Address safety, settle excessive irritability and maintain useful movement.
What to do
Reduce painful sprinting, kicking and cutting load
Maintain pain-tolerable walking and hip ROM
Begin low-load adductor isometrics
Exercise dosage
Adductor squeeze isometric: 4–5 x 20–30 seconds
Comfortable hip ROM: 5–10 reps
Progress when
Daily function is stable or improving.
No new red flags or progressive neurological deficit.
Exercise response returns to baseline by the following day.
Phase 2 — Mobility, Strength & Capacity
Restore the specific strength, mobility and control required by the condition.
What to do
Progress adductor strength through short to long muscle lengths
Add trunk, hip and lower-limb strength
Restore linear running before high-speed cutting
Exercise dosage
Copenhagen progression at suitable lever: 2–3 x 6–12
Hip/trunk strength: 2–3 x 8–15, 2–3 days/week
Progress when
Target movement and resistance are tolerated with good quality.
Functional capacity is improving without sustained symptom flare.
Progression is based on objective performance and patient goals.
Phase 3 — Functional Restoration & Return to Activity
Rebuild real-world, occupational or sporting capacity.
What to do
Progress sprinting, kicking and multidirectional drills
Increase speed and volume separately
Complete sport-specific training before return
Exercise dosage
Sprint/change-direction drills: 2–4 sets, quality first
Progress total weekly field exposure gradually
Progress when
Condition-specific return criteria are met.
Full task exposure is completed progressively.
No clinically meaningful deterioration during the following 24 hours.
Manual Therapy — Role & Application
Manual therapy may address associated hip mobility restriction but is not a substitute for adductor loading.
Avoid painful aggressive stretching early.
Modalities — Use / Avoid
No modality replaces progressive adductor strength and sport exposure.
Compression shorts may be comfortable but are not a treatment by themselves.
Return / Discharge Criteria
Adductor strength and squeeze tolerance restored
Sprint, kick and cutting tasks completed at high intensity
Full training exposure without significant next-day flare
Common Clinical Mistakes
Returning when straight-line jogging is pain-free but cutting remains painful
Ignoring hip joint or stress-fracture differential
Only stretching weak adductors
Clinical Pearls
Use the Doha classification to describe the clinical entity, not to assume a single tissue diagnosis.
Copenhagen exercise should be progressed to current capacity.
Continue learning
Connect assessment with management
Use the related PNA learning pathways to explore examination techniques and structured rehabilitation. A test result should always be interpreted alongside the history, full examination and clinical presentation.
Use these sources as a starting point for clinical learning. A reference being listed here does not, by itself, establish that every recommendation on this page is strongly supported. Check the original publication, study design, population and limitations before applying findings to an individual patient.
Educational resource only. Tests and treatment plans must be adapted to the individual patient, irritability, comorbidities, surgical restrictions and local scope-of-practice requirements.
