A pulled groin muscle, medically called an adductor strain, responds best to a combination of early protection, controlled loading, and progressive strengthening exercises that rebuild the injured tissue over weeks. The approach is largely the same regardless of sex, but women dealing with groin pain face some unique diagnostic challenges because several conditions common in female athletes can mimic or coexist with a simple muscle pull. Knowing what to do in the first few days, how to rehabilitate properly, and when the pain signals something other than a muscle strain can make the difference between a quick recovery and months of frustration.
What Actually Gets Injured
The groin area houses a group of muscles called the adductors, which run from the pelvis down the inner thigh and pull the leg inward. The adductor longus is the most commonly strained of the group. Its tendon at the top is surprisingly small, measuring only about 12 mm long and under 4 mm thick according to cadaver research, which helps explain why it is so vulnerable to sudden overload.1Diagnostic and Interventional Imaging. Imaging of adductor-related groin pain Other muscles in the group, including the adductor brevis, adductor magnus, and gracilis, can also be strained, though less frequently.
These injuries typically happen during movements that demand quick direction changes, explosive kicks, sprinting, or sudden deceleration. Sports like soccer, hockey, basketball, and tennis are common culprits, but a groin pull can also happen during everyday activities like slipping on ice, stepping awkwardly off a curb, or lunging during a workout.2LUMEN ET VIRTUS. ADDUCTOR MUSCLE INJURY DUE TO STRAIN: DIAGNOSTIC AND THERAPEUTIC APPROACH You do not have to be an elite athlete to strain a groin muscle.
How to Gauge the Severity
Groin strains are commonly classified by how much of the muscle or tendon is damaged. A minor partial tear involves a small amount of disruption to the muscle fibers, and you might feel tightness and mild pain but can still walk without much trouble. A moderate partial tear means more fibers are torn, causing noticeable weakness, more pain with activity, and sometimes visible bruising on the inner thigh. A subtotal or complete tear, sometimes involving the tendon pulling away from the bone (avulsion), produces severe pain, significant loss of function, and often an inability to bear weight comfortably.3PubMed Central. Classification systems for assessing acute muscle injuries: a retrospective comparison of inter-reader agreements
The severity matters because it determines how aggressive your treatment needs to be and roughly how long recovery will take. Mild strains can resolve in a couple of weeks with self-care. Moderate strains often need four to eight weeks of structured rehabilitation. Complete tears may require months of recovery and, in rare cases, surgery. If you heard a pop at the time of injury, felt sudden sharp pain, or cannot squeeze your knees together without significant pain, treat it as potentially moderate to severe and get it evaluated.
The First Few Days After Injury
The traditional advice of rest, ice, compression, and elevation has been updated in sports medicine. A newer framework called PEACE and LOVE captures what the research now supports for soft-tissue injuries like groin strains. The first phase, PEACE, covers the initial days after injury: protect the area by avoiding activities that increase pain, elevate when practical, avoid anti-inflammatory medications early on (because inflammation is part of the healing process), compress the area to manage swelling, and educate yourself about the injury so you set realistic expectations.4Orthopaedic Journal of Sports Medicine. Review of PEACE and LOVE the new era of RICE in acute soft tissue injury management? – A narrative review
The LOVE phase kicks in after the first couple of days and stands for optimism (psychosocial attitude affects recovery), vascularization (gentle aerobic activity to promote blood flow), and exercise (progressive loading to stimulate tissue repair). The key takeaway is that complete rest beyond the first day or two is not ideal. Early, pain-guided movement actually helps healing. Walking gently, light stationary cycling if tolerable, and pool-based exercise are good ways to maintain circulation without stressing the injured tissue.
One practical point worth highlighting: the advice to avoid anti-inflammatories like ibuprofen in the first 48 to 72 hours surprises many people. The early inflammatory response helps recruit repair cells to the injury site. If the pain is unbearable, acetaminophen (Tylenol) is a better choice for those initial days because it manages pain without suppressing inflammation. After the acute phase passes, anti-inflammatories become less of a concern.
Rehabilitation Exercises That Work
Once the initial pain subsides enough that you can move without sharp discomfort, structured exercise becomes the most important part of recovery. The evidence consistently supports exercise programs that include strengthening, and most successful programs use functional, standing positions that resemble real movement patterns.5PubMed Central. A systematic review of the literature on the effectiveness of exercise therapy for groin pain in athletes Programs in the research literature have lasted anywhere from about four weeks to sixteen weeks depending on injury severity.
One exercise that has emerged as a standout for groin rehabilitation is the Copenhagen adductor exercise. It is performed as a side plank where your top leg rests on a bench and your bottom leg squeezes up to meet it, loading the inner thigh muscles eccentrically (while they are lengthening). A systematic review found that this exercise significantly increases eccentric hip adduction strength in every study that measured it.6PubMed Central. The Neuromuscular Effects of the Copenhagen Adductor Exercise: A Systematic Review A randomized trial in soccer players with groin injuries found that those who performed the Copenhagen exercise showed greater strength gains and more pain reduction than the comparison group.7PubMed. The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial
You do not need to jump straight into the full version. The Copenhagen exercise can be scaled by starting with your knee on the bench instead of your foot, reducing the lever arm and the load. A typical progression looks something like this:
- Week 1–2: Gentle isometric squeezes (pressing a pillow between your knees while lying down), short-lever Copenhagen holds with the knee on the bench, and pain-free stretching.
- Week 2–4: Longer isometric holds, progressing to short-lever Copenhagen repetitions, light resistance band adduction in standing, and single-leg balance work.
- Week 4–6+: Full Copenhagen exercise with the foot on the bench, heavier resistance work, sport-specific drills like lateral lunges and cutting movements.
Core stability work should run alongside adductor strengthening throughout. Eccentric strengthening of the adductors combined with core exercises has been shown to improve both strength and functional activity in the lower limb.8PubMed. Recovery of two elite footballers from adductor strain with dry needling and eccentric strengthening: Two case studies The adductors do not work in isolation; they share load with the abdominals and hip flexors, so strengthening everything together produces a more resilient groin.
When to See a Doctor
Mild groin strains often heal fine with self-directed rehabilitation. But groin pain in women has a wider differential diagnosis than many people realize, which means the pain might not be a simple muscle pull at all. Several conditions can produce similar symptoms, and some of them overlap or coexist with adductor strains.
Osteitis pubis, an inflammation of the pubic bone and the joint at the front of the pelvis, is one of the more common mimics. It produces central groin pain that can feel identical to a muscle strain, and distinguishing the two based on symptoms alone is difficult. Imaging like MRI and bone scans can help sort this out.9PubMed Central. Osteitis pubis in elite athletes: Diagnostic and therapeutic approach Interestingly, adductor damage and pubic bone inflammation often coexist. In one study of athletes with osteitis pubis, the side where adductor lesions appeared on MRI correlated better with the side of symptoms than the bone changes did.10PubMed Central. Prevalence and patterns of adductor lesions on MRI in athletes with osteitis pubis
Athletic pubalgia, sometimes called a sports hernia, is another condition that can cause groin pain in women. It involves weakness or tearing in the abdominal wall near the pelvis rather than in the adductor muscles themselves. Specialized MRI protocols that include imaging during a Valsalva maneuver (bearing down) can help detect abdominal wall deficiencies that standard imaging might miss.11PubMed Central. Athletic Hernia/Athletic Pubalgia Among Women Hip joint problems like labral tears or hip impingement can also refer pain to the groin and sometimes coexist with adductor injuries.
Consider seeking medical evaluation if any of these apply:
- Pain persists beyond two to three weeks despite rest and gentle rehab exercises.
- Severe pain or inability to bear weight immediately after injury, suggesting a higher-grade tear.
- Pain is central rather than clearly on the inner thigh, which raises the possibility of pubic bone or abdominal wall pathology.
- Pain worsens with coughing or straining, which can point toward a hernia or abdominal wall deficiency.
- Pain is deep in the hip joint or includes clicking and catching sensations, suggesting a labral or joint issue.
MRI is the most useful imaging tool for sorting out groin pain. It can evaluate the adductor muscles, the pubic bone, the hip joint, and the abdominal wall in a single session, which makes it especially helpful when the pain is hard to localize.12PubMed Central. Hip Imaging of Groin Pain: Magnetic Resonance and Ultrasound Imaging Features Ultrasound is another option, particularly for evaluating the pubic region in real time, and it has the advantage of being performed dynamically during movement.
Medical Interventions for Persistent Cases
Most groin strains heal with exercise-based rehabilitation alone, but some cases drag on, particularly when there is tendon involvement or chronic degeneration rather than a clean acute tear. For these situations, platelet-rich plasma (PRP) injections have been explored as a way to jumpstart the healing process. PRP involves drawing your blood, concentrating the platelets, and injecting them into the injured area. The idea is that the growth factors in platelets accelerate tissue repair and promote new blood vessel formation. There is evidence supporting PRP for tendon-related problems, and it may reduce the need for surgery and time lost from sport in cases of adductor-related groin pain.13PubMed Central. Nonsurgical Management of Adductor-related groin pain with Ultrasound-Guided Platelet-Rich Plasma Injection and Physical Therapy in a Competitive Soccer Player: A Case Report
PRP is not a first-line treatment for a fresh groin strain. It is worth discussing with a sports medicine physician if you have been doing structured rehab for several weeks without meaningful improvement, especially if imaging shows tendon damage. Corticosteroid injections are another option some providers offer, though they are more controversial for muscle and tendon injuries because steroids can weaken tissue if repeated. Surgery for adductor injuries is rare and typically reserved for complete tendon avulsions from the bone that do not respond to conservative treatment.
Knowing When You Are Ready to Return to Full Activity
Returning too quickly is one of the most common mistakes with groin strains, and it is a major driver of re-injury. Rather than going by a set timeline, research supports using specific performance criteria to determine readiness. A prospective study on acute adductor injuries used a detailed checklist that athletes had to pass before returning to sport.14PubMed Central. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study The criteria included being completely pain-free during palpation, maximal isometric squeezing, full passive stretching, Copenhagen exercises, and sprinting at full effort. Beyond that, agility drills and sport-specific movements also had to be pain-free.
A recent expert consensus on return-to-play criteria after adductor longus injury validated similar benchmarks, including pain on palpation, flexibility, strength assessments, movement quality, and performance under simulated match conditions.15PubMed Central. Consensus of Return-to-Play Criteria After Adductor Longus Injury in Professional Soccer These criteria were developed in professional soccer, but the principles translate well to any active woman recovering from a groin strain. The core idea is that you should be able to perform every movement your sport or activity demands, at full intensity, without pain or compensation, before you consider yourself recovered.
A practical self-test progression you can use at home:
- Level 1: Walk briskly without any groin discomfort.
- Level 2: Jog at a moderate pace for 10 to 15 minutes with no pain.
- Level 3: Sprint at about 75% effort in a straight line, pain-free.
- Level 4: Sprint at full effort, change direction, and perform lateral movements without pain.
- Level 5: Complete a full workout or practice session in your sport, including all reactive and unplanned movements, pain-free.
Move to the next level only when the current one is consistently comfortable. Skipping levels is how re-injuries happen.
Why Groin Pain in Women Is Often Misdiagnosed or Dismissed
Groin pain has historically been studied and treated as a male athlete’s problem. Much of the landmark research has been conducted in men’s soccer and hockey, and the clinical frameworks were built around male anatomy and male injury patterns. This creates a real problem for women. Groin pain in female athletes is less common than in men, but when it does occur, it is more likely to be attributed to something vague or dismissed as hip-related rather than evaluated systematically.
Women are also more likely to have overlapping sources of groin pain. The wider female pelvis changes the biomechanical forces on the adductor muscles and pubic bone. Gynecological conditions like ovarian cysts, endometriosis, or pelvic floor dysfunction can produce pain that radiates to the groin, further complicating the picture. A woman with what feels like a pulled groin muscle might actually have a combination of a mild adductor strain and an underlying pelvic floor issue, each feeding into the other.
If your groin pain does not follow the typical trajectory of a muscle strain, with steady improvement over two to four weeks of rehabilitation, push for a thorough evaluation. Ask specifically about athletic pubalgia, hip joint pathology, and pelvic floor assessment. A sports medicine physician or orthopedic surgeon familiar with female groin pain is more likely to consider the full range of possibilities than a generalist who may default to recommending rest and waiting.
Preventing Re-Injury and Future Strains
Groin strains have a frustrating tendency to recur, especially when the original injury was not fully rehabilitated. The single most important thing you can do to prevent re-injury is to maintain adductor strength after you have recovered. The Copenhagen adductor exercise, used during rehabilitation, doubles as an excellent prevention tool. Incorporating it into your regular training routine two to three times per week keeps the adductors strong enough to handle sudden loads.
Other practical prevention strategies include warming up properly before explosive activity. A dynamic warm-up that includes lateral lunges, leg swings, and controlled adductor stretches prepares the muscles for the forces they are about to face. Static stretching before exercise, by contrast, does not prevent muscle strains and may temporarily reduce muscle force output, so save long holds for after your workout.
Strength imbalances also play a role. If your adductors are significantly weaker than your abductors (the muscles on the outside of the hip), the imbalance creates vulnerability. A simple way to monitor this is periodically testing whether you can squeeze your legs together with the same force you can push them apart. If squeezing feels noticeably weaker, your adductors need more targeted work. Maintaining a balanced strength ratio between these muscle groups is one of the most evidence-supported ways to keep the groin healthy over the long term.