A Squeeze Is Not A Squeeze Is Not A Squeeze: If All You Do Is Squeeze, Everything Is an Adductor Problem

Study Title:
Not all weak squeezes are created equal: a clinical reasoning framework for interpreting low hip adduction force

Authors:
Buchheit, M. and King, E.

Publication Information:
Sport Performance & Science Reports (2026) 302: v1.

Background Information (and why I wanted to read it):
The authors report that groin pain affects close to half of soccer players over a single season, with a third of them still carrying symptoms into the next one. Personally and currently, I work in hockey and without digging into sport specific research, I would suggest that the epidemiology is quite similar.

As a result, and with the advancement of tech and its exponential increased usage, the squeeze test has become close to universal across many different sports as a way to “flag” adductor problems early.

It's cheap, it's reliable, and it's fast.

Actually, “cheap” is relative and “reliable” is tester dependent…but it IS fast.

But back to the paper, the rationale for writing and publishing wasn’t because they had an issue with the test itself — their reasoning was because of what typically happens when the number - the testing score - comes back low.

The reality is that in most environments the reflex is immediate: low squeeze —> prescribe adductor strengthening. With the assumption that stronger adductors then fix the problem and/or decrease injury risk.

This paper, written from the combined lens of a performance/monitoring practitioner (Buchheit) and a clinical specialist in groin rehab (King), makes the case that this reflex skips several steps of reasoning that actually matter, and offers a framework to slow the process down.
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*Note: This isn't a paper arguing against the squeeze test. It's a paper arguing against treating a single number as a diagnosis.

What the Test is Actually Telling You

• The squeeze test measures total frontal-plane force from both legs pressing together — it’s a whole-system output, not an isolated readout of the adductors.
• Beyond the primary adductors (Pect., ADD L, Grac., ADD B., ADD M.) and secondary contributors, the forces registered depend on trunk control, pelvic position, and cross-segment coordination. Low scores can come from any of the above.
• While in healthy athletes testing is mostly about force changes, in athletes with pain, it is about both force AND pain. And here’s the important part, improvement in squeeze function (in this group) can be interpreted as any of the following:
  • more force with the same pain
  • less pain with the same force
  • an improvement in both
• So Buchheit and King use this paper to propose a clinical reasoning framework that replaces the reflexive “low squeeze = adductor strengthenign” approach with in improved process for identifying the true cause of a low score and matching it to the appropriate intervention.

Limitations of Squeeze Testing (stuff we say we know but our actions often say otherwise)

• It's often bilateral — this is a HUGE time saver (I get that) and probably provide relatively more reliable scores, but it cannot pick up a unilateral deficit…for one.
• It's isometric and tested toward inner range. This is a huge one for me. And even if testing unilaterally, most adductor injuries occur in outer range. The analogy they use is that we would never test hamstring capacity only at 90 degrees of knee flexion and call it done — yet that's essentially what we do with the adductors. Brilliant.
• Eccentric hip adduction strength has been shown to be significantly lower in symptomatic athletes (with minimal to no change in isometric strength), suggesting that eccentric loading may be more sensitive to clinically meaningful deficits.
• Because of all this, the authors suggest adding unilateral testing with the eccentric break test as the starting point.  

Four Reasons a Squeeze Score is Low
The meat and potatoes of their paper. The section we should probably read several times.

Low scores can fall into four buckets:

• Pain. The athlete can't push maximally because of protective inhibition. This doesn't tell you where the pain is coming from just that it hurts. As we all (should) know, let’s stop the test here.
• Direct deficit. The adductors themselves genuinely lack capacity — structural, neural, whatever.
• Indirect deficit. Upstream. Something else in the system is the limiting factor — stabilizers (obliques, glute min, deep rotators) or synergists (psoas, glute med, hamstrings, glute max) that set up the position for the adductors to work.
• Test execution. Probably more common than not — no true maximal effort, due to poor cueing, no familiarization trial, or an inadequate warm-up.

Reminder - the test only has value if the effort is maximal!

Evidence that Strength isn’t the Whole Story
Using existing research, Buchheit and King walk us through several explanations why we shouldn’t follow the overly common “weak squeeze = strengthen adductors” pathway. Specifically:

1. ​Force production around the hip is influenced by pelvic position and intersegmental coordination and,
2. Squeeze scores improve without targeted adductor work.

 

• Vasilikos et al. (2024) showed that simply altering pelvic tilt angle changes hip extensor torque and agonist-antagonist ratios — meaning two athletes with identical adductor strength could produce different squeeze numbers purely from differences in pelvic control.

This reminds us that the output of any single test reflects the coordination of the whole chain and that a deficit in a small stabilizer may limit the output of a much larger prime mover.

• Baida et al. (2021): studied athletes with and without groin pain. In it, a rehab program built around intersegmental control — with no directed adductor strengthening — resolved baseline strength deficits.
• King et al. (2018): did the same thing in a study with 205 patients rehabilitated with the same intersegmental-control. Squeeze scores improved without addressing the adductors directly (they used intersegmental control).

Three potential reasons why squeeze scores improved without without targeted adductor work:

• Pain resolves allowing athletes to push harder
• Intersegmental control work improves synergistic muscle ability to support force production
• General lower limb loading provides an indirect loading stimulus to the adductors

The conceptual switch the authors want readers to make: when a squeeze score goes up after this kind of rehab, it doesn't necessarily mean the adductors got stronger in isolation. It means the system got better at producing force in that test position.

The squeeze test measures system output, and the system has improved. 

The Decision Tree
I’ve included the figure below, but here’s the rough outline.

• Painful squeeze → identify the diagnosis, manage appropriately (medical/rehab), track force and pain separately throughout → progress towards full assessment used with other pathways.
• Pain-free and dropped from baseline monitoring → likely a fatigue/recovery response. Modify load for 48–72 hours and re-test before assuming anything else is going on.
• Pain-free and low at first test (baseline screening) → compare against population norms or team-specific historical data → straight into full assessment.
• Full assessment → test indirect contributors first (iliopsoas, glute med, deep rotators, obliques), then unilateral direct adductor strength across inner/mid/outer range → re-squeeze. If it improves, the indirect contributor was the dominant driver. If unchanged, lean toward a direct deficit.

Buchheit, M. & King, E. (2026). Sport Performance & Science Reports, 302: v1.

A caveat from the authors: athletes rarely fall cleanly into one category. The decision tree simply tells you what to prioritize with your intervention.

Full Assessment
The authors provide detailed descriptions, images and protocols for each of the unilateral tests using a hand dynamometer. They also provide the same for each of the tests for the indirect contributors (hip flexors, hip rotators, obliques, etc). I encourage everyone to not only read these but actually practice and use them, if not already doing so.

• Unilateral testing - determine which leg is involved
• Indirect contributors - Iliopsoas, GMed, Deep Hip Rotators, Obliques
•  Direct Contributors  - tested unilaterally via eccentric break testing (hand held dynamometer)
  • ​inner range
  • mid range
  • outer range

Authors Final Thoughts

• The means of strengthening deficits around the hip and groin are few and far between, but more important than exerc​ise selection is identifying what to prioritize.
• When addressing indirect contributors - an improvement in test scores should be noticed (if that was the issue in the first place).
• When addressing direct deficits - exercises should be pain free and the range, contraction type and intensity used (in the exercise) should match the desired adaptation.

Authors Practical Recommendations

1. Always record both force and pain on every squeeze test (not just force)
2. When a score is low, ask whether it’s painful or painless before intervening
3. Consider assessing indirect contributors before going straight into adductor strengthening 

My Thoughts

Many: “I know this already”
Some: “We do this already”

But seriously, I could see others diving deeper into (potentially) better unilateral and indirect testing procedures. There are many roads to Rome and the important thing is to cater it to your own population and testing strengths and comforts.

The key though, is to take their message to heart - a squeeze is not a squeeze is not a squeeze.

PS. Don’t forget the joint.