Definition

Soft tissue damage (stretch or rupture) to the ligaments and muscles of the inner thigh (adductor longus, brevis and magnus, gracillas, pectineus)

Sprain (ligaments)/strain (muscle) grading severity:

  • Grade 1: Simple sprain/strain, minimal disruption of adjacent fibres Estimated 1-10% fibre damage

Minimal pain, splinting, minimal palpatory pain Trigger points, some loss of ROM Healing time: 7 days to 4 weeks

  • Grade 2: Moderate sprain/strain, partial tearing of ligaments or muscle, haemorrhage, marked pain and splinting

Estimated 11-50% fire damage Athletic injury, lifting, trauma

Same clinical picture as above but more severe Healing time: 2 weeks to 1 year

  • Grade 3: Severe sprain/strain, may be complete laceration Estimated 51-100% fibre damage

Marked dysfunction, palpate torn muscle and oedema Healing time: 8 weeks to over 1 year

Aetiology

  • Direct trauma-falls, MVA, sports injuries
  • Overuse, fatigue, repetitive microtrauma (heavy lifting and bending), over hours or days of the same motion
  • Muscle imbalance, prior injuries, leg length inequality
  • Inappropriate increase in training regime
  • Weak core and abdominal obesity

History, symptoms and signs

  • Local pain depending on the structure/s injured (most likely dull pain)
  • Referred pain depending on soft tissue injured (most likely dull pain)
  • Pain on movement depending on soft tissue injured
  • Feeling of instability, depending on the severity of injury
  • Neurological symptoms depending on the severity of the injury
  • Antalgic list
  • Surrounding muscle spasm
  • Possible hematoma and swelling
  • Pain on palpation of injured area and surrounding muscle hypertonicity
  • Reduced and guarded ROM depending on structure/s injured
  • Neurological testing is generally normal unless the injury was severe enough to affect the nerve roots

Prognosis

  • Prognosis is good for complete recovery in first time cases
  • Possible complications: joint instability, arthrosis, myofibrosis/periarticular fibrosis
  • Periarticular fibrosis: post injury fibrous repair of myofascial soft tissue(muscle/ligament/tendon). Often the result of significant trauma or prolonged Palpable nodule causing reduced elasticity of tissue predisposing to recurrent injury.
  • Possible surgery indicated for grade 3

Do’s and don’ts

The amount of swelling or local bleeding into the muscle (from torn blood vessels) can best be managed early (first 48 hours) by applying ice packs and maintaining the strained muscle in a stretched position. Heat can be applied (after 48 hours) when the swelling has lessened. However, the early application of heat can increase swelling and pain.

Note: Ice or heat should not be applied to bare skin. Always use a protective covering such as a towel between the ice or heat and the skin.

  • Take nonsteroidal anti-inflammatory drugs (NSAIDS) such as cataflam or ibuprofen to reduce pain and improve your ability to move around. Do not take NSAIDS if you have kidney disease or a history of gastrointestinal bleeding or if you are also taking a blood thinner.
  • Protection, rest, ice, compression, and elevation (known as the PRICE formula) can help the affected Here’s how: First, remove all constrictive clothing, including jewellery, in the area of muscle strain. Then:
    • Protect the strained muscle from further
    • Rest the strained Avoid the activities that caused the strain and other activities that are painful.
    • Ice the muscle area (20 minutes every hour while awake). Ice is a very effective anti- inflammatory and pain-reliever. Small ice packs, such as packages of frozen vegetables or water frozen in foam coffee cups, applied to the area may help decrease
    • Compression can be gently applied with an elastic bandage, which can both provide support and decrease Do not wrap tightly.
    • Elevate the injured area to decrease Prop up a strained leg muscle while sitting, for example.
    • Activities that increase muscle pain or work the affected body part are not recommended until the pain has significantly
  • For Grade 1/2, muscle should not be completely immobilised but rather used within pain