Groin pain in sports people: what is the cause?

People often refer to groin pain in sport as a groin strain or groin pull. These names suggest that the cause of pain is due to a muscle tear. While some cases of groin pain in sport are due to a groin pull, most longstanding or recurrent groin pain is due to another cause.

What are the causes of groin pain in sport?

The hip and groin comprise pelvic bones, joints, muscles and tendons. These structures surround important pelvic organs such as the uterus, ovaries, bladder and bowel. In addition, important nerves pass through pelvic muscles adding to complexity. So, there are many structures in the hip and groin that can cause pain.
What is the most common cause of groin pain in the sporting population?

Most cases are due to a condition called pubic overload. This condition is also known as osteitis pubis or athletic pubalgia. Abnormal or excessive forces on the bones, joint and tendons surrounding the pubic joint lead to bone or tendon swelling resulting in groin pain. The location of the swelling determines were the pain is felt; for example, swelling of the adductor tendon causes adductor pain whereas swelling of the abdominal muscles produces pain in the abdomen. Other features include pain that moves to the other side and pain that gets worse with coughing or sports.

Can the hip joint cause a groin strain?

The simple answer is yes. While a cartilage tear or early arthritis of the hip usually causes hip pain, we know that sometimes these hip problems can present as groin pain. Part of the skill of finding the correct cause of groin pain is to examine the hip joint with specific movements. Also, imaging such as X-ray or MRI can help support the hip joint as the cause of groin pain.

What about a sports hernia?

A hernia is a hole in the wall of the abdomen. As the hole gets bigger, contents of the abdomen such as fat or bowel can poke through the hole. This causes pain in the groin. Typical hernia pain is often sharp pain in the groin triggered by increasing abdominal pressure such as coughing or sneezing. Also, patients might see or feel a lump in their tummy that can come and go. We confirm a diagnosis by feeling for a lump during a cough. Also, an ultrasound scan can help see the hole in the abdominal wall and poking of contents through hole during a cough.

Sports hernia is a controversial term referring to a weakness of the abdominal wall without a defined hole. Recent studies suggest that a sports hernia should be considered a part of pubic overload rather than a true hernia.

Do gynaecological problems cause groin pain in female athletes?

Yes. Female reproductive organs such as the uterus and ovary sit just behind the hip joint and pubic symphysis. Therefore, it makes sense that conditions such as endometriosis or ovarian cysts can cause groin pain. It is important to ask questions that may give clues to gynaecological causes such as pain that gets worse with periods or changes to the menstrual cycle such as a increased bleeding.

What do you do if you have persistent groin pain?

It is important to see an expert in groin pain to get a speedy diagnosis. Dr Masci is a sports doctor who has an expertise in assessing hip and groin pain. He will undertake a thorough assessment to find the cause. He will also suggest investigations such as X-ray, ultrasound and MRI to confirm the diagnosis. Working at Onewelbeck allows patients easy access to other experts such as hip surgeons, hernia surgeons and gynaecologists if needed. But the most important part of the assessment is getting the diagnosis right from the beginning.

In summary, groin pain is sporting population is common and often misdiagnosed as a groin strain or groin pull. The most common cause is pubic overload but other conditions need to be kept in mind such as hernia, hip arthritis and endometriosis. Getting the right diagnosis the first time is essential for getting you on the path to recovery.

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Written by Dr Lorenzo Masci

Dr Lorenzo Masci is a Sports and Exercise Medicine physician based at OneWelbeck orthopaedics. Sports and Exercise Medicine physicians take a holistic approach to diagnosing and managing any musculoskeletal condition.