Adductor Tendinopathy: Symptoms, Causes, and Treatment of Pain with Physiotherapy

Adductor tendinopathy

Adductor tendinopathy is a common musculoskeletal injury, particularly in physically active individuals. It occurs when the tendon of the inner thigh muscles is subjected to repeated mechanical overload, leading to pain in the groin or inner thigh and limited movement.

Adductor muscles play a fundamental role in hip stabilisation and movement control, particularly in activities such as running, changing direction, or kicking. In clinical practice, this condition is common in football, athletics, or rugby players, especially during periods of increased workload or return to competition after a break.

When the load exceeds the tendon's capacity, structural changes can occur, leading to pain and difficulty with movement. Without a structured approach, adductor tendinopathy tends to become persistent, limiting sports participation and quality of life.

Clinical assessment in physiotherapy

The approach in Physiotherapy begins with a detailed assessment that is not limited to the location of the pain. Clinical reasoning integrates:

• Clinical history and training load analysis
• Pain assessment, considering location, intensity and behaviour
• Adductor and Abductor Strength Tests
• Hip mobility and lumbo-pelvic control assessment
• Functional analysis of gestures such as running, changes of direction and shooting

In practice, it is common to identify deficits in motor control and strength asymmetries that contribute to tendon overload, and that only an individualised clinical assessment can identify.

Model of Tendinopathy and Implications for Intervention

Physiotherapy intervention is based on the tendinopathy continuum model, widely described in scientific literature, and is adjusted to the stage the tendon is in.

• In the reactive phase, a predominance of pain and sensitivity is observed, with load modulation and symptomatic control being a priority.
• In the dysfunction phase, structural changes with potential for reversibility are present, with therapeutic load being progressively introduced.
• In the degenerative phase, more marked structural changes occur, with the intervention aimed at optimising function and reducing the risk of progression.

How has the treatment evolved?

Physiotherapy intervention is always adapted to the individual's situation and evolves over time.

In the first phase, the focus is on reducing pain and recovering mobility, returning to movement safely and without worsening symptoms.

As the situation improves, work progresses to muscle strengthening, movement control, and the gradual reintroduction of daily activities or training.

The ultimate goal is to consolidate the gains achieved, improve functional resistance, and ensure the problem does not return.

Physiotherapy intervention

Current evidence supports an active, exercise-centred therapeutic approach with the aim of progressively reducing pain and recovering movement.

Load management and education

Mechanical load management is one of the pillars of intervention, being essential for controlling pain and preventing the worsening of symptoms. This process involves:

• Adjustment of volume, intensity, and frequency of training
• Prevention of abrupt load increases
• Individual education concerning pain and the safe progression of activity

Progression is always adjusted based on the individual's response to the load and the evolution of symptoms. In clinical practice, progression that is too rapid is one of the most common factors associated with symptom persistence.

Therapeutic exercise

Exercise is the primary intervention tool, being progressive and adapted, with the aim of reducing pain and improving function.

In clinical practice, it is observed that too rapid progression of load is one of the most common factors associated with symptom persistence, reinforcing the importance of a structured plan.

• In the initial phase, corresponding to the reactive phase, isometric exercises are favoured, with the aim of reducing pain and activating the musculature without aggravating symptoms.
• In the intermediate phase, concentric and eccentric exercises are introduced, with progressive loading to improve effort tolerance and reduce pain during movement.
• In the advanced phase, geared towards returning to sport, exercises with higher functional demand and specificity are included, with the integration of plyometric components and changes of direction.

Manual therapy

Manual therapy can be used as a complement, contributing to pain reduction, improved mobility, and easier movement without discomfort.

It includes techniques such as massage, joint mobilisations and myofascial release strategies.

Neuromuscular control and kinetic chain integration

Contemporary physiotherapy emphasises the functional integration of the lower limb within the global kinetic chain. This process includes:

• Training of core and lombo-pelvic control: strengthening and coordination of the abdominal, lower back, and pelvic muscles, which help to stabilise the spine and hip during movement.
• Improvement of intermuscular coordination: bettering how muscles work together, ensuring movement is efficient and without excessive strain on specific structures.
• Optimisation of movement patterns: improving how the body moves (e.g. running, changing direction or kicking), reducing compensations and distributing loads better.

Physiotherapy prevention

Physiotherapy intervention extends beyond the rehabilitation phase, integrating clinically relevant preventive strategies.

• Pre-season strength and conditioning programme implementation
• Identification and correction of asymmetries
• Monitoring load throughout the sports season

In athletes, monitoring weekly load and managing intensity peaks are crucial for reducing the risk of recurrence.

When to seek help

Adductor tendinopathy does not always resolve spontaneously, especially when pain persists or interferes with activity.

Does it make sense to seek assessment when there is:

• Persistent pain in the groin or inner thigh
• Pain when running, kicking or changing direction
• Difficulty training or maintaining activity without worsening
• Recurrent feeling of weakness, instability or discomfort

In these cases, a physiotherapy assessment allows for the identification of factors contributing to the overload and the definition of an approach tailored to the situation.

Timely intervention can prevent the persistence of symptoms and facilitate a more consistent recovery.

Understanding adductor tendinopathy from an integrative perspective

Adductor tendinopathy requires a structured approach, in which Physiotherapy plays a central role, not only in recovery but also in preventing recurrence.

A rigorous assessment, combined with appropriate load management and individualised exercise prescription, not only allows for pain reduction and functional recovery, but also a safe return to activity.

The scientific evidence is clear: an active, progressive, and person-centred intervention is the most consistent strategy for recovering from this condition in the long term.

At Integrativa, in Restelo (Lisbon), our team of Physiotherapists specialised in Sports Physiotherapy will support you through every stage, from initial assessment to your return to activity, with an individualised plan tailored to your pace.