by Gary Vitti
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It’s being widely reported that LeBron James has suffered a re-injury to his groin during the 2019 Christmas Day game. This injury has occurred one year after sustaining a groin injury during the 2018 Christmas Day game. I have no direct knowledge of what exactly the injury is or to what degree but there are a few things that are confusing in the media as to whether this is an actual re-injury or something completely unrelated to last year’s injury. What we do know is, last year LeBron said he felt a pop which is a telltale sign of a strain ( tear ). This year he said he was kneed in the groin by Patrick Beverly as he was trying to draw a charge. Those are markedly different mechanisms of injury. It was also reported that last year the injury was to the left side of his body, this year it is to the right. Are the two related or is it a coincidence?

Much has been said about LeBron’s training habits so one would like to think he has been completely rehabilitated from an injury that occurred one year ago. Since that’s all we know I can’t speculate about LeBron’s injury but I can give you an overview of what I know about groin injuries.

First off groin injuries are difficult to evaluate because there are several things in the groin area that are completely different injuries but mimic the same signs and symptoms. Video replay and good communication from the athlete about the history and mechanism of injury along with diagnostic ultrasound and MRI will help narrow down what the issue is and how to treat it.

It is integral to differentiate a sports hernia (athletic pubalgia), inguinal hernia, hip flexor strain or osteitis pubis as well as several other obscure causes of groin pain from the more common injury we call a groin strain. The groin strain involves the muscles and tendons we call the adductors that bring the leg towards the midline of the body. I will limit this blog to the more common strain of the adductors.

It is generally accepted that there are 5 adductor muscles: adductor brevis, adductor longus, adductor magnus, pectineus and gracilis. Some anatomists add adductor minimus and the obturator externus to the list. They all originate at the bottom of the pelvis and mainly insert at the inside back of the thigh bone ( femur ). Their primary function is bringing the thigh towards the midline of the body ( adduction ) in non-weight bearing motions and stabilization of the lower extremity and pelvis during weight-bearing motions. Renstrom and Peterson reported in the British Journal of Sports Medicine that the adductor longus is the most commonly strained adductor muscle in sports activity.

The adductor muscle group is most at risk in sports that require dynamic deceleration ( eccentric load ) and change of directions ( torque ). Research has shown the adductor/abductor strength ratio can be a contributing factor as well as leg length discrepancies, and poor foot mechanics. It has also been reported that athletes that sustained a previous groin strain were 2 to 3 times more likely to re-injure.

In my experience, most often the key factors are the biomechanics of the lower extremity contributing to anterior pelvic tilt and pelvic instability. It is not uncommon for an NBA player to present himself to the athletic trainer with groin pain not associated with a particular incident. It could be as simple as I was fine yesterday and I woke up this morning with pain in my groin. If there is no mechanism of injury than the groin pain can be the result of mechanical issues vs structural damage as in a strain. Understanding and correcting how the body transfers force through the pelvis to run and jump will determine a treatment protocol to help treat and prevent groin pain as well as lower the risk of injury.

The sacroiliac joint in the back of the pelvis and the pubic symphysis in the front of the pelvis form the pelvic girdle to stabilize the pelvis as the athlete moves through space in an uncontrolled manner. Poor pelvic stability will create a shearing force at the pubic symphysis creating an asymmetrical loading and leading to restricted hip motion and muscle imbalances.

Through myofascial release, stretching of tight muscles and activation of weak muscles the athletic trainer or physical therapist can get that athlete’s pelvis back into a neutral position and eliminate the groin pain as well as the risk of further injury. Once the pelvis is in neutral, a good core program must be initiated to keep the pelvis in neutral especially during dynamic movement required in sports.

I still hear people talk about abs in terms of the core. The athlete needs to look deeper as in the core of an apple. The core that has both a stabilizing and mobilizing role.

There are several ways for an athletic trainer or physical therapist to assess core stability with the goal of establishing a neutral pelvic position, spinal alignment and optimal load transfer.

Groin pain can be complicated to evaluate, debilitating, difficult to treat and time-consuming to rehab.

As always the best way to treat an injury is to prevent it. Evaluating and correcting the postural distortion patterns of an athlete by a qualified athletic trainer or physical therapist is the best way to prevent and/or treat groin pain. This is not accomplished overnight. Treating groin pain should not be taken lightly. It requires expertise, time and patience. Failure to do so will most likely result in re-injury and chronic pain.

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