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The adductor muscles are a group of muscles that include the adductor magnus, longus, and brevis. They are involved in accelerating and decelerating the limbs in different directions and are one of the only muscle groups in the lower limb that are always on during walking and running movements. Testing the adductor muscles is important because weakness in these muscles is an intrinsic risk factor for groin injuries. This article will explore some of the common ways to test the adductor muscles, including the adductor squeeze test and the Copenhagen Adduction exercise.
| Characteristics | Values |
|---|---|
| Test Name | Adductor Squeeze Test |
| Test Purpose | Used in the diagnosis of groin injuries and for the measurement of adductor muscle strength |
| Test Position | 0°, 45° and 90° of hip flexion, with the patient lying supine |
| Test Steps | The examiner places their fist between the patient's knees and the patient is instructed to squeeze the examiner's fist, contracting the adductor muscles maximally |
| Test Result | The test is considered positive if the individual complains of pain in the adductor muscles |
| Test Use Case | Athletes who endure a large number of side-to-side movements, repetitive twisting and kicking, and rapid changes of direction appear to be most at risk of developing groin pain |
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What You'll Learn
The Adductor Squeeze Test
To perform the Adductor Squeeze Test, the patient should lie on their back on an examination table with their knees bent and feet flat on the table. The examiner stands at the side of the table, facing the patient's feet, and places one hand on the patient's knee on the side being tested and the other hand on the opposite knee to provide stabilization. The examiner then instructs the patient to "squeeze your knees together as hard as you can." The examiner applies resistance to the patient's knees, attempting to pull them apart, while the patient simultaneously tries to squeeze their knees together.
The examiner assesses the strength of the adductor muscles by evaluating the patient's ability to resist the applied resistance and maintain their knees squeezed together. The test is performed in three positions: 0 degrees, 45 degrees, and 90 degrees of hip flexion. Several angles are used due to the multi-factorial role of the hip adductor muscles. The greatest pressure values and muscle activity have been observed at 45 degrees of hip flexion.
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The Copenhagen Adduction Exercise
- Lie on your back with one leg extended and the other leg hanging off the side of a plinth or table.
- A tester will then place a goniometer on your hip, with one arm joining both anterior-superior iliac spines and the other arm placed over the anterior face of the extended leg.
- The tester will then read and record the angle formed by the longitudinal axis of the anterior surface of the limb from the vertical plane.
- This process is repeated with the other leg.
This exercise helps to determine the flexibility of the adductor muscles and can be used to identify athletes who may be at an increased risk of injury. It is a valid and reliable test that has been approved by major American medical organizations.
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Testing for Obturator Neuropathy
MRI scans can be used to detect atrophy of the adductor brevis, longus, and gracilis muscles, which may indicate denervation and obturator nerve entrapment. This technique is particularly useful for obtaining baseline anatomical structures and excluding other causes of groin pain. However, it cannot detect nerve abnormalities in the thigh or fibro-osseus tunnel. Ultrasound imaging and CT scans are recommended when intrapelvic mass lesions are suspected of entrapping the obturator nerve.
Another method is needle EMG, which can confirm acute or chronic denervation of the hip adductors while excluding other lower extremity muscles. EMG is considered the most useful technique for detecting obturator neuropathy.
Additionally, nerve blocks can be administered at the obturator foramen to relieve pain and reproduce exercise-induced weakness. This approach can be diagnostic in determining obturator neuropathy.
Conservative management, including pharmacologic pain management, physical therapy, and nerve blocks, is often the first line of treatment for obturator neuropathy. However, surgery may be considered for patients who do not respond to conservative therapy but show improvement with diagnostic nerve blocks.
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Assessing Flexibility
The adductor muscles are located on the inner thighs and play a crucial role in hip stabilization. When tight, they can lead to imbalances, restricted mobility, and pain in the hips, lower back, and knees.
To assess the flexibility of the adductor muscles, clinicians and sports medicine practitioners often use two methods: the passive hip abduction test (PHA) and the passive hip abduction test at 90° of hip flexion (PHA90°). These tests are considered appropriate by important American medical organizations. During the PHA test, the subject lies supine on a plinth with the contralateral leg hanging off the side, while the tested leg is extended and placed on the plinth. The tester uses a goniometer to measure the angle formed by the longitudinal axis of the anterior surface of the limb.
Another way to assess adductor muscle flexibility is through the adductor squeeze test, which is used to diagnose groin injuries and measure adductor muscle strength. This test is performed at 0°, 45°, and 90° of hip flexion, with the patient lying supine. The examiner places their fist between the patient's knees, and the patient is instructed to squeeze the examiner's fist, contracting the adductor muscles maximally.
In addition to these clinical tests, self-administered release techniques can also be used to assess and improve adductor muscle flexibility. These techniques include using a release tool or a softball/foam roll to apply pressure to the inner thigh, as well as performing adductor stretches such as swinging the outside leg forward and backward while holding onto a wall for support.
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Testing for Osteitis Pubis
Osteitis Pubis is a non-infectious, chronic inflammatory state of the pubic symphysis and surrounding soft tissues. It is usually caused by the repetitive use of the hips, pelvis, and groin, and is most common in athletes. It can also be caused by pregnancy, childbirth, or surgery in the abdominal area.
To test for Osteitis Pubis, a physical examination is carried out, and imaging tests are used to take pictures of the pubic symphysis joint. The patient will be asked about their symptoms, and the groin will be examined for inflammation. Imaging tests such as an MRI (magnetic resonance imaging) or a CT (computed tomography) scan can be used to diagnose Osteitis Pubis.
The most specific test for Osteitis Pubis is the direct-pressure pubic spring test. This test involves palpating the athlete's pubic bone directly over the pubic symphysis, as tenderness to touch is often noted at that point. The fingertips are then slid a few centimeters to each side, and direct pressure is applied to the pubic rami. With this pressure, the patient will feel pain in the symphysis. To determine if one side is more painful than the other, ipsilateral pressure is applied. If the pain is not reproduced over the pubic symphysis, other diagnoses must be considered.
The adductor squeeze test can also be used to diagnose Osteitis Pubis. This test is performed in three positions: 0°, 45°, and 90° of hip flexion, with the patient lying supine. The examiner places their fist between the patient's knees, and the patient is instructed to squeeze the examiner's fist, contracting the adductor muscles maximally. This test is used to diagnose groin injuries and measure adductor muscle strength.
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Frequently asked questions
The adductor squeeze test is used to diagnose groin injuries and measure the strength of the adductor muscles. The patient lies on their back with their hip joint in a flexed position and their feet resting on a plinth. The examiner places their fist between the patient's knees, and the patient forcefully adducts their thighs to squeeze the examiner's fist.
Strains involving the adductor muscles are the most common groin injury. Acute groin strains generally involve the vulnerable musculotendinous junction or muscle belly, while chronic repetitive stress leads to proximal irritation at the tendinous insertion. If you suspect a groin strain, you should consult a medical professional for a proper diagnosis.
The adductor muscles include the adductor magnus, longus, and brevis. These muscles are involved in decelerating and accelerating the limbs in different directions and are one of the only muscle groups in the lower limb that are "always on" during running and walking movements.
The Copenhagen Adduction exercise is a single-leg exercise that focuses on the eccentric (lengthening part) of hip adduction. This exercise can be easily performed at any training facility and can help prevent and treat groin injuries.
