Adductor Squeeze Test: Groin Strength Monitoring Protocol

You've been through a hard preseason block of change-of-direction work, and now there's a dull ache on the inside of your thigh every time you plant and cut. Or maybe you're the one running the session, and three players have mentioned the same tightness in the last two weeks. Adductor strain rarely shows up as a single dramatic event — it builds quietly through a training block until someone finally pulls up short during a game. The squeeze test won't diagnose a tear, but it gives you a five-minute number that tells you whether an athlete's hip adductors can handle the loads you're about to put on them.

This guide walks through the standard squeeze test positions, a step-by-step protocol you can run pitchside with a blood pressure cuff, and how to read the numbers against two of the most-cited validation studies on the test.

Where Adductor Injuries Actually Happen

Groin and adductor strains sit among the top three injury categories in soccer, ice hockey, and Gaelic games, and unlike hamstring strains, they tend to recur — reported recurrence rates in some soccer cohorts run above 20% within the same season. Most of these strains happen at the myotendinous junction of adductor longus, and the mechanism is almost always the same: a rapid eccentric load during a plant-and-cut or a skating stride, applied to a muscle that was already working from a strength deficit or accumulated fatigue. Part of the problem is that adductor strength is rarely checked until an athlete is already limping. Coaches track sprint times and jump height because those numbers are easy to collect; adductor strength gets skipped because it usually means a clinic visit and an isokinetic dynamometer.

The squeeze test closes that gap. Thorborg and colleagues validated a standardized version — now often called the Copenhagen five-second squeeze — using nothing more than a sphygmomanometer cuff and a stopwatch (Thorborg et al., 2017, British Journal of Sports Medicine). In their cohort of sub-elite footballers and handball players, athletes who reproduced their groin pain during the test could be distinguished from pain-free athletes with reasonably strong accuracy, and the test also showed good day-to-day reliability when the same tester repeated it. It's not a substitute for a clinical exam, but as a five-minute screen it flags who needs a closer look before a full-blown strain shows up.

When the Test Earns Its Place in a Program

• Preseason baseline, before change-of-direction volume ramps up.
• Weekly or biweekly monitoring in sports with heavy cutting demand — soccer, hockey, hurling, futsal.
• Return-to-play decisions after a groin strain, alongside pain-free hip range of motion and sport-specific movement.
• Anytime multiple athletes report groin tightness in the same week — that pattern usually points to a training-load issue, not three unrelated injuries.

Three Standard Hip Positions

The squeeze test can be run at three hip angles, and each one loads the adductors slightly differently. Most field settings only need the 0° position, but running all three gives a fuller picture, particularly for athletes returning from injury.

What You Need

• A standard sphygmomanometer (blood pressure) cuff, or a pressure biofeedback unit if your clinic has one.
• A flat table or plinth.
• A stopwatch or phone timer.
• A second person to inflate the cuff and read pressure — running this solo produces inconsistent readings.

Setup

1. Athlete lies supine on the table, hips and knees positioned for the angle you're testing (0° is the default for most screening).
2. Place the deflated cuff between the athlete's knees for the 0° and 45° positions, or between the ankles for the long-lever position.
3. Inflate the cuff to a baseline pressure of 10 mmHg before the athlete does anything — this removes slack from the cuff so the reading reflects actual squeeze force, not cuff compression.

Execution

1. Cue the athlete to squeeze in as hard as possible and hold the contraction for the full five seconds.
2. Read the peak pressure reached during that window, not just the value at the five-second mark.
3. Rest 30 to 45 seconds between attempts.
4. Run three trials per position and record the highest of the three, along with whether the athlete reported any pain reproduction and where.
5. Repeat for the opposite side to check symmetry, and add the other hip angles if the athlete has a history of groin issues.

Common Execution Errors

The most frequent mistake is letting the athlete brace through the low back and glutes instead of isolating the adductors — watch for the pelvis lifting slightly off the table. Cue a flat lumbar spine and re-test if you see compensation. The second common error is inconsistent cuff placement: moving it from mid-thigh to just above the knee between trials changes the lever arm and the number, so mark the spot with tape if you're testing the same athlete repeatedly across a season.

What Counts as a Meaningful Number

Squeeze test values are cuff-dependent, so absolute mmHg readings from your team won't match another program's numbers exactly — track change within the same athlete on the same device rather than comparing across teams. That said, a few reference points are useful. In male university and semi-professional soccer players, published 0° squeeze values commonly fall somewhere in the 200 to 280 mmHg range, though the spread across individuals and cuff protocols is wide enough that this should be treated as a rough band, not a pass or fail line. Ice hockey players, who load the adductors differently through the skating stride, sometimes trend a little higher on the same 0° test — another reason to build sport-specific reference ranges from your own roster rather than importing a number from a published paper on a different population.

Side-to-Side Comparison

Bilateral asymmetry matters more than the absolute number in most field settings. Calculate a limb symmetry index the same way you would for a hamstring or quad test: weaker side divided by stronger side, times 100. A gap beyond roughly 10 to 15% between sides is worth flagging for follow-up, especially if it's a new finding compared to the athlete's own baseline.

Pain Reproduction Is a Result on Its Own

Delahunt and colleagues followed a squad of elite Gaelic football players through a full season and found that lower preseason squeeze scores, combined with a lower HAGOS Sport and Recreation subscale score, were associated with a higher likelihood of sustaining a groin injury during the season (Delahunt et al., 2017, Journal of Science and Medicine in Sport). The effect wasn't overwhelming on its own — squeeze score alone was a modest predictor in a single-sport cohort — but combining the strength number with the athlete's self-reported function score sharpened the picture. The practical takeaway isn't that one low score means an injury is coming; it's that a low score paired with an athlete who mentions groin discomfort during warmups is a combination worth acting on, not waiting out.

Building It Into a Weekly Routine

Testing every athlete every week isn't necessary and it burns out your staff. A more sustainable cadence is a full-squad baseline in preseason, then targeted re-testing for anyone who reports groin tightness, missed a session for lower-body soreness, or is returning from a lower-limb injury.

A Quick Pre-Session Checklist

• Cuff inflated to a 10 mmHg baseline before every trial, not eyeballed.
• Same tester and cuff placement across the season wherever possible.
• Log pain reproduction separately from the pressure number — a strong squeeze with pain reported is not a pass.
• Cross-reference with recent change-of-direction volume before assuming an athlete is just weak — a real strength deficit and a fatigued, under-recovered adductor can look identical on a single test.