The Hockey Groin
Russell Gunner, C.A.T. (C)

The Hockey Groin

Due to the aggressive nature of hockey, with hard checks, and quick push-offs, there is always the chance of an injury occurring. This is especially true in the early season games and practices. Every team I have worked with over the past 15 years has had several players out in the early season due to a groin injury. In the previous N.H.L. seasons, the incidence of pre-season groin injuries was significantly higher than that of the regular season. Several of the N.H.L. therapists attest this to the lack of off-season conditioning, or poor pre-practice/game stretching routines. Whatever the reason, injuries will occur, and when they do, how do we treat them? We all know the R.I.C.E. (Rest, Ice, Compression and Elevation) and P.I.E.R. (Pressure, Ice, Elevation and Rest) principles for immediate treatment, but after this, most of us are stuck.

Most groin injuries will involve the pectineus and iliopsoas muscles when related to hockey players. These muscles are located deep in the groin, either midway or just in front of the pelvis. The concern however with these injuries in hockey players is the chance of a small tear in the abdominal muscles. If this occurs, the injury can take months of rehab and even worse, surgery. Anytime you hear of N.H.L. players taking months off or even the entire year due to a groin injury, there is a good chance the abdominals were torn, rather that he pectineus or iliopsoas muscles.

Over 26% of all N.H.L. injuries in recent years were associated with the groin and pelvis area. This is a significant amount, and something needs to be done to avoid this from occurring at such a rapid rate. Most athletic therapists in the N.H.L. attest this high incidence rate due to the skating stride in hockey. When a player is improperly recruiting these muscles during the basic skating stride, this may place unnecessary strain upon the groin muscles, which will inherently break down over time. The body cannot handle these stresses and this is what places the athlete in jeopardy. They will then need to rehabilitate the groin and miss several weeks, if not months, off the ice. Anybody who has had this injury will attest to the fact that it is a frustrating injury to deal with. Being unable to skate for weeks due to pain, can soon affect the player psychologically. This is why it is very important for the player to still stay involved with the team, such as traveling, dressing room and team functions, etc.

The groin may also be injured from a sudden violent force (i.e. skate taken out from underneath player). When this happens, the first and foremost thing to do is reduce the swelling and inflammation right away with ice. Rest is also an extremely important factor, and skating should not be attempted again until full strength in that groin is regained. I have seen too many hockey players return too soon following a groin injury and aggravate it further, thereby increasing their total time away from the rink. You should not return until your sports physician and therapist decide that the muscles are fully healed. Unfortunately, the hockey player is not always the best judge of when to return. They will often put the team ahead of their own well-being.

Signs and Symptoms of a Groin injury:
1. Pain with motion or stretching of the hip joint. Usually located on the inside, and can sometimes be very close to the pubic bone.
2. Muscle spasm in the abdomen and groin area or thigh. If the pain is more associated in the abdomen region, please get it assessed immediately. This may be something other than "The Hockey Groin", such as a hernia.
3. Swelling around the groin.
4. Loss of strength depending upon the severity of the injury.
5. Can be very tender to the touch.

Treatment:
1. You should always consult your Physician or Athletic Therapist following an injury for further evaluation.
2. P.I.E.R. /R.I.C.E. for at least 48 hours. Icing every hour for 20 minutes over a wet towel.
3. Crutches may be necessary if the strain is very serious. Minimal to no weight bearing for at least 48 hours.
4. After 48 hours, exercises can begin gently increasing range of motion and strength.
5. Depending upon severity, groins will take a long time to heal. The athlete should not attempt to be skating again until they can walk and run pain free.
6. Treatment that is effective with this injury: Correction of pelvic mechanics, Soft Tissue Release/ART, laser and a good stretching routine.

Stretches (Hold all stretches 30 seconds and repeat 2 times):
1) Lunge (Iliopsoas) stretch – Kneeling on the injured side knee with the opposite foot in front. Lean forward until a stretch is felt in the front groin area. Keep your back straight.
2) Alternative lunge (pectineus) stretch – Kneeling on the injured side knee with the opposite foot in front. Take the injured groin out to the side further than above, while keeping the arch of the injured side foot flat on the ground. Then lean the injured groin towards the opposite foot until the stretch is felt in the inside groin area. Keep your back straight.
3) Groin (adductor) stretch – While kneeling on both knees, take the knees as far apart as they can go within your pain free limits. Lean forward and rest on your elbows. Keep the arches on the feet flat on the ground. Keep the back straight and lean slowly backwards towards the feet until a stretch is felt in the groin.