Adductor tendinopathy exercises and recovery

What is adductor tendinopathy?

The adductors are the group of muscles you can feel along the inside of your thigh. They start up on the pubic bone at the front of the pelvis, run down the inner thigh, and they draw the leg in toward the other one, which is the movement a ball squeeze asks for. Adductor tendinopathy is pain and loss of tolerance in the tendon end of those muscles, where they attach to the pubic bone, and it comes from load rather than from one accident.

The pattern is specific enough to recognize. It builds over weeks, usually after you increased your training or came back to sport after a layoff. It is sore to press high on the inner thigh, it hurts to squeeze your knees together against resistance, and it is worst at the start of a session before easing as you warm up. The next morning is often the honest report on yesterday.

This page is for adults with that gradual pattern, managed without an operation. It is written for sport, and the early stages suit anyone with a load-related inner thigh pain. If you have had groin or hip surgery, follow your surgeon's program rather than this one. A child or teenager with a limp, or with pain in the groin, hip, thigh or knee, should be seen by a doctor before starting any program.

Is it adductor tendinopathy or something else?

This is the question that decides your next 3 months. Give it more of your attention than the exercise list. Several different problems live in this patch of the body, and they do not share a treatment.

An acute adductor strain begins at one moment: a sprint, a kick or a stretched-out tackle, with sharp pain and often bruising over the following days. If that is your story, the groin strain program is the right page, and a criteria-based rehabilitation program for exactly that injury exists in the published literature (Serner and colleagues, 2020). Tendinopathy, by contrast, has no single moment behind it, and squeezing a ball between your knees today tells you more about it than any scan would.

A hip joint problem sits deeper in the groin and comes on with bending and twisting, often with a click or a catch. Hip impingement, a labral tear and hip osteoarthritis all sit here, and the Doha expert group advised that the hip joint should always be considered in groin pain (Weir and colleagues, 2015). It also goes the other way round. Pain in the front of the hip with a sore hip flexor points at hip flexor strain, and pain over the bony point on the outside of the hip at greater trochanteric pain. Pain tucked up under the buttock where you sit belongs to hamstring tendinopathy, which behaves the same way under load but at the back of the thigh instead of the inside.

The pubic bone at the front of the pelvis is the near neighbor that gets missed. The two halves of the pelvis meet at a small joint there, and in the Doha taxonomy pubic-related groin pain is tenderness directly over that joint and the bone either side of it, with no single resistance test that picks it out (Weir and colleagues, 2015). An athlete can have more than one of these problems at once, and this one tends to sit alongside adductor pain rather than instead of it. If your sorest spot is on the bone at the very front rather than up the inner thigh, say so when you are examined, because the squeezes in this program press through that joint as well and the pacing may need to be different. It is also why pain over the pubic bone turns up as a reason to stop in the notes under the exercises below.

Then there are the time-critical ones, and this is where a web page earns its keep. A hernia shows as a bulge or lump where the leg joins the body, which the NHS says may grow when you cough or sneeze and go down when you lie down. A painless one needs a doctor's appointment. One that becomes painful or tender, or comes with a bloated tummy, vomiting, constipation or a fever, needs help the same day, because a hernia that gets trapped can lose its blood supply, and that is not a groin to exercise.

Pain in a testicle is not a groin strain either, and it has the shortest clock on this page. Sudden severe pain in a testicle, pain there alongside feeling sick, being sick or tummy pain, or pain that has lasted more than an hour or carries on while you rest, means an emergency department now rather than tomorrow. A lump or swelling in a testicle, a change in its shape or size, or an ache there that worries you is an urgent same-day appointment with a doctor instead.

The last one has a clock on it as well, and it is the one that most resembles tendinopathy at the start: a stress fracture in the neck of the thighbone. It builds up with running, marching or jumping, usually after a jump in training, and then starts hurting when you walk. These are rare and are often missed at first, so it has to be suspected early in anyone whose groin pain came on with training and who is also sore at the ends of hip movement. Being seen again soon is what stops one progressing to a displaced fracture, which considerably worsens the long-term outlook (Clough, 2002).

Keep loading that leg and you can turn a crack into a break, so this one needs advice the same day, no running or jumping in the meantime, as little walking as you can manage, and an emergency department if you cannot put weight on the leg. Groin pain works through the rest of the causes.

What the evidence says about loading the adductors

Strength work has the best support, and the trial that established it is worth knowing in detail. A Danish team randomized 68 athletes whose adductor-related groin pain had lasted a median of 40 weeks into two groups: an 8 to 12 week active training program aimed at the strength and coordination of the muscles around the pelvis, especially the adductors, or physiotherapy treatment without active training. Four months after treatment ended, 23 athletes in the training group were back at their sport at the same level without groin pain, against 4 in the other group, an odds ratio of 12.7 with a 95% confidence interval of 3.4 to 47.2 (Hölmich and colleagues, 1999). The examining doctor did not know which group anyone had been in.

Set against that, a later randomized trial is a useful dose of realism. It compared a home exercise program with a return-to-running plan against a multimodal package of heat, manual therapy and stretching that had a return-to-running plan of its own, in athletes who had at least 2 months of pain at the top of the adductor tendons. The multimodal group got back to full sport faster, at an average of 12.8 weeks against 17.3 weeks. But only about half of the athletes in either group made a full return at all, there was no difference in pain during sport, and the authors wrote plainly that neither treatment was very effective (Weir and colleagues, 2011).

Read those two trials together. The loading approach is the best-supported option and the results in the real world are mixed, and knowing the second half of that sentence is what stops a slow month feeling like failure. It does not rest on one trial either: the Doha expert group, looking at the same field, reported moderate evidence that supervised active training returns more athletes with long-standing adductor-related groin pain to play than passive treatments, and moderate evidence that adding hands-on treatment can return them faster without making success more likely (Weir and colleagues, 2015). A systematic review of all the non-surgical options reached the same conclusion from a different direction: 19 studies across 7 treatment types, with the evidence base described by its own authors as limited and of low quality (Bisciotti and colleagues, 2021).

How long does adductor tendinopathy take to heal?

Plan in months. The trials above ran their programs for 8 to 12 weeks and then measured the result months later, and the faster of the two groups in the 2011 trial averaged 12.8 weeks to full sport. Anyone promising you 3 weeks has not read them.

More useful than a number is the order things come back in, because it saves a lot of worry. Getting out of a car and rolling over in bed usually ease first. A firm squeeze of a ball stops hurting next, which is your gate out of stage 1. Then walking, then easy jogging, then wide and loaded positions. Sprinting, kicking and sliding come last and are often still uncomfortable when everything else feels normal, which is not a sign the program failed.

Progress is lumpy, not steady, and that catches people out. A good two weeks followed by a sore one is the usual shape of tendon rehabilitation, not a relapse. What matters is the trend over a month, so if you want to track something, track how many sets you can do at the same soreness rather than how the groin feels on a given morning.

What we see in the clinic

The groin gets blamed for a training error more often than for anything wrong with the groin. Ask what changed 4 to 6 weeks before it started and you usually get an answer: preseason, a new gym program, a return after a long break, or a sport added on top of another. Nothing has to be wrong with the tendon for a sudden doubling of sprinting to hurt it.

Two habits keep it going. The first is warming up until it feels fine and then training as though nothing is wrong, because a tendon that eases with warmth has not been fixed by it, only quietened for an hour. The second is stretching it. Almost everyone with this problem has been stretching the groin hard for weeks by the time they arrive, usually in a butterfly position, and in our clinics it is the habit that most often keeps it sore. A tendon that hurts under load is not short.

What people also miss is how little of this is the inner thigh alone. The adductors pull on a pelvis, and if the muscles at the side and back of the hip are not steadying it, the groin is working against a moving anchor. The trial above trained the whole pelvic group rather than the adductors in isolation, which is why there is a clamshell and a glute bridge in this program and not just a ball to squeeze.

How to use this program

Pick the stage that matches your groin today, and start at stage 1 if you are not sure. Move up when the stage you are on feels easy and the groin is no sorer the next morning. The gate from stage 1 to stage 2 is simple and you can test it yourself: a firm squeeze of the ball no longer hurts and you walk normally.

Each exercise page gives its own starting dose, and the stage texts above repeat the numbers so you do not have to open four pages to plan a session. As a rough guide, the holds are 5 to 10 seconds repeated 5 to 10 times once or twice a day, and the strength work is 2 to 3 sets of 8 to 15, daily for the early exercises and 2 to 3 days a week for the standing work in stage 3. Your physio will adjust the exercises and the numbers to your groin and your sport.

Before you start, read the checks below against yourself. They are the reasons to get the groin looked at or to change an exercise, so they sit before the program and not halfway down it.

Squeezing the inner thighs puts effort through the joint at the front of the pelvis, so if you are pregnant, have had a baby recently, or have pain over the pubic bone, check with your physio or midwife before you begin. Past the first 3 months of pregnancy, ask about the exercises done flat on your back as well, and use the seated hold instead.

If you have had a hip replacement or any other hip surgery, get the go-ahead from your surgeon or physio before you start. Several of these exercises bend the hip past a right angle, take the leg across the middle of the body or turn the thigh outward, and surgeons limit those after some operations for the first months. Ask the same question after back surgery, because both bridges lift your hips off the floor, and after knee surgery or a knee replacement, because the two standing squats in stage 3 depend on how deep and how wide your surgeon lets you go. Get those limits from the person who operated or from your physio rather than guessing them.

The half kneeling stretch needs you to kneel and to get down to the floor and up again, so check that one as well after knee surgery, and keep a sturdy chair beside you. Your head finishes below your heart in it, so if you have glaucoma or have had recent eye surgery, ask your doctor or physio before you try it. If you have low bone density (osteoporosis), stay up on your hands in that stretch with your back long, rather than curling down onto your elbows, and ask your physio whether it suits you at all.

If you have high blood pressure, breathe steadily through every hold and never hold your breath. Counting the seconds out loud is the simplest way to keep the air moving. Check with your doctor before you start if you have a heart or lung condition, or blood pressure that is not under control.

If you have fallen in the past year, feel unsteady on your feet, or take medicines that make you dizzy, keep a hand on a kitchen counter through the standing exercises in stage 3, practice only when someone else is at home, and ask your doctor or physio about a falls check. Ask them about the half kneeling stretch too, because getting down to the floor and back up again is a transfer that needs balance of its own.

Read the warning signs at the foot of this page before your first session rather than after something happens. Three of them stop the program outright until the groin has been looked at: a painful lump or bulge in the groin and groin pain that built up with running and now makes you limp both need help the same day, and sudden or lasting pain in a testicle needs an emergency department now.

The exercise program

The exercises below carry their own stop signs and precautions. Open the line under an exercise and read them before you try it.

Getting the detail right

Stage 1 looks too easy to be doing anything, which is exactly where people overdo it. A tendon that has been sore for months does not need your hardest squeeze on day one, so set the adductor ball squeeze at a moderate effort and leave something in reserve. Three habits quietly cheat it: your hips lifting off the bed, your back arching to push harder, and your breath held through the count. Only the knees press in. Keep using that ball as your daily test, because the day a firm squeeze stops hurting is the day stage 1 has done its job.

When only one side is the problem, use your hand instead of the ball. In seated isometric hip adduction you reach across, press one knee in against the opposite hand, and let go the instant the groin complains, which a ball pressing back at you will not allow. Stay tall as you reach, because leaning toward the hand makes the press feel stronger without the inner thigh doing any more work.

The first moving exercise surprises people, because the lift is much smaller than they expect. In side lying hip adduction the bottom leg comes up only a short way, since the inner thigh muscles pull at a poor angle from down there, and that small lift with one hip stacked above the other is the whole exercise. Roll the hips backward to gain height and the work moves off the muscle you are here for. The bottom knee stays straight and the toes point forward.

Then the squeeze that has to survive a bigger movement. In the bridge with ball squeeze and the squat with ball squeeze, the squeeze is the part that fades, and it usually goes on the way up. Ask yourself at the top of every repetition whether the knees are still pressing or just resting against the ball. Pick a ball that fits between your knees when they sit straight over your feet, and keep the kneecaps roughly over your second toes through the squat.

Which exercises should you avoid with adductor tendinopathy?

Early on, the ones that stretch the muscle long while it is also working hard. That combination is what an irritable adductor tendon tolerates worst, and it accounts for most of the flares we see. The list is short and specific: wide lunges and side lunges, deep sumo squats, breaststroke kick, hard stretching into the groin, sliding tackles, and the Copenhagen adduction exercise, which has its place later and is far too much in the first weeks.

None of that is banned for good, and the difference between a sensible pause and avoidance is the plan to bring it back. Wide and loaded positions return in stage 3 of this program, then the Copenhagen adduction once your physio judges the groin ready, then sport. The one thing that does not come back is stretching into pain: the gentle length work in stage 2 is as far as that goes, for the reason above.

Two things not to drop. Walking, because a groin that stops moving stiffens and the first sprint back is worse for it. And easy straight-line running, if it is pain free during and after, because it loads the tendon in a direction it usually copes with and keeps you fit while the strength work does its job.

Getting back to sport and keeping the groin

The order is the useful part. It is the same one every time. Straight-line running first, built up to full sprints. Then changes of direction you have planned, then ones you react to. Kicking last, starting with short passes.

Tell a coach that list rather than a diagnosis, and ask to sit out small-sided games until you are through it, because that is where the sharp turns and stretched-out tackles live.

The step almost everyone skips is carrying on. Groin problems recur, and the groin prevention program with the largest trial behind it kept going through the season rather than stopping at the end of rehabilitation: teams of semiprofessional male soccer players doing an Adductor Strengthening Programme built on the Copenhagen adduction exercise, 3 times a week before the season and once a week during it, reported fewer groin problems than teams training as usual (Harøy and colleagues, 2019). That trial set out to stop groin problems across whole squads, not to stop one coming back after adductor tendinopathy, so treat it as a sensible habit rather than a tested one: two sessions a week of the stage 3 work, with the Copenhagen adduction added when your physio says so.

A sore day with no obvious cause does not mean stopping. It means going back a stage: keep the holds going, keep walking, and spend a few days climbing back to where you were.

When to see a physio or doctor

See a physio or doctor if the groin is no better after 6 to 8 weeks of steady loading, if it settles and flares every time you go back to sport, or if you cannot tell whether the pain is coming from the adductors, the hip joint or somewhere else. A physical therapist (physiotherapist) can usually sort that out in one appointment and pick your starting stage, which is quicker than working through it alone.

Go sooner if you are not sure this is tendinopathy at all. The alternatives above have different treatments and three of them have a deadline, so a page cannot settle it and an examination usually can.

The warning signs below say which problems need help faster than a physiotherapy appointment, and how fast, from an emergency department now down to an appointment within 2 weeks.

For physiotherapists

This page is a starting framework for adults with adductor-related groin pain of gradual onset. The Doha agreement defines adductor-related groin pain as adductor tenderness and pain on resisted adduction testing, in an athlete who reports pain in that region that worsens on exercise. It also asks that the pain provoked on resistance testing be felt in the adductors themselves and not somewhere else, for example the inguinal region (Weir and colleagues, 2015). Gradual onset is this page's own restriction and is not part of that definition.

Acute adductor injury is routed to the groin strain page, which follows the criteria-based protocol of Serner and colleagues (2020). Hip-related groin pain, the pubic-related, inguinal-related and iliopsoas-related entities, femoral neck stress injury and testicular causes are handled in the differential section and the warning signs. Two Doha points carry through both: the hip joint is always considered, and one athlete can carry more than one entity.

The staging is built on Hölmich and colleagues (1999): an 8 to 12 week active training program targeting strength and coordination of the pelvic muscles, especially the adductors, in 68 athletes with a median symptom duration of 40 weeks. A blinded examiner assessed them 4 months after treatment ended: 23 were back at sport at the same level without groin pain, against 4 in the comparison group, odds ratio 12.7 (95% confidence interval 3.4 to 47.2). The published abstract does not state how the 68 were split between the two arms. The review that extracted the trial reports 34 in each, in its narrative text and in its extraction table, and that is the source for the split given here (Bisciotti and colleagues, 2021). The same review scores the trial 13 of 24 on MINORS and rates its risk of bias as high, so the size of that odds ratio is worth less than the direction of it, which the Doha synthesis supports separately.

The page carries the counterweight. Weir and colleagues (2011) found a mean return to full sport of 12.8 weeks (SD 6.0) with multimodal treatment against 17.3 weeks (SD 4.4) with exercise therapy, p = 0.043. Only 50 to 55% of athletes in either arm made a full return, there was no difference in the objective outcome score or in pain during sport, and the authors concluded that neither treatment was very effective. That abstract does not state the number randomized, so this page does not state one.

Isometric loading in stage 1 and the pelvic work alongside the adductors are the two design choices worth flagging. The isometrics are a tolerance-led entry point rather than an analgesic claim, and no analgesic effect is asserted on the page, because the trial evidence for one in this tendon is absent. A published modification of the Hölmich protocol, evaluated before and after in 15 male athletes, opens its first part with pain-free isometric adduction against a soccer ball between the knees in crook lying and brings in through-range elastic adduction from week 3 (Yousefzadeh and colleagues, 2018), which is the order used here. Adductor stretching was part of the physiotherapy both arms received in that 1999 trial, as the Bisciotti and colleagues (2021) extraction records, which is why a gentle stretch sits in stage 2 while stretching into pain stays out. The seated hand-resisted hold is prescribed where the problem is unilateral, because the bilateral ball squeeze permits unquantified substitution by the uninvolved limb and the patient cannot detect it.

On hold length: the first part of that modified protocol holds each pain-free squeeze for 10 seconds, 3 sets of 10, three times a week. Ten seconds is the top of the 5 to 10 second range stage 1 gives, which is the dose on the adductor ball squeeze and side lying isometric exercise pages, with the seated hand-resisted page at about 10 seconds. The lower end of that range is the tolerance-led entry, and the repetition count here sits deliberately below the protocol's. The 30 to 45 second holds a reader may have met elsewhere come from isometric analgesia protocols written for other tendons, and with no analgesic effect claimed on this page there is nothing for them to be doing.

Long-length and weight-bearing loading is deferred to stage 3. Progressive eccentric work, including the Copenhagen adduction, is left to the treating clinician, and the Copenhagen adduction is named rather than linked because the library holds no video of it. Harøy and colleagues (2019) support the Copenhagen-based Adductor Strengthening Programme for prevention in male football players, and the groin strain page carries that trial's detail and its figures.

Bisciotti and colleagues (2021) screened 234 articles, included 19 across 7 treatment categories, and rated the strongest level of evidence as moderate for compression clothing, manual therapy combined with strengthening exercise, and prolotherapy, with the remaining four categories conflicting. Read the grade letters from its table 5 and its conclusion, which put those three at C and the other four at D, not from its abstract, which prints D for all seven and contradicts both. Those ratings appear on the page as a limitation, not as a menu to pick from.

Adductor tenotomy exists and is not staged here, so the page carries no post-operative section. For the non-responder, the Doha group recorded moderate evidence that partial release of the adductor longus tendon is effective for return to sport over time (Weir and colleagues, 2015). That conversation belongs with a sports physician or surgeon. Screen for femoral neck stress fracture in runners and recruits with exertional groin pain and a limp, which is often missed initially (Clough, 2002), and for inguinal and femoral hernia, testicular causes, lumbar referral and, in adolescents, apophyseal avulsion at the pubic bone.

Common questions

References

1. 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;49(12):768-774. doi:10.1136/bjsports-2015-094869
2. Hölmich P, Uhrskou P, Ulnits L, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. The Lancet. 1999;353(9151):439-443. doi:10.1016/S0140-6736(98)03340-6
3. Weir A, Jansen JAC, van de Port IGL, Van de Sande HBA, Tol JL, Backx FJG. Manual or exercise therapy for long-standing adductor-related groin pain: a randomised controlled clinical trial. Manual Therapy. 2011;16(2):148-154. doi:10.1016/j.math.2010.09.001
4. Bisciotti GN, Chamari K, Cena E, et al. The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review. Biology of Sport. 2021;38(1):45-63. doi:10.5114/biolsport.2020.97669
5. 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;53(3):150-157. doi:10.1136/bjsports-2017-098937
6. Yousefzadeh A, Shadmehr A, Olyaei GR, Naseri N, Khazaeipour Z. The Effect of Therapeutic Exercise on Long-Standing Adductor-Related Groin Pain in Athletes: Modified Hölmich Protocol. Rehabilitation Research and Practice. 2018;2018:8146819. doi:10.1155/2018/8146819
7. Schöberl M, Prantl L, Loose O, et al. Non-surgical treatment of pubic overload and groin pain in amateur football players: a prospective double-blinded randomised controlled study. Knee Surgery, Sports Traumatology, Arthroscopy. 2017;25(6):1958-1966. doi:10.1007/s00167-017-4423-z
8. Serner A, Weir A, Tol JL, et al. Return to sport after criteria-based rehabilitation of acute adductor injuries in male athletes: a prospective cohort study. Orthopaedic Journal of Sports Medicine. 2020;8(1):2325967119897247. doi:10.1177/2325967119897247
9. Clough TM. Femoral neck stress fracture: the importance of clinical suspicion and early review. British Journal of Sports Medicine. 2002;36(4):308-309. doi:10.1136/bjsm.36.4.308
10. NHS. Hernia. Page last reviewed 19 May 2026. https://www.nhs.uk/conditions/hernia/
11. NHS. Deep vein thrombosis (DVT). Page last reviewed 30 April 2026. https://www.nhs.uk/conditions/deep-vein-thrombosis-dvt/
12. NHS. Sepsis. Page last reviewed 14 May 2026. https://www.nhs.uk/conditions/sepsis/

Written and checked by the PocketPhysio editorial team. Last updated 2026-10-29.

This page is general education, not a diagnosis or a personal treatment plan. See a physiotherapist or doctor for advice about your own situation.