Considering this management plan was written over ten years ago, my only addition would be the reduction of ice therapy and the addition of massage and heat therapy during the 2nd, 3rd, and 4th phase. Regardless of my suggestions, the following will be extremely useful for anyone who is, or has suffered from a groin strain.

Injury Situation:A women varsity basketball player had a history of tightness in her groin. During a game she suddenly rotated her trunk while also stretching to the right side. There was a sudden sharp pain and a sense of "giving way" in the left side of the groin that caused the athlete to immediately stop play and limp to the sidelines.

Symptoms & Signs:As the athlete described it to the athletic trainer, there was severe pain when rotating her trunk to the right and flexing her left hip. Inspection revealed the following:

• There was major point tenderness in the groin, especially in the region of the adductor magnus muscle.  

• There was no pain during passive movement of the hip, but severe pain did occur during both active and resistive motion.  

• When the groin and hip were tested for injury, the hip joint, illiopsoas, and rectus femoris muscles were ruled out as having been injured; however, when the athlete adducted the hip from a stretch position, it caused here extreme discomfort.

Management Plan:This detailed management plan comes from one of my old university text books, called by Daniel D. Arnheim. It's one of those 900 page door-stoppers, but it's the book I refer to most for information on sports injury prevention and rehabilitation. It's extremely detailed and a valuable resource for anyone who works in the health and fitness industry. So...

Based on the athletic trainer's inspection, with findings confirmed by the physician, it was determined that the athlete had sustained a second-degree strain of the groin, particularly to the adductor magnus muscle.

Phase 1

Management Phase: Goals: To control haemorrhage, pain and spasms. Estimated Length of Time (ELT): 2 to 3 days.

Therapy: Immediate Care: ICE-R (20 min) intermittently, six to eight times daily. The athlete wears a 6-inch elastic hip spica.

Exercise Rehabilitation: No Exercise - as complete rest as possible.

Phase 2

Management Phase: Goals: To reduce pain, spasm and restore full ability to contract without stretching the muscle. ELT: 4 to 6 days.

Therapy: Follow up care: Ice massage (1 min) three to four times daily. Bipolar muscle stimulation above and below pain site (7 min).

Exercise Rehabilitation: PNF for hip rehabilitation three to four times daily (beginning approx. 6 days after injury)Optional: Jogging in chest level water (10 to 20 min) one or two times daily. Must be done within pain free limits.General body maintenance exercises are conducted three times a week as long as they do not aggravate the injury.

Phase 3

Management Phase: Goals: To reduce inflammation and return strength and flexibility.

Therapy: Muscle stimulation using the surge current at 7 or 8, depending on athlete's tolerance, together with ultrasound once daily and cold therapy in the form of ice massage or ice packs (7 min) followed by light exercise, two to three times daily.

Exercise Rehabilitation: PNF hip patterns two to three times daily following cold applications, progressing to progressive-resistance exercise using pulley, isokinetic, or free weight (10 reps, 3 sets) once daily.Optional: Flutter kick swimming once daily.General body maintenance exercises are conducted three times a week as long as they do not aggravate the injury.

Phase 4

Management Phase: Goals: To restore full power, endurance, speed and extensibility.

Therapy: If symptom free, precede exercise with ice massage (7 min) or ice pack.

Exercise Rehabilitation: Added to phase 3 program, jogging on flat course slowly progressing to a 3-mile run once daily and then progressing to figure-8s, starting with obstacles 10 feet apart and gradually shortening distance to 5 feet, at full speed.

Phase 5

Management Phase: Goals: To return to sport competition.

Exercise Rehabilitation: Athlete gradually returns to pre-competition exercise and a gradual return to competition while wearing a figure-8 elastic hip spica bandage for protection.

Criteria for Returning to Competitive Basketball:

1. As measured by an isokinetic dynamometer, the athlete's injured hip and groin should have equal strength to that of the uninjured hip.
2. Hip and groin has full range of motion.
3. The athlete is able to run figure-8s around obstacles set 5 feet apart at full speed.

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