Adductor tendonitis is just one of the many possible diagnoses for groin pain in runners or athletes. In a previous blog, Dr Masci discussed the causes of groin pain. In most cases, groin pain is due to an overload of the tendons and joints surrounding the pubic symphysis. The treatment of this groin pain, also known as pubic overload, consists of a progressive exercise program. However, some patients fail to settle with therapy. What are the options for managing more complex cases of pubic overload or adductor tendonitis? Some doctors recommend injecting in the groin, such as an adductor tendonitis injection. But how effective are injections?
What Injections Are Appropriate for Groin Pain?
Generally, the cause of the groin pain determines the treatment.
- If the reason is pubic overload or osteitis pubis, an injection into a groin tendon or joint may be possible. For example, performing an adductor tendonitis injection makes sense if a person has adductor tendonitis. Alternatively, an ultrasound-guided injection of the pubic symphysis or osteitis pubis would be more effective if the pain originates from this joint.
- If the groin pain is due to hip joint pathology, a hip joint or iliopsoas sheath injection would be better.
It is essential to understand that injecting in the groin should only be performed as an addition to a rehab program. They do not replace exercise therapy and should not be considered a substitute for it.
What are the different injections available for adductor tendonitis?
The most common injection performed for adductor tendonitis is a cortisone injection in the adductor tendon. Cortisone is a potent anti-inflammatory medication that reduces pain associated with tendonitis. In a previous blog, Dr Masci discusses cortisone injections for tendonitis and has written a review paper on their use in treating tendonitis. Although cortisone is a reasonable option for adductor tendonitis, it is essential to be aware of its potential adverse effects on tendons, including tendon weakening and skin side effects.
More recently, platelet-rich plasma, or PRP, has been used for groin pain. We obtain PRP from whole blood, which is spun and separated from the red and white blood cells. The plasma is then injected into a tendon or joint. In a previous blog, Dr Masci discussed the pros and cons of PRP injections. Although groin specialists use PRP to help with adductor tendonitis and other causes of groin pain, there is little evidence of its effectiveness.
Cortisone or PRP injections into tendons or joints in the groin are usually done under ultrasound guidance. Generally, ultrasound offers greater accuracy and fewer side effects.
Apart from cortisone and PRP, are there other adductor tendonitis injection options?
Perhaps yes. Recently, groin specialists have been using nerve injections to reduce pain. The pain-relieving effect lasts for weeks to months and can be helpful when people are experiencing persistent pain. For example, we can perform an injection targeting the obturator nerve in the adductor muscle group to relieve pain from adductor tendonitis. Alternatively, an ilioinguinal nerve injection targeting the abdominal wall nerves can help alleviate pain arising from the pubic symphysis joint. In this way, we can achieve a pain-relieving effect without directly injecting a tendon or joint, and thus, we believe these injections are safer. Occasionally, nerve injections are combined with tendon or joint injections to achieve a greater effect. In general, most groin specialists inject the groin using ultrasound.
How does a nerve injection relieve pain in a groin tendon?
Generally, we believe that temporarily numbing the nerves with a local anaesthetic reduces the pain signals sent to your brain. This injection alters nerve pathways in your brain, producing a longer-lasting effect than the numbing effect of the local anaesthetic. Also, some doctors add a small dose of cortisone, which reduces nerve inflammation. So, we get pain relief without the risks of injecting the tendon directly with harmful substances like cortisone.
The image below is an example of an obturator nerve injection. We position the tip of the needle in the exact location of the nerve.
Final Word from Sportsdoctorlondon about Adductor Tendon Injection Options
In general, groin specialists perform injections for groin pain to reduce pain. Adductor tendon or osteitis pubis injections using either cortisone or PRP may be helpful in some cases. We use nerve injections to relieve pain without the potential side effects commonly associated with tendon or joint injections. Overall, injecting in the groin is typically performed in conjunction with a rehabilitation program.
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