Adductor-Related Athletic Groin Pain: A Clinical Commentary.
Derrick Larkins, Robert Rowland, Michael Zarro and 1 others
PMID 42694044WHAT IT FOUND
Adductor groin pain in athletes: the Copenhagen adduction exercise is the best-evidenced prevention tool, rehabilitation must include lumbopelvic control beyond isolated strengthening, and return-to-sport clearance needs more than a single strength test.
Key findings
01In a cluster-randomized trial of 35 semiprofessional Norwegian soccer teams, a Copenhagen-based strengthening program reduced groin injuries by 41% and time lost from sport by 20% compared with controls.
02A three-round Delphi panel of 32 sports medicine experts reached strong negative consensus that imaging findings should not be a return-to-sport criterion; performance tests (93.7% consensus) and planned/unplanned change-of-direction tasks at 45°–180° (96.9% consensus) should be.
03A 2025 systematic review and meta-analysis of healthy athletes found that the adductor-to-abductor strength ratio showed only a trivial association with subsequent groin pain or time-loss injury, challenging its use as a universal screening benchmark.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a narrative commentary, not a systematic review: no formal search strategy, inclusion/exclusion criteria, or quality appraisal of the cited studies is described. The evidence base is heavily weighted toward male athletes in soccer and ice hockey; the review itself notes that female athletes present with a different Doha-category distribution and that female data are limited. The strongest prevention evidence (Copenhagen trial) comes from a single cluster-randomized trial in semiprofessional Norwegian soccer teams; generalizability to other sports, levels, and countries is not established. Strength-ratio evidence is explicitly conflicting: one prospective study found a meaningful difference (95% vs. 78%), a subsequent cohort of 163 players found no significant association, and a 2025 meta-analysis found only trivial association. The review does not resolve this. The role of movement screening for prospective injury prediction remains inconclusive per the review's own summary; the three-cluster movement framework is described but its predictive validity is not established. No funding source or conflict-of-interest declaration is present in the provided text.
Declared interests
No funding or conflict-of-interest declaration is present in the provided text. The review cites industry-adjacent programs (FIFA 11+) and commercial exercise protocols but does not disclose any financial relationship between the authors and these entities.
The easy way to misread this
Do not read the 41% injury reduction from the Copenhagen adduction exercise trial as settled evidence for every sport and every athlete. It was a single cluster-randomized trial in 35 semiprofessional Norwegian soccer teams, and the review itself cautions that strength-ratio thresholds derived from one sport population should not be applied as universal screening benchmarks. Likewise, do not use the adductor squeeze test as a rule-out: its negative likelihood ratio of 1.95 means a negative result actually increases the probability of adductor pathology.