Groin pain is a common complaint among athletes—especially those who participate in high-impact, cutting and pivoting sports like soccer, hockey, football, and basketball. But this type of pain is far more complex than many realize. Recent advancements in diagnosis and treatment have changed the way groin-related injuries are viewed and managed.
Understanding the Complexity of Groin Pain
Groin pain can originate from multiple sources. While many associate it with muscular strain, it's important to also consider the relationship between the hip joint and pelvic structures. Pain may stem from the hip itself, be secondary to a muscular imbalance, or involve separate anatomical issues altogether.
A way to better understand groin injuries is by viewing the area from the mid-thigh to mid-chest as one core functional unit. Within this core lie two important “joints”: the hip joint (ball-and-socket) and what some specialists call the “pubic bone joint”—a critical center for muscular attachments.
The Key Groin Pain Generators
Groin injuries often involve the insertion the rectus abdominis and adductor fibrocartilage to the pubis. Repetitive strain or injury in this area can lead to osteitis pubis—inflammation and fluid buildup that may extend into the bone marrow, causing bone marrow edema.
The muscles often “take the hit” when there is an underlying structural issue, such as Femoroacetabular Impingement (FAI). FAI limits hip mobility and transfers excessive stress to the pubic region, leading to secondary muscle or bone injury. Athletes suffering from both FAI and groin injuries may benefit from combined treatment strategies.
Diagnosis: Looking Beyond the Surface
A detailed evaluation is crucial to ensure the right diagnosis. Groin pain can be inguinal or adductor-related, traumatic or repetitive. Physical exams including strength testing, provocative maneuvers, and hip assessments; and advanced MRI focused on the parasymphyseal region can help detect fibrocartilage avulsion or aponeurosis tears—especially in the prepubic aponeurotic complex (pubic plate), a key pain generator in athletic groin injuries.
Non-Surgical vs. Surgical Approaches
Most groin injuries begin with conservative treatment: NSAIDs, physical therapy, and core stabilization exercises. Injections (PRP, steroids) may play a role to relieve inflammation and pain, especially in athletes with mild symptoms.
If pain persists and impacts performance—especially in elite athletes—surgical groin repair may be considered. Hip arthroscopy is another surgical option to address coexisting hip impingement (FAI) in the athlete with hip and groin pain.
Prevention and the Path Forward
Because many groin injuries are non-contact-related, prevention is possible. Movement assessments and tailored rehabilitation programs that address biomechanics and strength imbalances are critical. Future research and athlete registries will help refine treatment algorithms and predict which patients will benefit most from specific interventions.
AUTHOR: Srino Bharam MD, MBA is a board-certified, fellowship-trained sports medicine orthopedic surgeon and professor of orthopedic surgery specializing in the treatment of athletic injuries of the hip and groin. Dr. Bharam has over 20 years of experience in treating injuries and conditions of the hip to restore athletes and patients to an active lifestyle.
