Adductor Tendinopathy

  • Jean-Marcel FerretEmail author
  • Yannick Barthélémy
  • Matthieu Lechauve
Part of the Sports and Traumatology book series (SPORTS)


Adductor pain is very common in sports, but it is essential to distinguish among true tendinopathy, which is an enthesopathy (adductor longus insertion pain on the pubis), a tear of the myotendinous junction, which is rarer, and projected pain, where the adductors are affected the victims rather than being the cause: in abdominal groin pain (pubalgia) and all hip problems, especially femoral acetabular impingement (FAI), which affects young athletic population. Adductor tendinopathy can be isolated, but is also often associated with pubalgia. Once a positive diagnosis has been established, treatment can be tailored to the cause: medical for isolated tendinopathy, and often surgical in the form associated with pubalgia. Abdominal parietal pain is often the evolution of neglected adductor tendinopathy, which is why we must encourage those in the sporting environment to be more rigorous in the management of this pathological condition.


Adductor Tendinopathy Groin pain Femoral acetabular impingement 


  1. 1.
    Maffulli N, Renstrom P, Leadbetter WB (2005) Part 1 Tendon injuries, vol 5, Basic science and clinical medicine. Springer, London, pp 32–35CrossRefGoogle Scholar
  2. 2.
    Werner J, Hägglund M, Waldén M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43(13):1036–1040CrossRefPubMedGoogle Scholar
  3. 3.
    Gilmore J (1998) Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports Med 17(4):787–793CrossRefPubMedGoogle Scholar
  4. 4.
    Ekstrand J, Hilding J (1999) The incidence and differential diagnosis of acute groin injuries in male soccer players. Scand J Med Sci Sports 9(2):98–103CrossRefPubMedGoogle Scholar
  5. 5.
    Kaux JF, Forthomme B, Goff CL, Crielaard JM, Croisier JL (2011) Current opinions on tendinopathy. J Sports Med Sci 10(2):238Google Scholar
  6. 6.
    Valent A, Frizziero A, Bressan S, Zanella E, Giannotti E, Masiero S (2012) Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review. Muscles Ligaments Tendons J 2:142–148PubMedPubMedCentralGoogle Scholar
  7. 7.
    Robertson BA, Barker PJ, Fahrer M, Schache AG (2009) The anatomy of the pubic region revisited: implications for the pathogenesis and clinical management of chronic groin pain in athletes. Sports Med 39(3):225–234CrossRefPubMedGoogle Scholar
  8. 8.
    Tuite DJ, Finegan PJ, Saliaris AP, Renstrom PA, Donne B, O’Brien M (1998) Anatomy of the proximal musculotendinous junction of the adductor longus muscle. Knee Surg Sports Traumatol Arthrosc 6:134–137CrossRefPubMedGoogle Scholar
  9. 9.
    Strauss EJ, Campbell K, Bosco JA (2007) Analysis of the cross-sectional area of the adductor longus tendon: a descriptive anatomic study. Am J Sports Med 35:996–999CrossRefPubMedGoogle Scholar
  10. 10.
    Zoga AC, Kavanagh EC, Omar IM et al (2008) Athletic pubalgia and the “sports hernia”: MR imaging findings. Radiology 247(3):797–807CrossRefPubMedGoogle Scholar
  11. 11.
    McIntyre J, Johnson C, Schroeder EL (2006) Groin pain in athletes. Curr Sports Med Rep 5:293–299CrossRefGoogle Scholar
  12. 12.
    Tyler TF, Silvers HJ, Gerhardt MB et al (2010) Groin injuries in sports medicine. Sport Health 20:1–6Google Scholar
  13. 13.
    Bisciotti GN, Auci A, Di Marzo F, Galli R, Pulici L, Carimati G, Quaglia A, Volpi P (2015) Groin pain syndrome: an association of different pathologies and a case of presentation. Muscles Ligaments Tendons J 5(3):214–222PubMedPubMedCentralGoogle Scholar
  14. 14.
    Bouvard M, Lippa A, Reboul G (2011) Pubalgie du sportif. Appareil locomoteur, 14-323-A-10. Elsevier Masson SAS, ParisGoogle Scholar
  15. 15.
    Sailly M (2013) La pubalgie du sportif en pratique. Sci Sport 28(4):225–232CrossRefGoogle Scholar
  16. 16.
    Thorborg K, Holmich P (2013) Advancing hip and groin injury management: from eminence to evidence. Br J Sports Med 43:602–605CrossRefGoogle Scholar
  17. 17.
    Orchard JW, Read JW, Neophyton J (1998) Groin pain associated with ultrasound findings of inguinal canal posterior wall deficiency in Australian rules footballers. Br J Sports Med 23:141–145Google Scholar
  18. 18.
    Ferret JM (2012) La hanche du sportif: l’œil du terrain in Sport et vieillissement articulaire avec arthrose précoce et conflit antérieur de hanche. Revue de chirurgie orthopédique et traumatologique 98:313–314Google Scholar
  19. 19.
    Bouvard M, Lippa A, Reboul G, Lutz C (2012) Mise au point: La pubalgie du sportif. J Traumatol Sport 29:105–128CrossRefGoogle Scholar
  20. 20.
    Weir A, de Vos RJ, Moen M, Hölmich P, Tol JL (2011) Prevalence of radiological signs of femoroacetabular impingement in patients presenting with long-standing adductor-related groin pain. Br J Sports Med 45:6–9CrossRefPubMedGoogle Scholar
  21. 21.
    Nepple JJ, Brophy RH, Matava MJ, Wright RW, Clohisy JC (2012) Radiographic findings of femoroacetabular impingement in National Football League combine athletes undergoing radiographs for previous hip or groin pain. Arthroscopy 28:1396–1403CrossRefPubMedGoogle Scholar
  22. 22.
    Allen D, Beaulé PE, Ramadan O, Doucette S (2009) Prevalence of associated deformities and hip pain in patients with cam-type femoroacetabular impingement. J Bone Joint Surg Br 91:589–594CrossRefPubMedGoogle Scholar
  23. 23.
    Bonin N, Tanji PH (2012) Sport et conflit: relation entre conflit et lésions Sport et vieillissement articulaire avec arthrose précoce et conflit antérieur de hanche. Revue de chirurgie orthopédique et traumatologique 98:315–317CrossRefGoogle Scholar
  24. 24.
    Agricola R, Bessems JH, Ginai AZ, Heijboer MP et al (2012) The development of Cam-type deformity in the adolescent and young male soccer players. Am J Sports Med 40(5):1099–1106CrossRefPubMedGoogle Scholar
  25. 25.
    Ganz R, Parvizi J, Beck M, Leunig M, Nötzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120PubMedGoogle Scholar
  26. 26.
    Siebenrock K, Ferner F, Noble P, Santore R, Werlen S, Mamisch TC (2011) The cam-type deformity of the proximal femur arises in childhood in response to vigorous sporting activity. Clin Orthop Relat Res 469:3229–3240CrossRefPubMedPubMedCentralGoogle Scholar
  27. 27.
    Murray RO, Duncan C (1971) Athletic activity in adolescence as an etiological factor in degenerative hip disease. J Bone Joint Surg Br 53(3):406–419PubMedGoogle Scholar
  28. 28.
    Philippon MJ, Weiss DR, Kuppersmith DA, Briggs KK, Hay CJ (2010) Arthroscopic labral repair and treatment of femoroacetabular impingement in professional hockey players. Am J Sports Med 38:99–104CrossRefPubMedGoogle Scholar
  29. 29.
    Siebenrock KA, Schoeniger R, Ganz R (2003) Anterior femoro-acetabular impingement due to acetabular retroversion. Treatment with periacetabular osteotomy. J Bone Joint Surg Am 85:278–286PubMedGoogle Scholar
  30. 30.
    Morales-Conde S, Socas M, Barranco A (2010) Sportsmen hernia: what do we know? Hernia 14:515CrossRefGoogle Scholar
  31. 31.
    Pesquer L, Reboul G, Dallaudiere B, Meyer P (2013) Imagerie de la tendinopâthie des adducteurs. In: Actualités en échographie de l’appareil locomoteur. Sauramps Medical Ed, Montpellier, pp 55–64Google Scholar
  32. 32.
    Riley G (2004) The pathogenesis of tendinopathy. A molecular perspective. Rheumatology 43:131–142CrossRefPubMedGoogle Scholar
  33. 33.
    Estwanik JJ, Sloane B, Rosemberg MA (1988) Groin strain and other possible causes of groin pain. Phys Sport Med 19:59–65Google Scholar
  34. 34.
    Puig PL, Trove P, Savalli L (2004) La pubalgie: du diagnostic au retour sur le terrain. Ann Readpt Med Phys 47(6):356–364CrossRefGoogle Scholar
  35. 35.
    Orchard J, Read JW, Verrall GM, Slavotinek JP (2000) Pathophysiology of chronic pain in the athlete. ISMJ 1(1)Google Scholar
  36. 36.
    Nicolas SJ, Tyler TF (2002) Adductor muscle strains in sport. Sports Med 5:339–344CrossRefGoogle Scholar
  37. 37.
    Busquet L (2013) Traitement préventif pour diminuer la fréquence des pubalgies: analyse de la méthode des chaînes physiologiques. Kiné Actualité 1341:18–23Google Scholar
  38. 38.
    Seiller M, Mathieu R, Ferret JM (1990) Morphotype du footballeur: constat clinique à partir d’une population de joueurs professionnels. Sports Med 44:1–8Google Scholar
  39. 39.
    Ferret JM (2007) Prévention de la pubalgie. Compte rendu Congrès Pubalgie BordeauxGoogle Scholar
  40. 40.
    Holmich P, Holmich LR, Bjerg AM (2004) Clinical examination of athletes with groin pain: an intraobserver and interobserver reliability study. Br J Sports Med 38:446–451CrossRefPubMedPubMedCentralGoogle Scholar
  41. 41.
    Weir A, Jansen J, van Keulen J, Mens J, Backx F, Stam H (2010) Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: a case series. Phys Ther Sport 11(3):99–103CrossRefPubMedGoogle Scholar
  42. 42.
    Lowell G, Galloway H, Hopkins W, Harvey A (2006) Osteitis pubis and assessment of bone marrow edema at the pelvic symphysis with MRI in a elite junior man soccer quad. Clin J Sports Med 16:117–122CrossRefGoogle Scholar
  43. 43.
    Brennan D, O’Connell MJ, Ryan M, Cunningham P, Taylor D, Cronin C et al (2005) Secondary cleft sign as a marker of injury in athletes with groin pain: MR image appearance and interpretation. Radiology 235:162–167CrossRefPubMedGoogle Scholar
  44. 44.
    Pesquer L, Reboul G, Silvestre A, Poussange N, Meyer P, Dallaudiere B (2015) Imaging of adductor-related groin pain. Diagn Interv Imaging 96(9):861–869CrossRefPubMedGoogle Scholar
  45. 45.
    Brasseur JL, Laulom JP (2013) Pubalgie: apport de l’échographie. J Traumatol Sport 30:36–41CrossRefGoogle Scholar
  46. 46.
    Peetrons P (2007) les pubalgies: approche par l’échographie. In: Bassin et Hanche. Monographies de la SIMS. Sauramps Medical Ed, Montpellier, pp 179–183Google Scholar
  47. 47.
    Jansen JA, Mens JM, Backx FJ et al (2008) Treatment of longstanding groin pain in athletes: a systematic review. Scand J Med Sci Sports 18:263–274CrossRefPubMedGoogle Scholar
  48. 48.
    Holmich P, Uhrskou P, Ulnits L et al (1999) Effectiveness of active physical training as a treatment for longstanding adductor –related groin pain in athletes: randomized trial. Lancet 353:439–443CrossRefPubMedGoogle Scholar
  49. 49.
    Fyfe I, Stanish WD (1992) The use of eccentric training and stretching in the treatment and prevention of tendon injuries. Clin Sports Med 11(3):601–624PubMedGoogle Scholar
  50. 50.
    Queiros Da Silva C, Cotte T, Vicard L, Chantelot L, Ferret JM (2005) Interest of eccentric isokinetic exercises in cases of calcaneal tendinosis and thigh muscular injuries prospective study results. Isok Exerc Sci 13:39–44Google Scholar
  51. 51.
    Stanish WD, Rubinovich RM, Curwin S (1986) Eccentric exercise in chronic tendinitis. Clin Orthop Relat Res 208:65–68PubMedGoogle Scholar
  52. 52.
    Jensen J, Hölmich P, Bandholm T, Zebis MK, Andersen LL, Thorborg K (2014) Eccentric strengthening effect of hip adductor training with elastic bands in soccer players: a randomized controlled trial. Br J Sports Med 48(4):332–338CrossRefPubMedGoogle Scholar
  53. 53.
    Bouvard M, Dorochenko P, Lanusse P, Duraffour H (2004) La Pubalgie du sportif: stratégie thérapeutique. Revue de la littérature et proposition d’un protocole de rééducation. J Traumatol Sport 21:146–163CrossRefGoogle Scholar
  54. 54.
    Kaux JF, Crielaard JM (2013) Platelet-rich-plasma application in the management of chronic tendinopathies. Acta Orthop Belg 79:10–15PubMedGoogle Scholar
  55. 55.
    Le Picard P, Reboul G, Vuckovic Z (2013) Mise au point: le traitement chirurgical des pubalgies. Sci Sport 28:233–238CrossRefGoogle Scholar
  56. 56.
    Le Gall F (1993) la pubalgie du sportif. A propos de 214 cas. Thèse de médecine RennesGoogle Scholar
  57. 57.
    Rifi M, Muller J, Mezghani S, Londero A, Jaeger JH (2009) Intervention de Nesovic dans le traitement des pubalgies chez le footballeur. A propos d’une série de 80 cas. J Traumatol Sport 26:81–84CrossRefGoogle Scholar
  58. 58.
    Thomas JG, Kaitlin M, Carroll BS, Amun M, Andrew JW, Guillaume BS, Dumont D, Randy MC (2014) Surgical technique for treatment of recalcitrant adductor longus tendinopathy. Arthrosc Tech 3(2):e293–e297CrossRefGoogle Scholar
  59. 59.
    Orchard JW (2015) Men at higher risk of groin injuries in elite team sports: a systematic review. Br J Sports Med 49(12):798–802CrossRefPubMedGoogle Scholar
  60. 60.
    Rochcongar P (2013) Prévention de la pubalgie. In: Acquisition en médecine physique et de Réadaptation. Prévention des troubles musculo-squelettiques chez le sportif. Sauramps Medical Ed, Montpellier, pp 130–134Google Scholar
  61. 61.
    Gibbon WW (1999) Groin pain in athletes. Lancet 353(9162):1444–1445CrossRefPubMedGoogle Scholar
  62. 62.
    McCall A (2015) Injury risk factors, screening tests and preventive strategies: a systematic review on the evidence that underpins the perception and practices of 44 soccer teams from various premier leagues. Br J Sports Med 49:583–589CrossRefPubMedPubMedCentralGoogle Scholar
  63. 63.
    Gray Cook (2014) Functional Movement Screening: the use of fundamental movements as an assessment of function, Part 1. The International Journal of Sports Physical Therapy. 9(3):396.Google Scholar
  64. 64.
    Ibrahim A, Murrell GA, Knapman P (2007) Adductor strain and hip range of movement in male professional soccer players. J Orthopaedic Surg 15(1):46–49Google Scholar
  65. 65.
    Stanish WD (1984) Overuse injuries in athletes: a perspective. Med Sci Sports Exerc 16(1):1–7CrossRefPubMedGoogle Scholar
  66. 66.
    Middleton P, Montero C (2004) Eccentric muscular contraction: implications in treatment of athletes. Ann Readapt Med Phys 47(6):282–289CrossRefPubMedGoogle Scholar
  67. 67.
    Frizziero A et al (2014) The role of eccentric in sport injuries rehabilitation. Br Med Bull 110:47–75CrossRefPubMedGoogle Scholar
  68. 68.
    Rees JD et al (2009) Eccentric exercises; why do they work, what are the problems and how can we improve them. Br J Sports Med 43:242–246CrossRefPubMedGoogle Scholar
  69. 69.
    Aubert AE (2003) Heart rate variability in athletes. Sports Med 33(12):889–919CrossRefPubMedGoogle Scholar
  70. 70.
    Baumert M (2006) Heart rate variability, blood pressure variability, and baroreflex sensitivity in overtrained athletes. Clin J Sport Med 16(5):412–417CrossRefPubMedGoogle Scholar
  71. 71.
    Barthelemy Y, Kaux JF, Ferret JM (2014). Isocinétisme et sport de haut niveau: Applications à la traumatologie du sport. Scinece et Motricité 85:77–91.Google Scholar
  72. 72.
    Gill TJ, Carroll KM, Makani A, Wall AJ, Dumont GD, Cohn RM (2014) Surgical technique for treatment of recalcitrant adductor longus tendinopathy. Arthrosc Techn 3(2):e293–e297CrossRefGoogle Scholar
  73. 73.
    Reboul G (2014) La chirurgie de la tendinopathie des adducteurs. Congrès 1ère journée européenne de la Pubalgie. Clinique du Sport Bordeaux Merignac. BordeauxGoogle Scholar
  74. 74.
    Dallaudière B, Lempicki M, Pesquer L, Louedec L, Preux PM, Meyer P, Hummel V, Larbi A, Deschamps L, Journe C, Hess A. Silvestre A, Sargos P, Loriaut P, Boyer P (2013). Efficacité de l’injection intra-tendineuse du plasma riche en plaquettes dans le traitement tendinosis: évaluation globale d’un modèle de rat. Eur Radiol 23:2830.Google Scholar

Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  • Jean-Marcel Ferret
    • 1
    Email author
  • Yannick Barthélémy
    • 2
  • Matthieu Lechauve
    • 3
  1. 1.Sporea LyonLyonFrance
  2. 2.Charleroi Sport SantéMonceau Sur SambreBelgium
  3. 3.Clinic of Al Hilal Saudi FCRiyadKingdom of Saudi Arabia

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