A Rehabilitation Protocol excluding primary adductor exercises for chronic adductor- and pubic-related groin pain in an amateur football player: A Case Report

Abstract Introduction Adductor strengthening is the best-supported conservative treatment for long-standing adductor-related groin pain, but evidence is lacking for athletes who cannot tolerate it. Case Presentation A 24-year-old male amateur football player with chronic adductor- and pubic-related groin pain had experienced multiple recurrences since age 16 in football and futsal. From October 2024 to May 2025, despite care from several physiotherapists and sports medicine physicians, he no longer responded to the Hölmich protocol, its validated modifications or other groin pain programmes, whose adductor exercises all provoked pain ≥7–8/10 on a visual analogue scale (VAS). The adductor squeeze test was positive; ultrasonography suggested active enthesopathy at the ischial insertion of the left adductor magnus. A novel 114-day protocol excluded all exercises in which the adductors act as primary agonists. Its core was a progressively loaded parallel back squat, initially with a 3-1-3 tempo, plus knee, calf, gluteal, hip-flexor and trunk exercises, with 2–3 repetitions in reserve. Pain resolved completely (VAS 0/10) after the first month. During flare-ups (5–6/10), sessions were postponed until pain fell to 3–4/10. Tenderness at the common adductor insertion fell from 5–6/10 to 0–1/10 after week 6. Fifty-eight sessions were completed (88% adherence); squat load rose from 10 to 47.5 kg. After more than four consecutive weeks at 0/10, isolated adductor exercises were reintroduced and rehabilitation ended. Conclusions In an amateur football player intolerant to adductor-specific loading, a protocol excluding primary adductor exercises was associated with complete pain resolution. It could be useful for non-responders to traditional protocols.