Pectineus Pain: Causes and Treatment

The pectineus muscle is a flat, quadrangular muscle in the groin and upper thigh. Part of the adductor muscle group, you use the pectineus to flex your hip and move your leg toward your body.

Pectineus pain can be felt in your groin, inner thigh, or front top of your thigh. The pain can vary from a dull ache that gradually worsens to a sudden, sharp pain upon injury. The most common cause of pectineus pain is a strained or pulled muscle.

Activities like running, skating, exercising with tired muscles, or even sitting with your legs crossed for too long can injure the pectineus. Treatment for pectineus injuries includes rest, ice, physical therapy, and time.

This article discusses pectineus pain. It explains the anatomy of the upper thigh and groin muscles, common causes of pectineus pain, and how to keep your groin muscles healthy.

Where Is the Pectineus Muscle Located?

The pectineus originates from the pectineal line of the pubic bone, also known as the pectin pubis. It continues downward and in a posterolateral direction (behind and to the side) and inserts into the pectineal line of the femur (thigh bone).

The pectineus muscle is a hip adductor, one of a group of five large muscles on the medial (middle) thigh that adduct the leg. It is the most anterior (closest to the front) of the hip adductors.1

The other hip adductors include:2

• Adductor brevis
• Adductor longus
  
• Adductor magnus
• Gracilis

Most hip adductors are stimulated (innervated) by the obturator nerve and supplied by blood mainly via the branches of the femoral and obturator arteries. The pectineus receives its main blood supply from the medial circumflex femoral artery and contributions from the femoral and obturator arteries.

Similar to the adductor magnus muscle, the pectineus frequently has dual innervation; the anterior (front) part of the muscle is innervated by the femoral nerve, while the posterior (back) part is supplied by the obturator nerve.

What Does the Pectineus Muscle Do?

The main functions of the pectineus muscle are flexion, adduction, and external rotation of the hip. The pectineus muscle both flexes and adducts the thigh at the hip joint when it contracts.

Adduction is the movement of a limb or other part toward the midline of the body or toward another part.3

Flexion decreases the angle between the bones (bending the joint) and brings the thigh forward and upward to flex at the hip joint.4

Flexion can go as far as the thigh to a 45-degree angle to the hip joint. At that point, the angulation of the fibers allows the contracted muscle fibers to pull the thigh toward the midline, producing thigh adduction.1

What Causes Pectineous Pain?

Pectineus muscle injuries occur from moving the leg too far to the side or front of the body. This can be due to overstretching the muscle or rapid movements.

Activities associated with pectineus injuries include the following:15

• Changing directions too quickly while running or playing sports
• Exercising with fatigued muscle
• Inadequate stretching of the adductor muscle complex
• Jumping
• Kicking
• Playing basketball, football, or soccer
• Running
• Sitting with a leg crossed for too long
• Skating
• Sprinting

Groin Strain

The most common cause of pectineus pain is a groin strain or groin pull. An injury to the muscles of the inner thigh, it occurs when the muscle fibers become damaged or torn.

There are three degrees of groin strains:6

• Grade 1: Overstretched or torn muscle, damaging up to 5 percent of muscle fibers.
• Grade 2: More significant damage to muscle fibers caused by a tear
• Grade 3: A tear through most or all of the muscle or tendon

A groin strain can affect the primary hip flexor muscles, the hip adductor muscles, or a combination of the two.

Less Common Causes

Pectineus pain can also be caused by:

• Bursitis of the hip
• Hip strain
• Stress fracture

What Does Pectineous Pain Feel Like?

The most common symptoms of an injured pectineus muscle are:

• Pain
• Bruising
• Swelling
• Tenderness
• Stiffness

A groin strain can cause pain in the front hip area when closing your legs or raising your knee. You may hear a pop or snap when the injury occurs. Pain can range from mild to severe.

The level of pain and your ability to use your leg will vary depending on the degree of strain:6

• Grade 1: With this strain, walking may not be painful, but running, jumping, or stretching may cause pain.
• Grade 2: With this grade, you may need crutches to move around.
• Grade 3: This injury can cause immediate severe pain, swelling, and bruising. You may be able to feel the space where muscle fibers have been torn. In this case, it is important to avoid any running or jumping that would worsen the injury and seek medical attention immediately.
  

When to See a Healthcare Provider

Even though you may want to care for the injury yourself, seek medical attention immediately if:7

• You have new or severe pain or swelling in the groin area.
• Your groin or upper thigh is cool or pale or changes color.
• You have tingling, weakness, or numbness in your groin or leg.
• You cannot move your leg.
• You cannot put weight on your leg.
• Your condition does not improve as expected in your healthcare provider visits.

Evaluating Pectineus Pain

Pectineus pain is assessed by a physical examination. Your healthcare provider will likely:

• Ask about your symptoms and how they started, and have you rate your pain on a scale of 1 to 10.
• Look at the area for signs of bruising or swelling.
• Move your leg in a few directions to check the range of motion.

Imaging tests, such as magnetic resonance imaging (MRI) or musculoskeletal ultrasound, are sometimes used to identify the area and extent of the injury. These tests show:

• Ligaments
• Muscles
• Nerves
• Tendons and where they attach to bones
  

Treatment

An injured pectineus muscle can take time to heal. A mild to moderate groin strain can take three weeks to six weeks of rest or more to heal. A complete tear could require surgery (which is rare) and up to a three-month recovery period.

Initial Treatment

Initially, a pain management plan will usually include acetaminophen and non-steroidal anti-inflammatory medications.

Standard procedure regarding home care of this type of strain can be remembered by the initials P.R.I.C.E. :

• Protection
• Rest
• Ice
• Compression
• Elevation

Avoid movements that might cause further injury, like running and jumping, and minimize activities that use the pectineus muscle, like walking and crossing your legs.

Ice reduces swelling and pain. Put ice or a cold pack on the injured area for 10 to 20 minutes at a time every one to two hours for three days or until the swelling is relieved. Put a thin cloth between the ice and your skin for protection.

Once the swelling goes down after the first few days, apply heat. Use a warm water bottle, a heating pad set on low, or a warm cloth to apply heat to your groin area. Do not go to sleep with a heating pad on your skin, as it can cause burns.

Physical Therapy

After the initial healing period, your healthcare provider may refer you to physical therapy. PT exercises focus on:5

• Muscle strength
• Range of motion
• Stretching

Physical therapy can also include other treatments such as therapeutic ultrasound, electronic muscle stimulation, massage, and hands-on manipulation of the tissue.

An active training program directed at strength and conditioning of muscles of the pelvis and the adductor muscles is very effective at treating patients with long-standing, adductor-related groin pain.

Surgery

Most pectineus muscle injuries heal on their own. In rare cases, surgery may be needed to repair a torn groin muscle.8

After surgery, physical therapy is typically needed to restore the full functioning of the hip.

Prevention

Pectineus injuries can often be prevented by stretching your groin before and after activities. Stretches that help to keep the pectineus muscle in good working order include:

• Butterfly stretch
• Cross-leg stretch
• Standing adductor stretch
• Squatting adductor stretch
  

Summary

The pectineus muscles run from the pubic bone to the top of the inner thigh, an area known as the groin. It is part of the hip adductor muscle group that moves your

Pectineus pain can be caused by a sports injury, such as a groin strain, tear, or pull. Overstretching the hip to the front or side, such as sitting with your legs crossed for too long, can also cause pectineus pain. 

Most pectineus injuries heal on their own in time. To ease discomfort at home, ice and rest the injured area. If you have severe pain, numbness, or tingling or cannot bear weight on the leg, see your healthcare provider.