Fantasy Impact
As shown below, we see almost no impact on fantasy performance when players return from an adductor (groin) injury. Indeed, this result is quite surprising as the groin muscles are highly involved in sprinting and cutting. The data on QBs and TEs is too small of a sample size to make anything of; however, RBs and WRs provide us with useable samples.
This data suggests that for RBs and WRs, you may be able to trust starting them in your lineup in their first game back on the field after a groin injury.
Players Who Have Had An Adductor (Groin) Injury
Quarterbacks
| Quarterbacks | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Tyrod Taylor (2016 week 12) | 0 | 18.8 | 12.6 (-6.2) | 15.6 (-3.2) | 31.2 (+12.4)* |
| Average | 0 | 18.8 | -6.2 | -3.2 | +12.4 |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Point | 0/1 (0%) | 0/1 (0%) | 1/1 (100%) |
Running backs
| Running Backs | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Rashaad Penny (2022 preseason) | 0 | 18 | 7.7 (-10.3) | 4.5 (-13.5) | 16.8 (-1.2)ψ |
| Chase Edmonds (2022 preseason) | 0 | 11.6 | 8.5 (-3.1) | 9.9 (-1.7) | 4.4 (-7.2) |
| Justin Jackson (2021 week 4) | 1 | 3.6 | 1.2 (-2.4) | 7.9 (+4.3)ψ* | N/A |
| Alex Collins (2021 week 6) | 0 | 7.7 | 4.9 (-2.8) | 4.9 (-2.8) | 2.3 (-5.4) |
| Dalvin Cook (2020 week 5) | 1 | 19.4 | 47.6 (+28.2) | 25.7 (+6.3) | 17.2 (-2.2) |
| Kareem Hunt (2020 week 3) | 0 | 11.6 | 19.1 (+7.5) | 11.8 (+0.2) | 13.6 (+2) |
| David Montgomery (2020 preseason) | 0 | 9.3 | 7.9 (-1.4) | 13.3 (+4) | 12.1 (+2.8) |
| Marshawn Lynch (2018 week 6) | 10 | 13.6 | N/A | N/A | N/A |
| Mike Davis (2017 week 11) | 1 | 2.2 | 6.9 (+4.7) | 9.6 (+7.4) | 6.2 (+4) |
| Average | 1.9 | +2.6 | +0.5 | -1 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Point | 3/8 (38%) | 5/8 (63%) | 5/8 (63%) |
Wide Receivers
| Wide Receivers | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Demarcus Robinson (2022 week 8) | 0 | 2.6 | 1.7 (-0.9) | 10.5 (+7.9) | 6.2 (+3.6) |
| Nico Collins (2022 week 7) | 2 | 6.7 | 13.4 (+6.7) | 7.4 (+0.7) | N/Aψ |
| Dyami Brown (2022 week 6) | 2 | 6.1 | 0 (-6.1) | 1 (-5.1) | 1.9 (-4.2) |
| CeeDee Lamb (2022 week 4) | 0 | 10.8 | 7.8 (-3) | 9.7 (-1.1) | 19.3 (+8.5) |
| Jaylen Waddle (2022 week 3) | 0 | 16.8 | 4.9 (-11.9) | 8.9 (-7.9) | 18.8 (+2) |
| James Proche (2022 week 1) | 2 | 2.5 | 0 | 0.6 (-1.9) | 1.2 (-1.3) |
| Isaiah McKenzie (2022 preseason) | 0 | 4.8 | 8.9 (+4.1) | 11.2 (+6.3) | 6.5 (+1.7) |
| Devonta Smith (2022 preseason) | 0 | 5.2 | 0 (-5.2) | 19.2 (+14) | 9.9 (+4.7) |
| Robby Anderson (2022 preseason) | 0 | 8.7 | 18.7 (+10) | 2.3 (-6.4) | 2.6 (-6.1) |
| Corey Davis (2021 week 13)μ | 5 | 10 | N/Aμ | N/Aμ | N/Aμ |
| Deebo Samuel (2021 week 12) | 1 | 17.5 | 12.4 (-5.1) | 20.3 (+2.8) | 20.4 (+2.9) |
| Randall Cobb (2021 week 12) | 5 | 5.9 | 0 (-5.8)ρ | N/A | N/A |
| Corey Davis (2021 week 11) | 1 | 10 | N/Aμ | N/Aμ | N/Aμ |
| Rashad Bateman (2021 week 9)μ | 0 | 7.2 | 7.7 (+0.5) | 7.7 (+0.5) | 6.3 (-0.9) |
| Donovan Peoples-Jones (2021 week 7) | 2 | 6.6 | 15.6 (+9) | 2.1 (-4.5) | 6.4 (-0.2) |
| Curtis Samual (2021 week 5)μ | 5 | 11.2 | 1.8 (-9.4) | 0.2 (-11) | N/A |
| Darnel Mooney (2021 week 2) | 0 | 9.4 | 1.4 (-8) | 10.5 (+1.1) | 9.1 (-0.3) |
| Rashad Bateman (2021 preseason) | 5 | N/A | 4.9 | 8.6 | 6.9 |
| Jameson Crowder (2021 preseason) | 3 | 11 | 15.6 (+4.6) | 5.9 (-5.1) | 7.4 (-3.6) |
| Curtis Samual (2021 offseason) | 3 | 13.5 | 3.9 (-9.6) | N/Aμ | N/Aμ |
| TY Hilton (2020 week 8) | 1 | 5.7 | 6 (+0.3) | 10.6 (+4.9) | 17.7 (+12) |
| Robert Woods (2020 week 7) | 0 | 13 | 24.9 (+11.9) | 15.4 (+2.4) | 10.5 (-2.5) |
| Jameson Crowder (2020 week 7) | 2 | 14.9 | 9.6 (-5.3) | 3.4 (-11.5) | 10.2 (-4.7) |
| Devante Parker (2020 week 6) | 0 | 12.6 | 6.8 (-5.8) | 6.8 (-5.8) | 12.2 (-0.4) |
| Christian Kirk (2020 week 2) | 1 | 6 | 9.4 (+3.4) | 16 (+10) | 14.6 (+8.6) |
| Russell Gage (2020 preseason) | 0 | 8.7 | 15.9 (+7.2) | 8.6 (-0.1) | 4.7 (-4) |
| Will Fuller (2019 week 16) | 2 | 6.3 | 11.4 (+5.1)ρ | N/A | N/A |
| Odel Beckham Jr. (2019 week 8) | 0 | 10.7 | 7.7 (-3) | 9.5 (-1.2) | 9.9 (-0.8) |
| Deebo Samuel (2019 week 6) | 1 | 6.9 | 12.3 (+5.4) | 10.6 (+3.7) | 14.2 (+7.3) |
| Allen Robinson (2018 week 7) | 2 | 10.4 | 28.3 (+17.9) | 5 (-5.4) | 8 (-2.4) |
| AJ Green (2018 week 3) | 0 | 11.4 | 15.8 (+4.4) | 13.1 (+1.7) | 15.7 (+4.3) |
| Stefon Diggs (2017 week 5) | 2 | 14.5 | 4.6 (-9.9) | 10.5 (-4) | 8 (-6.5) |
| Average | 1.5 | -0.3 | -0.6 | +0.8 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Point | 14/29 (48%) | 17/26 (65%) | 18/24 (75%) |
Tight Ends
| Tight Ends | Games Missed | PPG Prior to Injury | PPG 1st Game After Injury | PPG Games 2-3 After Injury | PPG Games 4-6 After Injury |
|---|---|---|---|---|---|
| Gerald Everett (2022 week 10) | 1 | 6.6 | 5.8 (-0.8) | 7.9 (+1.3) | |
| Hayden Hurst (2022 week 7) | 0 | 6.9 | 6.2 (-0.7) | 5.2 (-1.7) | N/Aψ |
| Hayden Hurst (2022 week 2) | 0 | 5.6 | 1.2 (-4.4) | 12.3 (+6.7) | 5.9 (+0.3) |
| George Kittle (2022 preseason) | 2 | 14.3 | 4.8 (-9.5) | 4.3 (-10) | 15 (+0.7) |
| Irv Smith Jr. (2020 week 11)μ | 2 | 3.5 | 14.3 (+10.8) | 12.3 (+8.8) | N/A |
| Irv Smith Jr. (2020 week 9) | 1 | 3.5 | N/Aμ | N/Aμ | N/Aμ |
| Jarad Cook (2020 week 3) | 1 | 13.2 | 12.1 (-1.1) | 12.2 (-1) | 1 (-12.2) |
| Trey Burton (2019 preseason) | 1 | 4.8 | 0 (-4.8) | 2.8 (-2) | 1.3 (-3.5) |
| Average | 1 | -1.5 | +0.3 | -3.7 | |
| Number of Players Who Have Met Their Baseline at Current or Previous Time Point | 1/7 (14%) | 3/7 (43%) | 2/4 (50%) |
Anatomy of an adductor (groin) injury
Adductor (groin) injuries are prevalent in football, accounting for 39% of hip injuries.1 Five main muscles make up the groin: the adductor longus, adductor brevis, adductor Magnus, pectineus, and gracilis. Each of these muscles attaches from the pelvis to the femur (thigh bone), and collectively they are referred to as the “adductors” as mechanically, they all adduct the hip (move the thigh bone towards the midline). This action of adduction is involved with running, cutting, jumping, and stabilizing on one leg making the health of these muscles impactful for performance.
An injury to a muscle or tendon is called a strain, whereas an injury to a ligament is referred to as a sprain. A strain is when a portion of the muscle fiber or tendon fibers become torn, causing swelling, pain, and, depending on severity, possible loss of strength and range of motion.2 Adductor strains occur most frequently in the adductor longus and gracilis muscles and most commonly occur where the muscle blends into the tendon at the attachment towards the pelvis.2,3 Like all other soft tissue injuries, there is a grading system to classify severity.2 With adductor strains, complete avulsions (tendon pops off the bone) are rare but can occasionally occur.3
- Grade I: Pain, minimal to no tissue injury minimal or no strength and range of motion loss.
- Grade II: More pain, tissue damage resulting in loss of muscle strength and range of motion and function.
- Grade III: Complete tear of muscle or tendon resulting in complete loss of strength and function.
Cause of an adductor (groin) Injury
A strain occurs when one or more of the muscles is stressed by force beyond what it is capable of controlling, causing it to either overstretch or over contract, leading to a strain of either the muscle fibers or tendon.3 Adductor strains most frequently occur via non-contact when sprinting or cutting and commonly occur when a player tries to plant his foot to cut, but his foot slides, causing a significant stretch of the groin muscle.2,3 An example of this was David Montgomery’s injury in the 2020 preseason.
Studies in elite athletes show that adductor injuries are predominately non-contact, with percentages ranging from 67.5%-82.5% non-contact and roughly 14% occurring due to contact.1,4 There is some data on collegiate football players in positions that occur hip injuries most frequently (not specific to adductor strains). One study shows that of all hip injuries, 5.8% occur in quarterbacks, 10.3% occur in running backs, 15.9% occur in wide receivers, and the remaining in other non-fantasy relevant positions (tight end was not listed).1
Unfortunately, data across several studies suggest a high recurrence rate for adductor strains seen in football and other sports.1,4,5 Recurrence of injury can be as high as 18%, most of which occur in the first two months back on the field.1,4,5
There are identified risk factors that may lead an athlete prone to suffer an adductor strain; ideally, off-season training and rehab should focus on improving these factors. These factors include a previous history of an adductor strain (as mentioned above, the recurrence rate is high), decreased range of motion at the hip, and a strength imbalance of the adductors and hip abductors (muscles opposing the adductors).3,6 Of these factors, range of motion and strength imbalances are modifiable through a proper rehab and training program.
Adductor (groin) injury Rehab Process
The return to the field outlook following an adductor strain is typically not extended, as data on college football players shows that 62%-84% of players miss one week or less.1,4 On the surface, it would be plausible that the grade of strain would influence the return to sport time. This may be the case to some degree; however, studies looking at elite soccer players show very little difference in return to sport time between grades I-II strains, with both averaging returning to playing in 2-4 weeks (Obviously, we are talking football here, but studies on NFL players are limited).5 However, in this same study, grade III injuries took 2-3 months to return to play. Therefore, functionally grade I-II injuries can be looked at similarly for a return to playing timeline; however, grade III injuries will likely take longer to get back on the field.
The initial portion of rehab will be focused on reducing pain and swelling, which is done through rest, ice, compression, elevation, and, depending on severity, possibly offloading via crutches.2 During this phase, rehab will also focus on soft tissue treatments such as massage techniques, dry needling, and gentle stretching.2 During this phase, it is important to identify factors that may have contributed to the onset of injury, such as stiffnesses in the ankles or hips and weakness in the hip or core muscles.1,2,6
As pain begins to subside, the athlete can progress stretching of the adductor muscles and start strengthening them. Strengthening begins with isometrics, where the muscle engages but does not move the leg, and as tolerable progresses to concentric strengthening (muscle contracts and joint moves) and eccentrics (muscle contracts forcefully as it is stretching). During this phase, rehab will continue to focus on ankle mobility, hip mobility, glute, and core strength. It will also begin to incorporate balance exercises on unstable surfaces and/or on one leg. If the athlete has no pain with walking and a normal gait pattern, they may attempt gentle jogging, ideally on an anti-gravity treadmill. When all of these are tolerable and performed well, the athlete can progress to more sport-specific rehab.
When preparing to return to sport, a critical component is to ensure that the factors contributing to adductor strains are addressed. As mentioned above, these include a lack of range of motion at the hip and an imbalance of the hip adductors and abductor muscle strength.3,6 Correcting these via stretching and strengthening exercises is a critical part of rehab. Additionally, stability on one leg should be close to equal to the uninjured leg. During sports, athletes are constantly on one leg when running, cutting, or jumping, and the ability to be stable on one leg will reduce the likelihood of re-injury. When these factors are addressed, it is generally safe to begin running, agility, and plyometrics, eventually progressing to sprinting and football-specific moves.
| Rehab Phases | Treatments | Criteria to Enter Phase |
|---|---|---|
| Early Phase | Rest, ice, compression, elevation, NSAIDs. Crutches if needed. Soft tissue work, dry needling, electrical stimulation (pain control). Ankle and hip mobility. Glute and core strength. Adductor isometrics if tolerable. | N/A first phase |
| Intermediate Phase | Soft tissue work, dry needling. Ankle and hip mobility. Glute and core strength. Adductor concentric and eccentric strength. Balance exercises. Gentle jogging (anti-gravity treadmill) if tolerable. | Little to no pain with adductor isometrics. Little to no pain with walking (for initiating running program). |
| Sports Specific | Full weight lifting. Progress to 100% speed running. Agility, plyometrics. Position specific drills. | No pain with adductor eccentrics. Adequate hip range of motion. Adequate adductor/abductor strength balance. Adequate single leg balance. No pain with jogging. |
Generally speaking, adductor strains almost always respond well to conservative care, and surgery is very rare. In some instances, surgery may be impacted if a strain is severe and not healing well or if an avulsion fracture occurs where the tendon comes off of the bone and takes some of the bone with it.
Tom Christ, PT, DPT, OCS
References
- Makovicka J, Chiabra A, Patel K, Tummala S, Hartigan D. A decade of Hip Injuries in National Collegiate Athletic Association Football Players: An Epidemiologic Study Using National Collegiate Athletic Association Surveillance Data. J. Athl. Train. 2019;54(5):483-488.
- Sueki D, Brechter J. Orthopedic Rehabilitation Clinical Advisor. 1st ed. Maryland Heights, MO. Elsevier Inc.; 2010.
- Candela V, Carli A, Longu U, et al. Hip and Groin Pain in Soccer Players. Joints. 2021;7(4):182-187.
- Eckard T, Pauda D, Dompier T, Dalton S, Thorborg K, Kerr Z. Epidemiology of Hip Flexor and Hip Adductor Strains in National Collegiate Athletic Association Athletes, 2009/2010-2014/2015. Am J Sports Med. 2017;45(12):2713-2723.
- Serner A, Weir A, Tol J er al. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes. Orthop J Sports Med. 2020;8(1).
- Núnez J, Fernandez I, Torres A, et al. Strength Conditioning Program to Prevent Adductor Muscle Strains in Football: Does it Really Help Professional Football Players? Int J Environ Res Public Health. 2020;17(17):6408.