Suffering with Groin Pain?

Hip Adduction: Often forgotten in Hip Rehabilitation?

It is common for avid exercise enthusiasts to incorporate hip strengthening exercises into their routines that focus on the hip abductors. There is seemingly a surge in popularity of exercises targeting your glutes, for instance; leg lifts, single leg work, lateral band walks. However, arguably, many people neglect the much needed companion to the abductors, the adductors.

​Hip Adductor Complex

The adductors are a group of muscles on the inside of your thigh. The adductor magnus, adductor longus, adductor brevis, pectineus and gracilis muscles all have involvement in hip adduction (bringing your thighs together). The adductor magnus muscle has a large hip extensor muscle moment arm, which in simple terms, makes it an unappreciated hip extensor, while the other adductors are also hip flexors. Therefore, the adductors play a part in many movements of the hip

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​Some believe that the adductor complex does not need specific, targeted exercise, as compound exercises, such as squats, sumo squats, and lunges demonstrate activation of these muscles. However, some evidence would suggest this claim was false. Of course compound exercises are integral to any strengthening exercise programme, but it is advantageous to ensure you make time to consider specific adductor muscle components.
The adductor magnus is a very large and heavy muscle. It is much larger and heavier than the other adductors. By some measures it is the second largest muscle in the body after the gluteus maximus. Ignoring the adductor magnus is therefore likely to lead to a failure to maximize overall muscular hypertrophy (growth and increased size of muscle) in the lower body.
Injury Risk
Just like with the front and back of the leg, where there is a strength relationship between the quadriceps and hamstrings, there is also a relationship between the abductor and the adductor strength. For most, these relationships do not need to be assessed with a fine toothcomb, but these ratios are commonly used within high performance sport. Weakness in the hip adductors compared to the abductors has been shown to be a risk factor for developing groin pain in several sports, such as football and hockey.
 
‘don’t just sit on the hip adduction machine in the gym, seek advice on exercise from a physiotherapist or exercise professional to add variety to your programme’
 
During rehabilitation, it is important to remember that the adductors may be preferentially activated at different degrees of hip flexion. The adductor magnus is most active between 0 – 45 degrees, the adductor longus and gracilis are most active at 45 degrees, and the pectineus is most active at 90 degrees. Therefore, don’t just sit on the hip adduction machine in the gym, seek advice on exercise from a physiotherapist or exercise professional to add variety to your programme. Below is an example of an evidence-based exercise for strengthening your adductors.
‘Hands on’ treatment may be used in conjunction with exercise rehabilitation too. A large consensus paper, the DOHA agreement, stated that ‘Multimodal treatment including manual adductor manipulation can result in a faster return to play, but not a higher treatment success, than a partially supervised active physical training programme’.
Copenhagen Adduction Exercise
The Copenhagen adduction exercise (CAE) is a bodyweight, partner-assisted movement popularized by Danish researchers and sports therapists, including one of the leaders in groin injuries, Kristian Thorborg. 

The well-known, FIFA promoted, FIFA 11+ injury prevention and warm-up programme was disseminated worldwide in 2009. More recent research has suggested adding the Copenhagen Adduction exercise to the FIFA 11+ to potentially prevent groin problems.
Thorborg and colleagues also investigated other exercises using elastic bands in adductor muscle strengthening research. Here, a hip adduction movement was performed over full range of motion with 3 seconds in, 2 seconds hold, and 3 seconds out. The participants performed 3 sets of exercise with both legs during each session. 

Good luck strengthening your adductors and keep active!

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References
Harøy, J., Thorborg, K., Serner, A., Bjørkheim, A., Rolstad, L.E., Hölmich, P., Bahr, R. and Andersen, T.E., 2017. Including the copenhagen adduction exercise in the FIFA 11+ provides missing eccentric hip adduction strength effect in male soccer players: A randomized controlled trial. The American journal of sports medicine, 45(13), pp.3052-3059.
 
Ishøi L, Sørensen CN, Kaae NM, et al. Large eccentric strength increase using the Copenhagen Adduction exercise in football: A randomized controlled trial. Scand J Med Sci Sports. 2016 Nov;26(11):1334-1342.
Jackie L Whittaker, et al. (2015) Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med;49,pp.803-809
Jensen, J., Hölmich, P., Bandholm, T., Zebis, M.K., Andersen, L.L. and Thorborg, K., 2012. Eccentric strengthening effect of hip-adductor training with elastic bands in soccer players: a randomised controlled trial. Br J Sports Med, pp.bjsports-2012.
 
Weir, A., Brukner, P., Delahunt, E., Ekstrand, J., Griffin, D., Khan, K.M., Lovell, G., Meyers, W.C., Muschaweck, U., Orchard, J. and Paajanen, H., 2015. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med, 49(12), pp.768-774.