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ESSENTIAL SKILLS muscles. Proper treatment can eliminate this injury in a relatively short period of time, but without treatment, it can plague the person for many years. HOW AND WHY THESE INJURIES OCCUR The adductor muscles function to draw the legs together and help stabilize them in walking or running, working especially hard during side-to-side movements. The adductor muscles are anchored into the pubic bone and run to either the mid-thigh or the medial knee at the distal end. These structures can be injured easily while running, especially in sports that require sudden, quick, side-to-side movements, such as tennis, squash, and basketball. The adductors are also vulnerable in a sport like soccer, where the medial aspect of the foot is used extensively in kicking the ball. During this type of a kick, the adductor muscles provide the primary force. When two players kick the ball simultaneously in that way, this creates a great strain on these structures. The adductors can also be injured by vigorous dancing. Most frequently, however, these injuries result from forced stretching, overuse, or straining while using an adduction machine improperly at the gym. The average person's adductor muscles are not very flexible or strong. As you may recall from previous articles, limitations in the range of motion of muscles or joints makes these structures more vulnerable to injury. In addition, all of our muscles are naturally weaker near the end of their range of motion. As a result, when individuals start to use an adductor machine with the legs spread far apart at the end of their range of motion, they often injure themselves severely the moment they begin to draw their legs together. INJURY VERIFICATION There are a number of positions in which you can test the adductors. We will move from the easiest to the most stressful. TeST 1 With the client lying supine on the table, place your fist between the client's knees, with the sides of your fist (the soft part) against the bony portions of the knees. Now, ask the client to squeeze your fist by drawing the knees together. If this causes pain anywhere in the medial thigh, an adductor strain is present. TeST 2 If there is no pain in Test 1, ask the client to bend the knees and place the feet flat on the table, with the knees 10–12 inches apart. Now, apply pressure to the medial aspects of the knees and have the client draw the knees together as you resist with equal and opposite force (see image above). If that causes no pain, move the knees apart another foot and try again. If this causes no pain, allow the knees to drop out as far as they can toward the table and repeat the same test. 92 massage & bodywork march/april 2010 TeST 3 This final test is the most efficient way to assess the pectineus muscle- tendon unit. Ask the client to raise the knees toward the chest, with the legs splayed open as far as possible. Now, place your hands on the medial aspects of each knee and ask the client to draw the knees together, as you resist with equal and opposite force. PALPATION TESTING Because adductor strains do not cause any referred pain, the location of the pain tells you exactly where the injured tissue is located. Very medial pain indicates the gracilis, while slightly more anterior pain suggests the adductors magnus, longus, and brevis. If the pectineus is injured, the pain will be felt a bit higher up on the pubic ramus, lateral to the pubic symphysis. Following the client's lead, palpate the adductor muscle-tendon unit to determine where the pain is most acute. Start in the middle of the thigh, even if the injury is in the groin. (Sudden or unexpected contact high up on someone's thigh can feel uncomfortable