Adductor injury. Load it, test it, trust it.
A five-stage loading template for the athlete with adductor-related groin pain. Built from the plans I run with professional athletes, stripped back so you can use the structure yourself. There are no fixed timelines here. Palpation pain, adduction strength and the criteria at the end of each stage decide when you move on.
A strength problem at the pubic bone, not a tightness problem.
The adductor group anchors onto the pubic bone and controls your leg every time you decelerate, change direction, kick or reach. Injury usually happens where the muscle meets the tendon, or at the tendon's attachment to the bone. It is the most common groin injury in field and court sport.
Two findings define it: tenderness when you press on the adductor tendon, and pain when you squeeze your knees together against resistance. Stretching does not fix it. Loaded adductor strengthening does, and that is what this whole template is built around.
You probably have it if
- Tender to press along the adductor tendon, near the pubic bone
- Pain when you squeeze your knees together against resistance
- It bites on change of direction, kicking, lunging and sprint starts
- Often a gradual build over weeks, sometimes a sharp onset in one movement
Get it confirmed first
Groin pain has at least five recognised sources and they often overlap. This template assumes confirmed adductor-related groin pain. If you felt a pop with immediate weakness, or you can feel a gap in the tendon, get imaged before you load anything.
Rule things out
Same area, different problem, different plan.
The pubic bone is a shared anchor for your abdominals and your adductors, so these often travel together. If your rehab is stalling, it is frequently because the main driver is one of these rather than the adductor itself.
Athletic pubalgia
Abdominal-wall and posterior inguinal wall pathology, often alongside adductor tendinopathy because the two share an aponeurosis.
Tell
Pain above the inguinal ligament, reproduced by a resisted sit-up or a cough.
Pubic-related pain
Stress at the pubic symphysis itself. Needs core and pelvic control work and a longer conservative runway.
Tell
Tenderness centrally over the pubic bone rather than out along the tendon.
Hip joint pathology
Intra-articular hip problems refer straight into the groin and will not respond to adductor loading.
Tell
Pain and restriction on hip rotation and flexion testing, deep pinching rather than pulling.
Tendon avulsion
A complete tear off the bone. Around one in five confirmed acute adductor injuries. Not a template case.
Tell
A pop with sudden weakness, extensive bruising, or a gap you can feel in the tendon.
The one test that governs everything
Squeeze, score, decide.
Lie on your back, knees bent to 45°, a fist or ball between them. Squeeze hard for five seconds. Score the groin pain out of ten. Do it at the same point every day — before your session, not after — and let the number pick your next move.
Five-second squeeze pain score
Squeeze for five seconds with your knees bent, then rate the groin pain out of ten.
0–1 · Green
Progress on plan: next lever, next level, or the next milestone in your stage.
2–3 · Amber
Acceptable during loading. Repeat the same level. Nothing new until it drops.
4+ · Red
Regress a lever or a level. Back to isometrics if needed, and get it reviewed.
The template
Five stages. Isometric, isotonic, then athleticism.
Each stage has an aim, a restriction and an exit criterion. You leave a stage when you meet the criterion, not when the week ends.
Recovery
Protect · confirm the diagnosis
Aims
- Settle the irritation and get the diagnosis confirmed
- Cut the aggravating load: sprinting, kicking, change of direction, wide reaching
- Keep the rest of the body training — upper body, trunk, uninjured side
Restrictions
No sprinting, kicking or cutting. Walk pain-free before you jog. Avoid end-range stretching into the painful tissue.
Move on when
Pain-free walking and daily movement, and pain-free hip range of motion.
Where a clinician earns their keep
The main job here is deciding whether this is really adductor-driven. Get that wrong and the next four stages are aimed at the wrong tissue.
Rehab
Isometric into isotonic loading
Aims
- Isometric adductor squeezes at increasing angles and effort
- Introduce side-lying adduction, then the short-lever Copenhagen
- Rebuild trunk and hip control around the pubic bone — bridges, sit-up holds, prone holds
Restrictions
Loading in straight lines only. No cutting, kicking or maximal sprints. Keep squeeze pain at or below 3/10.
Move on when
Full pain-free adductor range, a 0/10 squeeze at rest, and short-lever Copenhagen completed cleanly.
Where a clinician earns their keep
Dose is where this stage lives or dies — effort level, hold time, how often. Two sessions a week of properly loaded work outperforms daily half-effort work.
Athleticism
Strength · running mechanics
Aims
- Progress Copenhagen through mid then long lever, then add weight
- Heavy compound work through the whole chain — squat, deadlift, split squat, lateral lunge
- Rebuild running: straight-line mechanics, then acceleration and deceleration, then arcs
Restrictions
Progress lever before load, and one variable at a time. Multidirectional work stays sub-maximal — roughly 60–80% — until the criteria are met.
Move on when
Adduction strength within roughly 10% of the other side, adduction-to-abduction ratio near 1.0, and a long-lever Copenhagen hold above 45 seconds.
Where a clinician earns their keep
Strength symmetry is the thing athletes guess at and get wrong. Dynamometry or force-frame testing here is what stops you carrying a deficit into full speed.
Practice
Sport re-entry · change of direction
Aims
- Maximal sprinting, then planned change of direction, then reactive
- Reintroduce the sport skill that loads the adductor most — kicking, wide reaching, lateral pushing
- Keep the Copenhagen and compound strength work going underneath it
Restrictions
Controlled sessions before open play. Build duration before intensity. Nothing reactive until planned cutting is pain-free.
Move on when
A full controlled sport-specific session at 0/10, hop and jump testing within 10% side to side, and no next-day flare.
Where a clinician earns their keep
The jump from gym strength to reactive sport is the highest-risk transition in the plan. Volume and order matter more than the exercises themselves.
Return to competition
Integration · prevention
Aims
- Graded exposure: full training, then part games, then full competition
- Track load every session — volume, intensity, and how hard it felt out of 10
- Keep one weekly Copenhagen session in place permanently
Restrictions
Nothing new in a competition week. Complete two full weeks of unrestricted training before you compete.
Move on when
Unrestricted. Full training and competition with the daily squeeze staying green.
Where a clinician earns their keep
Recurrence is reported as high as 19%, and it usually happens because the prevention work stopped. Load planning around a real fixture list needs your calendar in front of it.
Loading progressions
What to actually do, in order.
The Copenhagen adduction exercise is the single most effective adductor loading exercise studied. Progress the lever first — short, mid, then long — before you add weight. More volume is not better; a low-volume protocol built strength as well as a high-volume one.
Isometric
Stage 2 onward
- Adductor squeeze on a ball, knees bent to 45°
- Same squeeze with knees closer to straight as it settles
- Long side-plank and prone holds for trunk control
- Hold the angle that is strongest and least painful
Dose
5 holds × 30–45 seconds at hard-but-tolerable effort, squeeze pain 3/10 or less. Daily is fine at this stage.
Copenhagen
Stage 2 onward
- Level 1: side-lying hip adduction
- Level 2: short-lever Copenhagen, knee on the bench
- Level 3: full long-lever Copenhagen, foot on the bench
- Then hold longer, then add external load
Dose
3 seconds up, 3 seconds down. Build from 1 set × 6 reps toward 3 sets × 12–15, 2–3 sessions a week. Regress a level if groin pain goes above 3/10.
Whole-chain strength
Stage 3 onward
- Deadlift and sumo deadlift — the strongest adductor magnus loaders
- Squat, split squat, step-up for general lower-limb strength
- Lateral lunge and slide-board work for frontal-plane load
- Glute, hamstring, calf and trunk work alongside it
Dose
3–4 sets × 6–8 reps, 2–3 sessions a week. Progress load only once the previous week was 0–1/10 on the daily squeeze.
Running and change of direction
Stage 3–4
- Straight-line jogging, then striding, then maximal sprinting
- Acceleration and deceleration over short distances
- Planned cutting and lateral shuffles, then reactive and open drills
- Sport skill last: kicking, wide reaching, contested movements
Dose
Alternate days at first. One new element per session, and stop the drill when technique or landing quality drops off.
What you are measuring
Four markers, tracked weekly.
No single number tells you when you are ready — in the research, each of these explained only a fraction of rehab progress on its own. Read them together, and track the direction of travel rather than one day's reading.
Palpation pain
How much of the tendon is still tender, and how much it hurts. The single most informative measure of rehab progress in the research.
Target: 0/10, no tender length
Squeeze test
Five-second squeeze, scored for pain and, if you have a dynamometer, for force. Higher squeeze pain predicts groin pain and dropping performance on the pitch.
Target: 0/10, force matching the other side
Adduction strength
Eccentric or isometric adduction compared with the uninjured side, plus the adduction-to-abduction ratio. Weakness pre-season is the best-supported risk factor for a new injury.
Target: within 10%, ratio near 1.0
Range and function
Hip abduction range and bent-knee fall-out, then functional milestones: pain-free exam, controlled sport training, first full team session.
Target: equal side to side
Print and fill in
Adjuncts help at the edges. Loading is the treatment.
Worth it
Manual therapy
Performed about as well as exercise for long-standing groin pain in one trial, and can take the edge off early on. It works as a companion to loading, not a substitute for it.
Situational
Anti-inflammatories
Reasonable for short-term symptom control in the first days. No evidence they change the outcome or shorten the timeline.
Situational
Platelet-rich plasma
Meta-analysis of acute muscle strains showed earlier return overall, but the effect was inconsistent by muscle and the adductor-specific evidence is case reports only. Not established here.
Situational
Surgery
Considered for a proximal avulsion with a palpable defect or significant retraction, or for genuinely refractory pain after at least 8 to 12 weeks of proper conservative work.
Avoid
Corticosteroid injection
No supportive evidence for accelerating adductor rehab, and effects at a tendon attachment are short-lived at best.
Avoid
Rest and stretching alone
Passive care — rest, stretching, modalities — was clearly beaten by active loading in trial conditions. Stretching a painful adductor attachment tends to keep it irritated.
The evidence in one line
Active loading beat passive treatment — laser, massage, stretching, TENS — in a randomised trial of athletes with long-standing groin pain, and the advantage was still there eight to twelve years later. Adding the Copenhagen exercise to rehab produced greater strength gains, less pain and better function than rehab without it.
Then keep it in
A single-exercise programme built on the Copenhagen — three times a week pre-season, once a week in-season — cut the risk of groin problems by 41% in a cluster-randomised trial. Weak adductors are the best-supported modifiable risk factor there is, so the exercise that rehabilitated you is the one that keeps you available.
Make it yours
A template gets you moving. A plan gets you back.
This is the generic version. The athletes I work with get the same structure built around their calendar, their competition dates and their objective testing — force plate, hand-held dynamometry, adduction-to-abduction ratios — with the load reviewed every week rather than every stage. If you want that, get in touch.
This guide is general education, not individual medical advice. Groin pain has several possible causes, they frequently overlap, and every injury tolerates load differently. Have your groin assessed and your programme supervised by a qualified clinician before following it.
References
- Markes AR, Mauro C, Bradley JP, Arner J. Adductor Injuries in Athletes: Evidence-Based Treatment. Journal of the American Academy of Orthopaedic Surgeons, 2026.
- Weir A, Brukner P, Delahunt E, et al. Doha Agreement Meeting on Terminology and Definitions in Groin Pain in Athletes. British Journal of Sports Medicine, 2015.
- Herring SA, Kibler WB, Putukian M, et al. Initial Assessment and Management of Select Musculoskeletal Injuries: A Team Physician Consensus Statement. Medicine and Science in Sports and Exercise, 2024.
- Serner A, Weir A, Tol JL, et al. Associations Between Initial Clinical Examination and Imaging Findings and Return-to-Sport in Male Athletes With Acute Adductor Injuries. American Journal of Sports Medicine, 2020.
- Serner A, Hölmich P, Tol JL, et al. Progression of Strength, Flexibility, and Palpation Pain During Rehabilitation of Athletes With Acute Adductor Injuries. Journal of Orthopaedic and Sports Physical Therapy, 2021.
- Farrell SG, Hatem M, Bharam S. Acute Adductor Muscle Injury: A Systematic Review on Diagnostic Imaging, Treatment, and Prevention. American Journal of Sports Medicine, 2023.
- Almeida MO, Silva BN, Andriolo RB, et al. Conservative Interventions for Treating Exercise-Related Musculotendinous, Ligamentous and Osseous Groin Pain. Cochrane Database of Systematic Reviews, 2013.
- Siqueira APP, Hespanhol L, Oliveira AJ, et al. Conservative Interventions for Managing Exercise-Related Musculoskeletal Groin Pain. Cochrane Database of Systematic Reviews, 2025.
- Harøy J, Clarsen B, Wiger EG, et al. The Adductor Strengthening Programme Prevents Groin Problems Among Male Football Players: A Cluster-Randomised Controlled Trial. British Journal of Sports Medicine, 2019.
- Alsirhani AA, Muaidi QI, Nuhmani S, et al. The Effectiveness of the Copenhagen Adduction Exercise on Improving Eccentric Hip Adduction Strength Among Soccer Players With Groin Injury: A Randomized Controlled Trial. The Physician and Sportsmedicine, 2024.
- Thorarinsdottir S, Isaksen Johansen S, Ruud Askim Elvestad T, et al. The Effect of an 8-Week Low- or High-Volume Protocol of the Adductor Strengthening Programme on Hip Adduction Strength in Female Football Players. Scandinavian Journal of Medicine & Science in Sports, 2025.
- Collings TJ, Horsman A, Hams AH, et al. Hip Adductor Muscle Forces During Strength Training and Rehabilitation Exercises. Medicine and Science in Sports and Exercise, 2026.
- DeLang MD, Thorborg K, Hölmich P, Ishøi L. Are Pain and Strength During Adductor Squeeze Testing Associated With on-Pitch Football Performance and Pain in Male and Female Academy Players? Scandinavian Journal of Medicine & Science in Sports, 2026.
- Markovic G, Šarabon N, Pausic J, Hadžić V. Adductor Muscles Strength and Strength Asymmetry as Risk Factors for Groin Injuries Among Professional Soccer Players. International Journal of Environmental Research and Public Health, 2020.
- Huber PJ, Schönnagel B, Dalos D, et al. Muscle Injuries in 90 Professional Football Players Over 10 Consecutive Seasons: A Comparison of Two Classification Systems and Their Association With Return-to-Play Time. Scandinavian Journal of Medicine & Science in Sports, 2025.
- Forlizzi JM, Ward MB, Whalen J, Wuerz TH, Gill TJ. Core Muscle Injury: Evaluation and Treatment in the Athlete. American Journal of Sports Medicine, 2023.
- Maloy W, Merrigan B, Hulsopple CD. Groin Pain and Injuries: Evaluation and Management. American Family Physician, 2025.
- Sheth U, Dwyer T, Smith I, et al. Does Platelet-Rich Plasma Lead to Earlier Return to Sport When Compared With Conservative Treatment in Acute Muscle Injuries? A Systematic Review and Meta-Analysis. Arthroscopy, 2018.