Groin pain is so common but often difficult to manage on its own. When left to get better on its own, pain will often linger without improvement and movements will begin to feel restrictive through the groin area overall. The reason for this is that groin pain can occur from many different sources around the area and present with varying symptoms. The appropriate management of groin pain will heavily depend on a physical examination which allows us to identify which structures are contributing to the pain. As the groin is part of the connection point between the trunk and the lower limbs, rehabilitation often involves a combination of abdominal, hip, glute, groin, and lower back exercises!
Although there are many different ways that groin pains or injuries develop, issues commonly arise in sports, occupations or activities that involve a lot of change of direction, jumping, twisting, and lunging.
There are many different sources of groin pain in the current research today and we have provided a concise list of the most common we see in the clinic for you!
Different Sources of Groin Pain
There are many different sources of groin pain in the current research today, so here is a list of the updated classifications, terms and sub groups.
- Adductor related Groin Pain
– Groin Muscle Strain
– Adductor Tendinopathy
Adductor-related groin pain can involve an acute strain of the groin muscles themselves or can be long-standing issues with the tendons. Groin strains can feel similar to other muscle tears, with sharp pain through the middle of the muscle belly with loaded movements and possibly a dull aching feeling with rest. Groin tendon pain on the other hand presents as tenderness over the insertions at each end of the muscles. This would either feel like tenderness down towards the inside of the knee or high up and central groin pain. Long-standing adductor muscle pain often takes longer to settle, and a carefully monitored program of strengthening exercises and rehabilitation is often needed. It’s important to note that an assessment to determine whether the problem lies with the muscles or tendons is important. Groin strains and groin tendon pain require very different rehabilitation programs and will have different movements or activities to avoid as well.
- Pubic related Groin Pain
– Osteitis Pubis
Pubic-related groin pain is characterised by tenderness near the pubic bone. It is usually quite hard to reproduce pubic bone pain with testing as it flares up with continuous use such as running and jumping. This means that during a physical examination, we place more emphasis on the palpation of the tenderness or soreness within the groin area and connect this to your history of symptoms. A general type of related pubic bone pain is “Osteitis Pubis”, which is reported in many field sports such as AFL, soccer and hockey.
Note: Osteitis Pubis is no longer the “technical term” used by health professionals due to various reasons in how the condition forms and presents. However, the general public will still relate their symptoms to this type of groin injury as it was the umbrella term heavily used in the early 2000s.
- Inguinal related Groin Pain
– Inguinal Hernia
– Sportsman’s Hernia
Inguinal-related pain is a groin injury that generally takes the longest time to recover from. The inguinal-related pain is experienced ‘deep’ in the groin area, slightly higher up than an adductor-related type of groin pain. This can feel as though the issue is even up to within the abdomen at times rather than the groin. Activities that increase intra-abdominal pressure such as bracing, coughing, or sneezing will usually cause pain with this type of groin pain.
- Iliopsoas related Groin Pain
– Hip Flexor Muscle Strain
The Iliopsoas is a hip flexor muscle that helps with lifting your thigh up (used heavily in sprinting or kicking actions). A strain or injury to this muscle may present as pain within the groin or radiating down the top of the thigh muscles. It will usually hurt to lift the leg up and sometimes when having to straighten your knee.
- Hip related Groin Pain
– Hip Labral/Capsule Tear
– Hip Arthritis
– Femoroacetabular Impingement (FAI)
– Perthes Disease
– Stress Fracture
– Avascular Necrosis of the Femoral Head
Hip-related groin pain is related to the hip joint itself, which involves the bony structures such as the head of femur (leg bone) and the socket in which it sits on your pelvic bone. Although we think about our hips sitting towards the outside of our pelvis, the joint itself is actually quite central, mimicking pain in the groin area. In the field of sports medicine and physical therapy, it’s important to determine whether the pain is coming from the hip joint, the groin muscles, and tendons or other injuries such as inguinal hernias as they all require different management.
Groin Muscle Strain Treatment
The groin and surrounding muscles play a big role in how you twist and turn your hips and legs, so groin issues commonly arise in activities or jobs that involve a lot of twisting and lunging or sports that involve a change of direction, jumping/ landing, and kicking! Athletes playing sports like soccer and football have a higher chance of these types of injuries due to the variety of playing surfaces as well as the high demands of the sports. Other sports such as hockey, netball, and basketball are also common culprits for this type of groin injury.
A true groin strain involves one of the muscles of the groin (also known as hip adductor muscles). What you will most likely experience when you have a groin strain is a sharp pulling pain up towards your groin as you go running, jump or change direction. In the early stages of management, our goal will be to find out which of these movements are painful and which can still be performed pain-free. This allows us to gain a better insight into which muscles may be injured as they all have slightly different roles to play in how we move.
Initial management of a groin strain is hands on treatment to settle down the pain and isometric loading to begin the rehabilitation process. The isometric exercises we commonly use in the early stages are gentle groin squeeze exercises. This can be done with a ball, a pillow, or even up against a door frame (for one-sided isometrics) and is performed in different positions such as straight legs, bent legs and legs lifted off of the floor (in a lying down position).
Once we progress from these entry-level rehabilitation exercises, we can tailor the treatment to specific needs and goals such as returning to work, everyday activities or sports.
Osteitis Pubis Treatment
Osteitis Pubis is a term often used to describe tenderness and irritation over the pubic symphysis and the surrounding muscular attachments. You will often experience pain quite centrally in the groin area and find that it gets gradually worse and worse as you continue to try participating in your sport or activity.
Athletes frequently describe feeling as though they’ve lost power when sprinting or changing directions. Rest often appears to be the easy solution but unfortunately, it does not give long-term reprieve from this issue and athletes find that as soon as they attempt to participate in sport again it resurfaces. It’s often seen in taller athletes playing sports such as AFL and soccer.
The most frustrating thing for anyone suffering from Osteitis Pubis (or pubic-related groin pain) is that many factors influence its pain and recovery. For instance, part of the many attachments to the pubic symphysis include groin, abdominal and hip muscles, meaning even some forms of core or upper body exercises can flare up this type of groin pain. It is a load-related injury so doing too much can cause a flare-up, as well as doing too little. There is a trial and error period of rehabilitation where we need to find the most appropriate amount or dosage of exercise that our body responds to before returning back to the activities which caused pain in the first place.
Inguinal Hernia (Sports Hernia) Treatment
An inguinal hernia or sports hernia is a compromise of the soft tissue structures through the groin area or abdominals, caused by powerful twisting or sudden change of direction movements. This can result in a tear along with protrusions/bulging in severe cases.
In severe cases, the most successful management option is surgery to repair the tear, followed by physical therapy to rehabilitate the structures that were involved or operated on. For more minor or moderate hernia which does not result in full tears, we can treat conservatively through active rehabilitation and guidance on which movements, exercises, or activities to avoid – this will change depending on the severity and location of the hernia.
What needs to be done about Groin Pain?
You can now see why groin pain is quite complex and can be frustrating for clients to manage! We wish there were a simple guide to dealing with all of these pesky groin issues, but there simply isn’t.
So here are our 3 go-to tips on how to get on the right path to recovery!
- Don’t ignore the early niggles. Not all types of groin pain will begin with an incident or sharp painful movements. Overuse issues along with a number of hip-related groin pain will begin with simple tightness and restrictions. Groin issues are a lot easier to manage and quicker to recover from in these early stages so get in touch as soon as your niggles are lasting greater than a week!
- Identify the source of your pain! A detailed assessment of your symptoms by an expert team of physiotherapists along with muscle strength and mobility tests are essential to diagnose which type of groin pain you are suffering from!
- Stick to the plan! Groin pain can have its ups and downs and may flare up at times, but if you do not stick to the overall plan for the long term, it can be an injury or pain that lasts long term!
Our physiotherapists are experts in identifying all of the contributing factors that can lead to groin pain and have the facilities and equipment to accurately analyse your movement, strength, and mobility. Getting all the right information for your condition will help you to avoid wasting time and effort on exercises or treatments that are not getting to the source of your problem! Failure to address these factors may increase the likelihood of long-term pain, or recurrence once normal activity is resumed.
If you are experiencing groin pain or any of the other symptoms described above, then we would love to hear from you to discuss how we can help you!