Why the adductor squeeze test is a game changer for evaluating groin injuries

Key Takeaways

The adductor squeeze test evaluates hip adductor muscle strength and detects adductor pathology, pubic symphysis pain, and groin injury risk.

Three standardized positions (0°, 45°, and 90° hip flexion) are used, with 45° hip flexion shown to elicit maximum muscle activity and force values.

Test reliability is excellent (ICC 0.84-0.97 across positions) with peak force measured using a handheld dynamometer or sphygmomanometer.

Pabau’s digital assessment forms and client records software streamline documentation of squeeze test results, strength measurements, and return-to-sport progress.

The adductor squeeze test is a quick, objective clinical assessment that measures inner-thigh strength and identifies muscle weakness or injury. This guide covers the complete protocol, equipment options, measurement techniques, and how to integrate results into your physiotherapy or sports medicine practice.

What is the adductor squeeze test?

The adductor squeeze test measures the strength and function of the hip adductor muscle group-the muscles on the inner thigh that pull the legs together. During the test, the patient squeezes their knees inward against resistance (typically the examiner’s fist) while lying supine, creating an isometric contraction that reveals strength deficits, imbalances, or pain associated with groin injury.

This test is used to detect adductor tendinopathy, pubic symphysis pain, osteitis pubis, sports hernia, and general groin pain patterns. It’s a core assessment in musculoskeletal physiotherapy, sports medicine, osteopathy, and chiropractic practice. The test works because the adductor muscles cross both the hip and the pubic symphysis joint-weakness or pain here often signals pathology that limits performance and increases injury risk.

How to perform the adductor squeeze test: Step-by-step protocol

The adductor squeeze test is performed in three hip flexion positions. Each position tests the adductors at a different length-tension relationship and reveals different clinical information. Digital clinical assessment forms help clinicians document findings consistently across sessions.

1. Patient positioning: Patient lies supine with legs extended or in the designated hip flexion angle (0°, 45°, or 90°). Ensure the pelvis is neutral and the trunk is relaxed against the treatment table.
2. Examiner placement: The examiner places a closed fist between the patient’s knees at the level of the lower patella or upper tibia. The fist is the resistance object for the squeeze.
3. Instruction to patient: The patient is asked to squeeze the examiner’s fist as hard as possible for a 5-second maximal isometric contraction. The patient is told to hold steady pressure-no bouncing or rapid pulsing.
4. Measurement: Force is recorded using a handheld dynamometer (HHD) placed against the medial knee or proximal medial tibia, or by estimating squeeze pressure using a standard sphygmomanometer cuff inflated to 20 mmHg and positioned between the knees.
5. Pain recording: Simultaneous groin or adductor pain is noted on a 0-10 numerical rating scale (NRS). A positive test includes pain provocation OR significantly reduced force compared to the opposite side.
6. Three-position sequence: Perform the test at 0° (legs extended), 45° (legs bent at 45° hip flexion), and 90° (legs bent at 90° hip flexion). Rest 30-60 seconds between positions to avoid fatigue.

Optimal test position and measurement approach

Research published in the British Journal of Sports Medicine and MSK Science and Practice shows that 45° hip flexion is the optimal test position for eliciting maximum adductor muscle activity and peak squeeze values. At this angle, the adductor muscles generate the greatest force output compared to 0° or 90°, making 45° the most sensitive position for detecting strength deficits.

Measurement tools: Handheld dynamometry (HHD) is the gold standard for precision. When HHD is unavailable, a standard sphygmomanometer cuff inflated to 20 mmHg and positioned between the knees can estimate pressure. Peak force using the long-lever position (hip and knee fully extended at 0°) produces 69% higher torque values than the traditional short-lever 45° squeeze, making it the preferred clinical choice when testing athletes or documenting baseline strength.

Who uses the adductor squeeze test and why

Physiotherapists and clinicians using sports medicine software rely on the adductor squeeze test as a routine screening and monitoring tool. The test is essential for:

• Groin pain assessment: Identifying adductor tendinopathy, osteitis pubis, and pubic symphysis dysfunction in athletes and active patients.
• Injury risk screening: Reduced adductor strength is a documented risk factor for groin injury in football, basketball, rugby, and hockey. Pre-season screening using the adductor squeeze test identifies at-risk athletes.
• Return-to-sport decisions: Comparing bilateral squeeze test results helps clinicians determine when an athlete is ready to return to competition. Strength asymmetry >10% indicates persistent deficit.
• Treatment monitoring: Tracking squeeze test force over weeks documents strength progress during rehabilitation and guides exercise prescription intensity.
• Occupational therapy and chiropractic: Occupational therapy software now integrates hip and groin assessment into broader mobility screening, using the adductor squeeze test as a quick objective metric.

Sensitivity, specificity, and reliability data

The adductor squeeze test demonstrates strong reliability across populations. A multi-position study by the University of Chichester found intraclass correlation coefficient (ICC) values of 0.84-0.97 across all three test positions when using handheld dynamometry and taking the mean of three repetitions. The long-lever position yielded the highest reliability (ICC 0.97) with minimal detectable change of 6.6%.

When detecting adductor and pubic pathology in athletes with longstanding groin pain, the adductor squeeze test at 0° and 90° hip flexion showed sensitivity and specificity values ranging 0.60-0.80 depending on the palpation findings and pain provocation threshold. These values are considered moderate to good for a screening test.

Minimal detectable change for handheld dynamometry adductor testing is 10-15% for peak torque, meaning a clinically meaningful strength gain is a 10% or greater increase in squeeze force from baseline. This threshold helps practitioners decide whether strength changes reflect true recovery or measurement error.

Normal values and normative data

Normal adductor squeeze test values vary by age, sex, sport, and testing position. Values are typically expressed as peak force in kilograms (kg) or pressure in millimeters of mercury (mmHg).

• 45° hip flexion (optimal position): Peak force 10-20 kg in untrained adults; 20-40+ kg in male athletes; 15-30 kg in female athletes.
• 0° hip flexion (long-lever): Values typically 20-30% higher than the 45° position in the same individual.
• 90° hip flexion (short-lever): Values typically 10-20% lower than 45° due to reduced mechanical advantage.
• Bilateral asymmetry: Less than 10% difference between sides is normal. Asymmetry >10% suggests unilateral weakness or dysfunction.
• Sport-specific benchmarks: Football/soccer players often show adductor squeeze values 15-25 kg at 45°; professional athletes may reach 30-40 kg. These values drop 5-10% in the 48 hours post-match due to acute fatigue.

How to document adductor squeeze test results

Standardized documentation ensures consistency and allows comparison across sessions. Patient intake software streamlines data capture. Your adductor squeeze test record should include:

• Date and time: When the test was performed (important for tracking post-match fatigue or post-treatment changes).
• Measurement tool: Handheld dynamometer (specify model and calibration date) or sphygmomanometer.
• Bilateral results: Peak force for right and left sides at each position (0°, 45°, 90°).
• Asymmetry calculation: Percentage difference: (Weaker side / Stronger side) × 100.
• Pain provocation: 0-10 NRS pain score during squeeze at each position. Note side provoked (right, left, bilateral).
• Examiner observations: Muscle guarding, hesitation, asymmetrical effort, or pain patterns during the contraction.
• Follow-up status: Link to previous sessions and return-to-running protocols to track progress.

Use a SOAP note structure to record subjective reports of groin pain, objective adductor squeeze findings, assessment of adductor dysfunction, and plan for strengthening or return-to-sport clearance. Digital medical records management ensures these notes are linked to the client’s full history.

AI medical scribes can auto-populate measurements and generate strength-progress summaries from multiple test sessions, reducing manual entry time and improving note quality.

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Pabau's digital forms and client records help you document adductor squeeze test results, track strength progress, and manage return-to-sport timelines in one place.

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Return-to-sport criteria

Adductor squeeze test results inform return-to-sport decisions. Clearance typically requires: (1) bilateral symmetry <10% on the long-lever position (0° or 45°), (2) pain-free squeeze at ≥90% of baseline pre-injury force, and (3) sport-specific movement screening showing no groin pain provocation during running, cutting, or kicking activities.

Athletes with persistent adductor weakness (<80% of pre-injury baseline) benefit from progressive strengthening programs before return-to-sport. Physiotherapy practice management systems allow practitioners to schedule follow-up assessments every 2-4 weeks and track progression toward clearance benchmarks.

Related assessment tests and clinical integration

The adductor squeeze test is often paired with other hip and groin assessments to build a comprehensive clinical picture. Common paired tests include the Copenhagen squeeze test (isometric hip adduction in sidelying, emphasizing the long adductor), the FABER test (hip flexion-abduction-external rotation, assessing hip joint mobility), Thomas test (hip flexor tightness assessment), and straight leg raise (sciatic nerve tension and hamstring length).

Pain reproduction on the adductor squeeze test combined with pain on hip abduction resistance or palpation tenderness over the adductor muscle belly strongly suggests adductor tendinopathy. Pain at the pubic symphysis or lower abdomen with the squeeze test may indicate osteitis pubis or pubic symphysis dysfunction. Clinicians should use a structured SOAP note format to synthesize all findings.

Equipment and measurement tool comparison

Two main tools are used for adductor squeeze testing: handheld dynamometry and sphygmomanometry. Handheld dynamometers (e.g., Lafayette Instrument, Biodex) are the gold standard, offering precise force measurement in kilograms with excellent reliability. They require training and cost $300-$2,000 per unit. Sphygmomanometer cuffs are inexpensive ($30-$100), portable, and suitable for clinic screening, though less precise than dynamometry and prone to operator error.

For most physiotherapy clinics, a mid-range handheld dynamometer or a standard aneroid sphygmomanometer is adequate for baseline testing and progress monitoring. Competitive sports teams typically invest in calibrated handheld dynamometers for precise athlete profiling.

Conclusion

The adductor squeeze test is a simple, objective, reliable assessment tool that detects hip adductor weakness, pain, and pathology. Performing the test at 45° hip flexion maximizes sensitivity; bilateral comparison and tracking over time guide treatment and return-to-sport decisions. Integrating squeeze test results into your digital patient records ensures consistent documentation and evidence-based progression planning. Book a demo with Pabau to see how our assessment forms and client records software streamline adductor testing workflows.

Continue your research

Need a structured approach to hip assessment? Physical therapy EMR software provides integrated assessment protocols and outcome tracking for lower limb and hip complaints.

Looking to document clinical findings more efficiently? Digital assessment forms capture patient history, test results, and clinical observations in a standardized format that links directly to treatment plans.

Want to track athlete readiness objectively? Client portal software lets athletes view their strength progress, scheduled follow-ups, and return-to-sport milestones in real time.

Frequently Asked Questions