Adductor pain, that deep ache or sharp pull along your inner thigh, is most commonly caused by a strain of the adductor longus muscle, the longest and most frequently injured of the inner-thigh muscles that pull your leg toward your midline. But muscle strain is only one possibility. Groin pain overlaps with several other conditions, some of which have nothing to do with the muscle itself, and sorting them out matters because the right treatment depends on the right diagnosis.
What the Adductor Muscles Actually Do
You have five adductor muscles fanning from the pubic bone and pelvis down to various points on your femur: the adductor longus, adductor brevis, adductor magnus, gracilis, and pectineus. Their most obvious job is pulling your legs together, but they do more than that. Anatomical studies using cadaver dissection and MRI show that the adductor group also contributes to internal rotation of the hip and helps stabilize the pelvis in the side-to-side plane when you’re standing on one leg.1PubMed Central. Toward a Better Understanding of Hip Adductor Function: Internal Rotation Capability Revealed by Anatomical and MRI Evaluation That stabilizing role is why adductor problems show up not only in sports that involve squeezing the legs together (think horseback riding or hockey) but also in activities that demand quick side-to-side changes of direction.
Muscle Strains and How They Happen
The most common cause of sudden adductor pain is a muscle strain, and the adductor longus is the usual culprit. A strain isn’t just an overworked muscle. It happens when the muscle is stretched too far or, more precisely, when it is being forcefully stretched at the same moment it’s trying to contract. The damage concentrates near the junction where the muscle belly meets the tendon.2PubMed. Muscle strain injuries That’s the mechanical weak point, and it explains why you’ll often feel the pain high up near your groin rather than in the middle of the thigh.
Video analysis of professional soccer players who suffered severe adductor longus injuries found that most injuries happened during movements where the leg was planted on the ground while the body moved away from it. Roughly two-thirds of the injuries occurred in these “closed chain” situations, things like lunging sideways, changing direction, or reaching with the opposite leg. In those cases, the hip was extending, abducting, and externally rotating all at once, putting the adductor on a three-dimensional stretch.3PubMed Central. Mechanisms of Severe Adductor Longus Injuries in Professional Soccer Players: A Systematic Visual Video Analysis The remaining injuries occurred during open-chain actions like kicking and jumping, where the leg swings freely through the air and the muscle gets caught in a rapid switch from extension to flexion.4British Journal of Sports Medicine. Mechanisms of acute adductor longus injuries in male football players: a systematic visual video analysis
You don’t have to be a professional athlete for this to happen. A recreational soccer game, an awkward lunge at the gym, stepping on ice and having your leg slide sideways, or even an overly enthusiastic stretch can create the same mechanism: the muscle is lengthening quickly while it’s trying to fire.
What Raises Your Risk
Weak adductors are the most consistent predictor of future groin pain. A meta-analysis pooling data from multiple studies of healthy athletes found a moderate relationship between lower hip adductor strength and subsequent groin injury.5PubMed. Is hip adductor or abductor strength in healthy athletes associated with future groin pain? A systematic review and meta-analysis Interestingly, abductor strength (the muscles on the outside of the hip) and the ratio of adductor-to-abductor strength did not independently predict groin pain in that same analysis, which complicates the old idea that the ratio alone is what matters.
Other well-supported risk factors include a previous groin injury, a higher level of play, and lower levels of sport-specific training, meaning athletes who ramp up too quickly after the off-season or switch sports are more vulnerable.6British Journal of Sports Medicine. Risk factors for groin injury in sport Preseason is a particularly risky window.7PubMed Central. Groin injuries in sports medicine In hockey and soccer, preseason screening of adductor strength has been used to identify players who might benefit from targeted strengthening before the season starts.8PubMed. Measuring the Hip Adductor to Abductor Strength Ratio in Ice Hockey and Soccer Players: A Critically Appraised Topic
When It’s Not a Simple Strain
Inner-thigh pain doesn’t always come from the adductor muscle itself. Several conditions mimic the feeling of an adductor strain, and they can overlap with one another, making diagnosis tricky. If your groin pain has been lingering for weeks or keeps coming back, one of these other culprits may be involved.
- Femoroacetabular impingement (FAI): This is a structural issue in the hip joint where extra bone on the femoral head or the hip socket rim causes pinching during certain movements. FAI and adductor pain frequently coincide in athletes. One study of football players with chronic adductor-related groin pain found that about three-quarters of them also had signs of FAI, including reduced hip range of motion and weaker adductors.9Journal of Health, Wellness and Community Research. Prevalence of Femoroacetabular Impingement Symptoms in Football Players with Chronic Adductor-Related Groin Pain Treating the adductor alone without addressing the hip joint can leave you stuck in a cycle of re-injury.
- Athletic pubalgia (sports hernia): This involves a tear or weakness in the soft tissues around the pubic bone, and it shares many of the same symptoms as adductor tendinopathy. The two conditions, along with osteitis pubis (inflammation of the pubic symphysis), frequently overlap on physical examination.10PubMed Central. Groin Injuries (Athletic Pubalgia) and Return to Play FAI and athletic pubalgia also commonly coexist.11PubMed Central. The Role of Femoroacetabular Impingement in Core Muscle Injury/Athletic Pubalgia: Diagnosis and Management
- Obturator neuropathy: The obturator nerve runs through the inner thigh and supplies the adductor muscles. If it gets entrapped by surrounding tissue, the symptoms can include medial thigh or groin pain, weakness when squeezing your legs together, and sometimes numbness on the inner thigh.12PubMed Central. Obturator neuropathy This is less common than a muscular strain, but it’s worth considering when pain is chronic and accompanied by sensory changes.
Non-Athletic Causes of Adductor Pain
You don’t have to be an athlete to develop inner-thigh pain. Pregnancy-related pelvic girdle pain is a common source. The hormonal and biomechanical changes of pregnancy alter the way the pelvis moves and how muscles fire around it. A systematic review found moderate evidence that pregnancy-related pelvic girdle pain is associated with altered motor control and changes in how the pelvis moves.13PubMed Central. Is pregnancy related pelvic girdle pain associated with altered kinematic, kinetic and motor control of the pelvis? A systematic review The adductors, which attach directly to the pubic bone, can become overloaded or irritated as the pelvis shifts to accommodate the growing uterus.
Other non-sport causes include prolonged sitting in an awkward position (the kind that happens on long flights or at a desk with a poorly adjusted chair), sudden increases in walking or stair-climbing after a sedentary period, and osteoarthritis of the hip, which can refer pain to the inner thigh. Older adults sometimes develop adductor pain after a fall or a stumble that forces the legs apart without the dramatic athletic mechanism described earlier.
Getting the Right Diagnosis
A clinician will typically start with a physical exam: squeezing tests where you press your knees together against resistance, range-of-motion testing of the hip, and palpation of the pubic bone and tendon attachment. The squeeze test is simple and reasonably accurate for identifying adductor-related pain, but because multiple conditions share the same neighborhood, imaging often helps.
Musculoskeletal ultrasound has become a valuable first-line tool for evaluating adductor longus injuries. It’s sensitive for detecting both partial and full-thickness tears, can be done dynamically (the clinician moves the limb while watching the muscle on screen), and allows side-to-side comparison with the uninjured leg. It’s also faster and cheaper than MRI. That said, MRI is still the better choice when the picture is complicated or when the clinician needs to rule out bone stress injuries, labral tears, or other deeper structures that ultrasound can’t visualize as well.14International Journal of Sports Physical Therapy. Diagnostic Musculoskeletal Ultrasound in the Evaluation of Adductor Longus Injuries: Implications for Rehabilitation Providers
Conservative Treatment and Rehabilitation
Most adductor strains heal without surgery. In the first few days after an acute strain, the basics apply: rest from the aggravating activity, ice for pain control, and gentle movement within a pain-free range to prevent the muscle from stiffening up completely. Anti-inflammatory medication can help with short-term comfort, though it won’t speed healing.
The more interesting part of treatment is what comes after those first few days. Strengthening the adductors, especially with eccentric loading (where the muscle lengthens under tension), has the strongest evidence base. The Copenhagen adduction exercise, a side plank variation where you use your top leg to support your body weight while the inner-thigh muscles do the work, has been studied extensively. A systematic review found that it consistently improved eccentric adductor strength, hip range of motion, and dynamic balance while reducing groin-related symptoms.15Apunts Sports Medicine. The influence of Copenhagen adduction exercise on the management of groin pain: A systematic review A randomized trial in soccer players with groin injuries confirmed that adding the Copenhagen exercise produced greater strength gains and a more noticeable reduction in pain compared to a control group doing standard rehabilitation.16PubMed. The effectiveness of the Copenhagen adduction exercise on improving eccentric hip adduction strength among soccer players with groin injury: a randomized controlled trial
The catch is that training volume matters. Higher-volume programs produced better outcomes than lower ones, so doing a few half-hearted sets twice a week probably won’t cut it. Progressive overload, gradually increasing the difficulty by moving from easier versions to harder ones, is what drives adaptation.
For athletes with groin pain syndrome that hasn’t responded to standard exercise alone, focused shockwave therapy has shown promise as an add-on. A prospective study in soccer players found meaningful improvements in hip function scores and pain ratings after integrating shockwave therapy into a rehabilitation program, with continued improvements at follow-up.17PubMed Central. Integrating Focused Shockwave Therapy into Rehabilitation for Groin Pain Syndrome: A Prospective Study in Soccer Players Shockwave therapy is thought to promote tissue repair and reduce pain signaling, though the evidence is still developing and it’s usually considered an adjunct rather than a standalone treatment.
Injections and Whether They’re Worth It
If exercise-based rehab hasn’t resolved the problem, injections are sometimes offered. Platelet-rich plasma (PRP) has gained popularity on the theory that concentrated growth factors from your own blood can accelerate tendon healing. A case report in a competitive soccer player with chronic adductor pain suggested that PRP allowed a faster start to rehabilitation compared to physical therapy alone or corticosteroid injection, where recovery can take eight weeks for acute injuries and up to six months for chronic strains.18PubMed 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
The enthusiasm for PRP should be tempered by larger comparative data. A retrospective study comparing exercise-based therapy, corticosteroid injection, and PRP in football players with MRI-confirmed adductor-related groin pain found that all three approaches produced similar outcomes. Return-to-sport rates were roughly comparable across all groups, around 85 to 89 percent, with no statistically significant difference.19Sports Traumatology & Arthroscopy. Retrospective Comparison of Corticosteroid, Platelet-Rich Plasma, and Exercise-Based Therapies in the Management of Adductor-Related Groin Pain Among Football Players The practical takeaway is that exercise-based therapy alone appears to be just as effective as either injection type for most people, which is worth knowing before paying out of pocket for PRP (which insurance often doesn’t cover).
When Surgery Enters the Picture
Surgery for adductor pain is uncommon and typically reserved for chronic cases that have failed several months of conservative treatment. The most frequently described procedure is adductor tenotomy, where the surgeon partially or completely releases the tendon from its attachment to the pubic bone. Some surgeons release only the superficial fibers of the adductor longus, while others perform a full release.20Journal of Orthopaedic Experience & Innovation. Surgical and Conservative Management of Adductor Tendinopathy Yield Comparable Outcomes and Complications: A Systematic Review
A study evaluating adductor tenotomy in patients with chronic pain that hadn’t responded to conservative therapy found success rates of roughly 57 to 61 percent, depending on whether the tenotomy was performed alone or in combination with other procedures. No major complications were reported.21PubMed Central. Adductor tendinopathy as a source of ongoing chronic postoperative inguinal pain—evaluating outcomes of adductor tenotomy Those success rates are honest but not overwhelming, and they underscore why surgery is positioned as a last resort rather than a reliable fix. For cases involving osteitis pubis (inflammation of the pubic symphysis) alongside adductor tendinopathy, an arthroscopic approach combining pubic symphysis curettage with adductor reattachment has been described, with patients returning to full activity after about 14 weeks on average.22PubMed. Osteitis pubis and adductor tendinopathy in athletes: a novel arthroscopic pubic symphysis curettage and adductor reattachment
Returning to Activity Without Re-Injury
One of the trickiest parts of adductor injuries is knowing when you’re ready to go back to full activity. Going back too early is a well-documented path to re-injury, and the numbers are striking. A prospective study of male athletes with acute adductor injuries found that those who met specific rehabilitation milestones before returning to sport had a reinjury rate of about 5 percent, while those who returned before meeting those milestones reinjured at a rate of about 21 percent.23PubMed Central. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study That’s a fourfold difference, and it makes a strong case for using objective benchmarks rather than relying on how the injury “feels.”
Typical return-to-sport criteria include pain-free full-range hip motion, adductor strength at or above 90 percent of the uninjured side, the ability to perform sport-specific movements (cutting, sprinting, kicking) at full intensity without pain, and completion of a graduated return-to-play progression over days or weeks rather than jumping straight back into competition.
Preventing Adductor Problems in the First Place
Prevention and rehabilitation overlap heavily, because the best evidence for preventing adductor injuries involves the same exercises used to treat them. The Copenhagen adduction exercise has the dual benefit of being both a rehabilitative and a preventive tool, and it can be built into warm-ups without adding much time. Programs that include regular adductor strengthening, particularly during preseason when risk is highest, have been shown to reduce the incidence of groin injuries in team sports.
Beyond targeted strengthening, there are practical habits that reduce risk. Warming up properly before intense activity (dynamic movements, not static stretching alone) prepares the muscles for rapid contractions. Avoiding sudden jumps in training volume, the classic “too much too soon” pattern, gives the tendons time to adapt. And if you’ve had an adductor injury before, you are statistically at higher risk for another one, so maintaining adductor strength year-round rather than only during the season is a reasonable investment of your gym time.