Gracilis Syndrome

with Rehab

ExitCare ImageGracilis syndrome is a condition that causes pain and inflammation in the groin area, where the gracilis muscle attaches to the pelvis. The gracilis muscle is responsible for moving the thigh across the body (adducting). Gracilis syndrome includes both inflammation of the tendon (tendonitis) and tearing of the muscle or tendon (strains).

SYMPTOMS

  • Symptoms usually start slowly, after the aggravating activity, and progress to affect the whole activity, leading to constant pain.

  • Pain, discomfort or ache, tenderness, and swelling at the front of the pelvis, which may extend to the groin or inner thigh.

  • Pain that gets worse when pivoting on one leg (i.e. kicking a ball, sprinting, jumping, climbing stairs, or sudden change of direction while running).

  • Pain that gets worse with stretching, particularly when separating the legs and thighs or when bringing the thighs or legs together, against resistance.

  • Walking or running with a limp.

  • Weakness when bending the hip or kicking.

CAUSES

Gracilis syndrome may be caused by either a severe (acute) or ongoing (chronic) injury to the gracilis muscle or tendon. Causes of injury include:

  • Prolonged overuse (most common cause).

  • Sudden increase in intensity, frequency, or duration of activity.

  • Muscle imbalance or weakness.

  • Sudden, single episode of stressful over-activity, such as during kicking.

RISK INCREASES WITH:

  • Repetitive kicking (i.e. soccer or football kicking).

  • Sports that require repetitive jumping (i.e. basketball).

  • Distance runners, fencers, ice hockey players, and weightlifters.

  • Sports that require the legs to be brought together (i.e. gymnastics or horseback riding).

  • Poor strength and flexibility.

  • Previous osteitis pubis (inflammation of the joint at the front of the pelvis).

  • Previous sprain or injury to the pelvis.

  • Stiffness or loss of motion of the hip, or previous hip injury.

PREVENTION

  • Warm up and stretch properly before activity.

  • Maintain physical fitness:

  • Strength, flexibility, and endurance.

  • Cardiovascular fitness.

  • Learn and use proper exercise technique.

PROGNOSIS

If treated properly, gracilis syndrome usually heals within 2 to 6 weeks.

RELATED COMPLICATIONS

  • Longer healing time, if not properly treated or if not given adequate time to heal.

  • Recurring symptoms and injury, if activity is resumed too soon.

  • If untreated, progression to a complete tear (rare) or other injury, due to limping and favoring the injured leg.

  • Prolonged disability.

TREATMENT

Treatment initially involves the use of ice and medication to help reduce pain and inflammation. It is important to complete strengthening and stretching exercises, as well as modify any activity that aggravates symptoms. These exercises may be completed at home or with a therapist. For people with legs that are unequal in length, a shoe lift (orthotic) may be recommended. Rarely, surgery is necessary and is only considered after more than 6 months of unsuccessful non-surgical treatment.

MEDICATION

  • If pain medication is necessary, nonsteroidal anti-inflammatory medications (aspirin and ibuprofen), or other minor pain relievers (acetaminophen), are often advised.

  • Do not take pain medication for 7 days before surgery.

  • Prescription pain relievers may be given if your caregiver thinks they are needed. Use only as directed and only as much as you need.

  • Corticosteroid injections may be recommended. However, these injections should only be used for serious cases, as they can only be given a certain number of times.

HEAT AND COLD

  • Cold treatment (icing) relieves pain and reduces inflammation. Cold treatment should be applied for 10 to 15 minutes every 2 to 3 hours, and immediately after activity that aggravates your symptoms. Use ice packs or an ice massage.

  • Heat treatment may be used before performing the stretching and strengthening activities prescribed by your caregiver, physical therapist, or athletic trainer. Use a heat pack or a warm water soak.

SEEK MEDICAL CARE IF:

  • Pain, tenderness, or swelling gets worse or does not improve, despite 2 to 6 weeks of treatment

  • New, unexplained symptoms develop. (Drugs used in treatment may produce side effects.)

EXERCISES

RANGE OF MOTION (ROM) AND STRETCHING EXERCISES - Gracilis Syndrome

These exercises may help you when beginning to rehabilitate your injury. Your symptoms may go away with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Restoring tissue flexibility helps normal motion to return to the joints. This allows healthier, less painful movement and activity.

  • An effective stretch should be held for at least 30 seconds.

  • A stretch should never be painful. You should only feel a gentle lengthening or release in the stretched tissue.

ExitCare Image STRETCH - Adductors, Lunge

  • While standing, spread your legs, with your healthy leg forward and your injured leg behind you.

  • Lean away from your right / left leg by bending your opposite knee. You may rest your hands on your thigh for balance.

  • You should feel a stretch in your right / left inner thigh. Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Adductors, Standing

  • Place your right / left foot on a counter or stable table. Turn away from your leg, so both hips line up with your right / left leg.

  • Keeping your hips facing forward, slowly bend your opposite leg until you feel a gentle stretch on the inside of your right / left thigh.

  • Hold for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCH - Hip Adductors, Sitting

  • Sit on the floor and place the bottoms of your feet together. Keep your chest up and look straight ahead, to keep your back in proper alignment. Slide your feet in towards your body as far as you can, without rounding your back or increasing any discomfort.

  • Gently push down on your knees until you feel a gentle stretch in your inner thighs. Hold this position for __________ seconds.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRETCHING - Hip Flexors, Lunge

  • Half kneel with your right / left knee on the floor and your opposite knee bent and directly over your ankle.

  • Keep good posture with your head over your shoulders. Tighten your buttocks to point your tailbone downward; this will prevent your back from arching too much.

  • You should feel a gentle stretch in the front of your thigh and hip. If you do not feel any resistance, slightly slide your opposite foot forward and then slowly lunge forward, so your knee once again lines up over your ankle. Be sure your tailbone remains pointed downward.

  • Hold this stretch for __________ seconds.

Repeat __________ times. Complete this stretch __________ times per day.

STRENGTHENING EXERCISES - Gracilis Syndrome

These exercises may help you when beginning to rehabilitate your injury. They may resolve your symptoms with or without further involvement from your physician, physical therapist or athletic trainer. While completing these exercises, remember:

  • Muscles can gain both the endurance and the strength needed for everyday activities through controlled exercises.

  • Complete these exercises as instructed by your physician, physical therapist or athletic trainer. Increase the resistance and repetitions only as guided.

  • You may experience muscle soreness or fatigue, but the pain or discomfort you are trying to eliminate should never worsen during these exercises. If this pain does get worse, stop and make certain you are following the directions exactly. If the pain is still present after adjustments, discontinue the exercise until you can discuss the trouble with your clinician.

ExitCare Image STRENGTH - Hip Adductors, isometrics

  • Sit on a firm chair, so that your knees are about the same height as your hips.

  • Place a large ball, firm pillow, or rolled up bath towel between your thighs.

  • Squeeze your thighs together, gradually building tension. Hold for __________ seconds.

  • Release the tension slowly, and allow your inner thigh muscles to relax completely before repeating the exercise.

Repeat __________ times. Complete this exercise __________ times per day.

ExitCare Image STRENGTH - Hip Adductors, Straight Leg Raise s

  • Lie on your side so that your head, shoulders, knee and hip line up. You may place your upper foot in front to help maintain your balance. Your right / left leg should be on the bottom.

  • Roll your hips slightly forward, so that your hips are stacked directly over each other and your right / left knee is facing forward.

  • Tense the muscles in your inner thigh and lift your bottom leg 4-6 inches. Hold this position for __________ seconds.

  • Slowly lower your leg to the starting position. Allow the muscles to fully relax before beginning the next repetition.

Repeat __________ times. Complete this exercise __________ times per day.