A 38-year-old, male professional football player presents with pain in the posterior aspect of his right hip. He reported developing these symptoms approximately 24 hours after a normal gym session. He did not experience an acute onset of symptoms while training and couldn’t identify any other possible precipitant. The pain prevented him from training with his team.
A hip and thigh MRI was completed 36 hours after the onset of pain. The MRI illustrated a grade 3b structural muscle injury (Munich consensus) involving the adductor magnus. This involved increased signal (consistent with bleeding) and fibre disruption within the adductor magnus muscle near its insertion.
This player had a very short period of rest from all training (three days). He then underwent a rehabilitation programme which included local treatments, a graded strength programme and a progressive re-introduction of running based training. He was able to return to football training within three weeks.
There are six muscles in the medial compartment of the thigh and the adductor magnus muscle is the largest of these. Adductor injuries are among the most common muscle injuries in football players. The adductor longus is the most frequently injured individual muscle. These injuries generally occur during (or after) explosive abduction and external rotation movements, like changes of direction. In contrast, injuries to the adductor magnus are relatively rare. In addition to adducting the hip joint, adductor magnus has additional functions. For example, it is a more effective hip extensor than either the hamstrings or gluteus maximus when the hip is flexed. Peak contractions of the muscle are seen in positions of hip flexion, for example during a squat exercise. This may have been relevant in this player’s injury.
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