals before beginning a structured physical therapy program. Rehabilitation progresses gradually from restoring motion to strengthening and eventually sport-specific exercises. Most patients require 4 to 6 months before returning to unrestricted sports, although some high-level athletes may require slightly longer to regain full strength and performance.

Summary

A groin strain, or pulled groin, is an injury to the muscles on the inside of the thigh that help move and stabilize the hip. It commonly happens during sports that involve running, kicking, or quickly changing direction. Most groin strains are diagnosed with a physical examination, although an MRI may be needed for more severe injuries. Mild strains usually heal within a few weeks, while more serious injuries can take several months. Most people recover with rest, physical therapy, and a gradual return to activity. Surgery is only needed for a small number of patients with complete tendon tears or severe injuries that do not heal with non-surgical treatment.

Edited by Stephen Pinney MD, July 8th 2026.