Adductor tendinopathy is a disorder of the tendons of the adductor muscle group of the inner thigh. The adductor muscles are responsible for bringing the legs toward the midline and stabilising the pelvis during movement. When the tendons that attach these muscles to the bone become overloaded, irritated or degenerate, the condition known as adductor tendinopathy may develop. Because the adductor group plays a key role in change-of-direction, kicking and dynamic hip stabilisation, this condition is especially important in athletes and active individuals.

Anatomy and Function

The adductor muscle group includes muscles such as the adductor longus, adductor brevis, adductor magnus, gracilis and pectineus. These muscles originate from the pelvis (pubic ramus, ischial ramus and pubis) and insert along the femur and tibia (in the case of gracilis). The adductor tendons transmit force from muscle to bone during movements that bring the leg inward, stabilise the pelvis during walking or running, and assist in complex movements in sport.

Because the tendons are subject to repeated tensile stress and shear, especially during side-lunges, sudden changes of direction, kicking or skating, the mechanical load can exceed the repair capacity of the tendon. Over time this may lead to microscopic damage, tendon thickening, altered collagen structure and eventual pain or dysfunction.

Causes and Risk Factors

Causes

Adductor tendinopathy typically arises from chronic overuse or a sudden increase in load or training intensity rather than a one-time acute tear. Activities that repeatedly load the adductor tendons such as soccer, hockey, running with lateral movements, horse-riding and gymnastics are common origins. Poor movement patterns, inadequate warm-up, training errors or fatigue may contribute.

Risk Factors

Risk factors include:

• Rapid escalation of training volume or intensity
• Frequent directional changes, side-to-side or pivoting movements
• Muscle imbalances: weak abdominals, weak gluteals or weak hip stabilisers forcing the adductors to compensate
• Leg length discrepancy or biomechanical asymmetry
• Previous groin or adductor injury
• Age-related tendon degeneration, obesity or reduced recovery capacity

Clinical Presentation

Symptoms

Individuals with adductor tendinopathy may report inner-thigh or groin pain that develops gradually or occasionally acutely. Pain is often localised at the tendon insertion on the pubic bone or along the proximal adductor longus region. The pain may worsen when contracting the adductors (bringing legs together), stretching them (spreading legs), during sprinting, kicking or lateral movements, and even with simple daily tasks such as getting in and out of a car or putting on trousers.

Physical Examination

On examination one may find:

• Tenderness on palpation of the adductor tendon near its insertion
• Pain provoked by resisted leg adduction or by passive abduction (stretching the adductor)
• Possible visible or palpable thickening at the tendon insertion
• Reduced hip adductor strength compared with the opposite side
• Assessment of hip, groin, core and pelvic function to identify contributing factors

Because groin pain can originate from multiple causes, examination often includes assessment of the hip joint, pubic symphysis, intra-abdominal structures and other musculotendinous units.

Diagnostic Evaluation

Diagnosis is primarily clinical, supported by imaging when needed. Plain radiographs may show secondary changes such as enthesopathy or peri-pubic bone changes but are often unremarkable. Ultrasound and MRI may demonstrate tendon thickening, signal changes, partial tearing, or insertional degeneration. These imaging modalities assist in confirming diagnosis, assessing severity, and ruling out alternative causes such as stress fracture, hernia or hip joint pathology.

Treatment

The treatment of adductor tendinopathy aims to relieve pain, restore normal tendon load capacity and return to full activity while preventing recurrence.

Conservative Management

Conservative measures form first-line treatment:

• Relative load modification: reduce aggravating activities while maintaining general fitness
• Analgesics and cold therapy for symptom relief
• Graduated rehabilitation program focusing on adductor strength, hip and pelvic stability, core control and movement quality
• Isometric, concentric and eccentric loading of the adductor tendon, tailored to the stage of tendinopathy (reactive, disrepair or degenerative)
• Addressing predisposing factors including muscle imbalance, flexibility deficits and training errors

Many cases respond well to this approach though timelines vary depending on severity and chronicity.

Surgical or Interventional Management

In persistent or refractory cases (typically long-standing degeneration or failed conservative care), interventional options may be considered. These can include injection therapies or surgical procedures to release or debride the tendon insertion, correct biomechanical defects or repair tears. The decision for intervention is made on a case-by-case basis and often within a multidisciplinary context.

Rehabilitation and Return to Activity

Rehabilitation is gradual and involves progression from controlled loading to sport-specific drills and eventual return to full participation. Early phases emphasise tendon capacity and controlled loading. Once pain is managed and strength is adequate, progression includes change-of-direction drills, kicking or sport-specific movements. Return to competition depends on achieving pain-free movement, symmetrical strength and functional mechanics. Close monitoring is important to prevent recurrence.

Complications and Prognosis

Potential complications include tendon rupture (rare but possible in advanced degenerative tendinopathy), prolonged recovery, persistent groin pain or return to less than full performance. Prognosis is generally favourable when the condition is identified early and managed appropriately. Chronic cases require more prolonged rehabilitation and may have slower or incomplete return to previous activity levels. Prevention of recurrence through ongoing strength and conditioning is critical.

Prevention and Patient Education

Key preventive strategies include:

• Ensuring adequate warm-up, gradual progression of training load and sufficient recovery between sessions
• Strengthening hip, gluteal and core musculature to off-load the adductor tendon during high-demand activities
• Monitoring for early groin or inner-thigh pain and responding with load modification before significant degeneration occurs
• Incorporating sport-specific drills and change-of-direction training to prepare the adductor complex
• Maintaining flexibility and addressing movement asymmetries or leg-length discrepancies

References

McHugh, M. P., Nicholas, S. J., & Tyler, T. F. (2023). Adductor strains in athletes. International journal of sports physical therapy, 18(2), 288.

Dinis, J., Oliveira, J. R., Choupina, B., Marques, P. S., Sá, D., & Sarmento, A. (2024). Athletes with adductor-related groin pain: A narrative review. Cureus, 16(9).

Bisciotti, G. N., Chamari, K., Zini, R., Corsini, A., Auci, A., Bisciotti, A. L., … & Canata, G. L. (2023). Adductor longus tenotomy in the treatment of groin pain syndrome in athletes: a systematic review. Joints, 1, e602.