Across nearly every sport, explosive movement is the common denominator—quick cuts, sudden acceleration, powerful rotation, and repeated lateral stress. While the image may capture hockey in action, these same forces challenge the groin in soccer, basketball, football, tennis, and many other high-intensity activities. When groin pain lingers beyond a few practices or games, it’s often more than a routine strain. Frequently overlooked or misdiagnosed, this condition can quietly progress and keep athletes sidelined for months. Understanding the anatomy, symptoms, and modern treatment options behind groin pain is key to getting athletes back to full performance—strong, stable, and confident in every movement.
How Athletic Pubalgia Develops in Active Individuals
Despite the popular name "sports hernia," athletic pubalgia is not a true hernia. There is no hole in the abdominal wall or bulging of soft tissue. Instead, it is a complex overuse injury involving the tendons and muscles of the lower abdomen and groin. Specifically, it involves a weakening or tearing of the soft tissues (muscles, tendons, and ligaments) where the abdominal muscles meet the adductor muscles of the inner thigh.
This area, known as the pubic symphysis, acts as a fulcrum for the pelvis. When these opposing muscle groups pull against each other during high-intensity movement, the resulting shear force can cause significant micro-trauma to the attachments on the pubic bone.
Identifying the Symptoms of a "Sports Hernia"
Athletic pubalgia often presents as deep, sharp pain in the lower abdomen or groin area. Key indicators that your pain is more than a standard strain include:
- Pain that intensifies during "cutting" movements, twisting, or sprinting.
- Discomfort that radiates into the adductor region or even the scrotum.
- Tenderness specifically over the pubic tubercle.
- A noticeable "snapping" sensation during explosive activity.
While the pain may subside with rest, it almost always returns the moment you attempt to resume high-level athletic performance.
Why Diagnosis is Often Delayed
Because the anatomy of the hip and pelvis is so intricate, athletic pubalgia is frequently confused with hip impingement (FAI), adductor strains, or osteitis pubis. A precise diagnosis requires a specialist who can differentiate between these conditions through dynamic physical exams and specific imaging protocols, such as a "sports hernia protocol" MRI, which visualizes the subtle changes in the pelvic floor and muscle attachments.
Modern Treatment and Surgical Preservation
Recovery typically begins with a focused "core-to-floor" rehabilitation program. This physical therapy aims to balance the strength between the hip adductors and the abdominal stabilizers. However, if conservative measures fail to provide lasting relief, surgical intervention may be necessary. Modern pelvic preservation techniques involve reinforcing the inguinal wall or performing an adductor tenotomy to release tension, allowing the pelvis to function without the constant "tug-of-war" that causes the pain.
Professional Evaluation for Lasting Relief
If chronic groin pain is preventing you from competing at your full potential, a specialized evaluation is necessary to determine the root cause. Book an appointment with our office to discuss a customized diagnostic and treatment plan designed to get you back in the game.
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.
