Adductor Strains in AFL: Getting Back Quicker by Doing More, Not Less

May 26

Adductor strains are one of the three most common injuries in AFL, alongside hamstrings and ankle sprains. They share one frustrating feature with hamstrings: the recurrence rate is high when rehab is rushed.

The good news is the research on adductor injuries is clear, and the treatment approach works when followed correctly.

The Anatomy

The adductor group includes five muscles on the inner thigh: adductor longus, adductor brevis, adductor magnus, pectineus, and gracilis. In AFL, adductor longus is the most commonly strained, typically at the proximal musculotendinous junction near its origin on the pubic bone.

The adductors function not just to pull the legs together but to stabilise the pelvis during single-leg weight-bearing, which happens every step during running. When pelvic control is inadequate, the adductor longus takes on extra stabilising load, increasing its injury risk.

The proximity of the adductor origin to the pubic symphysis means adductor injuries can occur alongside pubic bone stress reactions or develop into osteitis pubis if managed poorly.

How It Happens in AFL

Direction changes, kicking, and one-legged landing from a mark are the primary mechanisms. The injury usually occurs when the leg is in an abducted, externally rotated position under load, such as a plant and cut or an overstriding kick. Pre-season training on hard ovals, particularly after an off-season, is the highest-risk period.

Grading and Assessment

Grade 1: Mild stretch, no significant structural disruption. Pain on palpation and resisted adduction. Return in 1-2 weeks. Grade 2: Partial tear, significant tenderness, pain with walking. 3-6 weeks. Grade 3: Complete rupture. Rare in isolation. Requires surgical assessment if proximal avulsion is involved.

The adductor squeeze test and a single-leg standing adductor squeeze are reliable clinical tools for assessment. MRI for Grade 2+ injuries confirms location and extent.

Treatment: Load Early

The evidence strongly supports early loading over passive rest. The Copenhagen adductor exercise is the single most effective intervention for both treatment and prevention.

Copenhagen adductor exercise: Side-lying position, top leg supported on a bench, bottom leg performing adduction off the floor. This exercise isolates and progressively loads the adductor group through a sport-relevant range.

Progressive loading protocol: - Week 1: Isometric adductor squeezes, pain-free walking - Week 2: Side-lying adduction, standing hip adduction with resistance band - Week 3: Copenhagen progression beginning with short lever, progress to long lever - Week 4-5: Running introduction, change of direction, kicking volume

Return to Play

Symmetrical adductor squeeze strength and pain-free performance of football-specific movements including kicking at full effort are the return criteria. Players who return based on pain level alone without strength criteria re-injure at significantly higher rates.

Prevention

Two Copenhagen exercises per week throughout the season reduces adductor strain incidence by over 40% in football players. This is one of the highest injury prevention returns on investment in the sport.

Want to understand this injury at a deeper anatomical level? The Club Physio’s online anatomy course breaks down the structures, biomechanics, and load patterns behind the most common sports injuries. Built for athletes and therapists alike. [Explore the course at theclubphysio.com.au]

josh zoppo