Athletic Groin Pain

Groin pain in athletes is exercise-related pain in the groin region, common in sports that involve kicking, sprinting and change of direction such as football, rugby and ice hockey. Groin injuries account for 4 to 19% of all injuries in male club football and 2 to 14% in women's football.

The Doha agreement (2015) classifies it on history and examination into 3 groups: 4 defined clinical entities (adductor-related, iliopsoas-related, inguinal-related and pubic-related), hip-related groin pain, and other causes. More than 1 entity is often present in the same athlete.

The adductors, iliopsoas, inguinal canal and abdominal wall, pubic symphysis and hip joint all converge on the pubis, so pain from each can overlap.

The adductor-rectus complex is the shared aponeurotic plate where rectus abdominis (above) and adductor longus (below) meet at the anterior pubis, linking adductor, pubic and inguinal symptoms.

Doha clinical entities:

• •Adductor-related: adductor tenderness and pain on resisted adduction. The most common entity
• •Iliopsoas-related: iliopsoas tenderness; more likely with pain on resisted hip flexion or hip flexor stretch
• •Inguinal-related: pain and tenderness in the inguinal canal region with no palpable hernia; more likely if worse with resisted abdominal testing, cough or sneeze
• •Pubic-related: local tenderness of the pubic symphysis and the adjacent bone
• •Hip-related: pain from the hip joint, such as femoroacetabular impingement (FAI) syndrome (defined by the Warwick agreement), labral tears or osteoarthritis

Onset is acute (usually an adductor strain from kicking or sprinting) or gradual, from repetitive loading.

Risk factors with the most consistent evidence are previous groin injury, a higher level of play, reduced adductor strength (absolute and relative to the abductors) and lower levels of sport-specific training.