What Is Causing My Groin Pain? Common Causes Explained

Groin pain is a common complaint in sport, particularly when football, netball and other running-based activities return to full training during pre-season.

Sometimes it happens suddenly. An athlete accelerates, changes direction or kicks a ball and feels a sharp pain in the inner thigh.

Other times, groin pain develops gradually. It may start as a mild ache after training before becoming more noticeable during running, kicking, turning or even everyday activities.

But what is actually causing the pain?

The answer is not always straightforward.

Groin pain describes a region of symptoms, not one specific injury. Several muscles, tendons, joints, bones and other structures can contribute to discomfort in this area.

At RHP Physiotherapy in Kelvin Grove, Brisbane, our sports physiotherapists assess acute and persistent groin pain in athletes, as well as hip and groin complaints affecting recreational activity and everyday life.

In this article, we’ll explain the most common causes of groin pain, what symptoms may help distinguish them, and how an appropriate assessment guides treatment and rehabilitation.

Where Exactly Is the Groin?

The groin is the region where the lower abdomen meets the upper thigh, around the front and inner aspects of the hip and pelvis.

It includes several closely related anatomical structures:

• Adductor muscles: Muscles along the inner thigh that contribute to hip adduction and force production.
• Hip flexors: Including the iliopsoas and rectus femoris, which contribute to lifting the thigh and controlling hip movement.
• Pubic symphysis: The joint at the front of the pelvis where the left and right pubic bones meet.
• Inguinal region: The area of the lower abdominal wall and inguinal canal.
• Hip joint: The ball-and-socket joint between the pelvis and the femur.
• Bone and nerve structures: Including the pelvis, upper femur and nerves travelling through the region.

Because these structures are close together, different conditions can produce symptoms in similar locations.

An athlete describing pain in the front of their groin could have a hip-related presentation, iliopsoas-related pain or another condition entirely.

That is why a clinical examination needs to consider more than the location of discomfort.

How Is Groin Pain Classified in Athletes?

Sports medicine historically used many different names for groin injuries.

Terms such as sports hernia, osteitis pubis, adductor tendinopathy and athletic pubalgia were sometimes used inconsistently, even when clinicians were describing similar presentations.

To improve communication, an international group of experts developed the Doha Agreement on terminology and definitions in groin pain in athletes.

The classification identifies four main clinical entities, with hip-related and other causes considered separately.

This approach is useful because it describes recognisable patterns of symptoms and examination findings without assuming a particular tissue has been damaged.

Importantly, an athlete can have more than one groin pain classification at the same time.

The Doha Agreement provides a clinical framework, not a definitive diagnostic test for every possible groin condition.

1. Adductor Muscle Strain: Sudden Inner-Thigh and Groin Pain

Adductor muscle strains are among the more familiar groin injuries in sport.

They can occur during activities that place high demands on the adductor muscles, including:

• Sprinting.
• Accelerating or decelerating.
• Rapid changes of direction.
• Kicking a football.
• Sudden reaching or stretching movements.

These injuries often involve the adductor longus muscle, although other adductors can also be affected.

What Does an Adductor Strain Feel Like?

Common features include:

• A sudden sharp pain in the groin or inner thigh.
• Pain during kicking or rapid changes of direction.
• Local tenderness over the affected muscle or tendon region.
• Pain with resisted squeezing of the legs together.
• Difficulty accelerating or sprinting.
• Occasional swelling or bruising with more significant injuries.

Not every adductor strain causes visible bruising or substantial swelling.

The severity of the injury varies from relatively minor muscle injury to a more significant tear.

Does an Adductor Strain Need Complete Rest?

Some reduction in demanding activity may be necessary initially.

However, rehabilitation generally involves progressively restoring the ability of the muscle to produce and tolerate force.

This may begin with appropriately dosed adductor loading before progressing towards higher-load strengthening, running, kicking and change-of-direction tasks.

The appropriate program depends on the severity and location of injury.

More significant injuries, particularly those involving the tendon or musculotendinous junction, may require additional investigation or a longer rehabilitation period.

2. Adductor-Related Groin Pain: When Symptoms Develop Gradually

Not all adductor pain follows a sudden injury.

Some athletes develop gradual discomfort near the adductor attachment at the front of the pelvis.

Symptoms may initially be noticeable after training before becoming more persistent during kicking, sprinting or changing direction.

This has often been described as adductor tendinopathy or chronic adductor groin pain.

However, the contemporary Doha classification generally uses the term adductor-related groin pain because symptoms do not always allow us to confidently identify one precise tendon pathology.

What Are the Symptoms of Adductor-Related Groin Pain?

Typical features include:

• Pain along the inner groin near the adductor attachment.
• Discomfort with kicking or long passing.
• Pain during resisted hip adduction.
• Tenderness through the proximal adductor region.
• Symptoms that increase with certain training demands.
• Persistent or recurring discomfort across a sporting season.

For some athletes, symptoms initially settle during a warm-up but return as training intensity increases or afterwards.

That pattern is worth exploring, although it does not confirm tendon pathology on its own.

Is Adductor Tendinopathy Simply Inflammation?

No.

Older descriptions sometimes separated a supposedly inflamed reactive tendon from a completely non-inflammatory degenerative tendon.

Modern understanding of tendon pain is more complicated.

Tendon loading, structure, cellular processes and pain sensitivity interact, and symptoms do not always correspond closely with imaging changes.

For clinical purposes, it is generally more useful to identify the athlete’s presentation, loading tolerance and physical deficits than assume that all gradual groin pain represents one stage of tendon degeneration.

3. Hip Flexor Pain: Iliopsoas-Related Groin Pain

The hip flexor muscles help lift the thigh and contribute to movements such as running, accelerating and kicking.

The iliopsoas is a major hip flexor, although it is not the only muscle capable of producing hip flexion.

Sudden hip flexor injuries can occur during high-speed movements, while other people experience more gradual iliopsoas-related symptoms.

What Does Hip Flexor-Related Groin Pain Feel Like?

Symptoms may include:

• Pain at the front of the hip or groin.
• Discomfort when lifting the knee.
• Pain during kicking or sprinting.
• Tenderness in the iliopsoas region.
• Pain with resisted hip flexion.
• Pain with movements that lengthen the hip flexors.

These features may support an iliopsoas-related presentation, but they are not specific enough to establish the diagnosis without further assessment.

Hip joint conditions and other structures can produce similar symptoms.

How Does Rehabilitation Differ From an Adductor Strain?

Although both injuries can affect running and kicking, the physical demands on the involved muscles differ.

Iliopsoas-related rehabilitation may place greater emphasis on progressive hip flexor strength, hip movement and tolerance to rapid thigh acceleration.

Adductor rehabilitation often places greater emphasis on forceful hip adduction, lateral movement and kicking-related loads.

However, both pathways may eventually require sprinting, agility and sport-specific rehabilitation.

The goal is to restore the physical demands that are meaningful to the athlete, rather than apply the same routine to every groin injury.

4. Osteitis Pubis and Pubic-Related Groin Pain

Another presentation occurs around the pubic symphysis, the joint at the front of the pelvis.

This area is exposed to loading through several interacting structures, including the adductor muscles, abdominal wall and surrounding pelvic tissues.

Historically, persistent pain around this region has often been described as osteitis pubis.

However, osteitis pubis has sometimes been used inconsistently to describe clinical symptoms, imaging findings or presumed inflammatory processes.

The Doha Agreement therefore recommends the clearer clinical term pubic-related groin pain.

What Does Pubic-Related Groin Pain Feel Like?

Symptoms may include:

• Pain near the centre of the pubic region.
• Local tenderness around the pubic symphysis.
• Discomfort during running or kicking.
• Pain with some changes of direction.
• Symptoms involving more than one nearby groin structure.

The presentation can overlap with adductor-related or inguinal-related groin pain.

That overlap is one reason a detailed clinical assessment is valuable.

Do You Need an MRI to Diagnose Osteitis Pubis?

Not always.

Pubic-related groin pain is a clinical classification based on the person’s symptoms and examination findings.

Imaging may be appropriate when the diagnosis is uncertain, symptoms are persistent or a different condition needs to be investigated.

However, MRI changes around the pubic symphysis can also occur in athletes without groin pain.

Finding bone marrow changes or other abnormalities on imaging does not automatically prove that they explain the person’s symptoms.

Clinical findings and imaging need to be interpreted together.

5. Sports Hernia vs Inguinal Hernia: What’s the Difference?

This is one of the more confusing areas of groin pain terminology.

The term sports hernia is still commonly used, particularly in football and other sports involving repeated acceleration, twisting and kicking.

However, a sports hernia is usually not a true hernia.

It is better understood within the broader category of inguinal-related groin pain, sometimes described as inguinal disruption or athletic pubalgia.

What Is Inguinal-Related Groin Pain?

Inguinal-related groin pain involves symptoms around the inguinal canal region of the lower abdominal wall.

It may be aggravated by:

• Accelerating or sprinting.
• Twisting or cutting movements.
• Kicking.
• Resisted abdominal muscle activity.
• Coughing or sneezing.

In the Doha classification, inguinal-related groin pain involves pain and tenderness in the inguinal canal region without a palpable inguinal hernia.

It does not automatically indicate a tear in one precise abdominal structure.

The condition can involve a complex presentation requiring examination and, in selected cases, further medical or surgical assessment.

What Is a True Inguinal Hernia?

A true inguinal hernia occurs when abdominal tissue protrudes through a weakened region of the abdominal wall.

It may produce:

• A visible or palpable lump in the groin.
• A dragging or pressure sensation.
• Discomfort during coughing, lifting or straining.
• Symptoms that change between standing and lying down.

A suspected true hernia should be medically assessed because some require surgical treatment.

Can a Sports Hernia Turn Into a True Hernia?

There is no established progression where an untreated sports hernia inevitably develops into a true inguinal hernia.

Despite the similar names, they are distinct clinical concepts.

The term sports hernia is problematic precisely because it implies the presence of a hernia when one is usually absent.

Management depends on the diagnosis and may involve rehabilitation, training modification and, for selected persistent cases, specialist review.

6. Hip Joint Problems That Can Cause Groin Pain

Not all groin pain originates from the muscles or tissues around the pubic region.

The hip joint itself can refer pain towards the front of the groin.

Two relevant presentations in active people are femoroacetabular impingement syndrome and some hip labral injuries.

Femoroacetabular Impingement Syndrome (FAI)

Femoroacetabular impingement syndrome, commonly called FAI syndrome, describes a hip-related condition involving a combination of symptoms, clinical signs and relevant bony morphology.

Some people have particular shapes of the femoral head-neck junction or acetabulum, commonly described as cam or pincer morphology.

But having these anatomical features on imaging does not automatically mean someone has a painful hip condition.

The Warwick Agreement on FAI syndrome emphasises that diagnosis requires:

• Relevant symptoms.
• Clinical examination findings.
• Supporting imaging findings.

Symptoms may include pain during deep hip flexion, squatting, twisting or sporting movements.

Some people also report clicking, catching or restricted hip movement.

Hip Labral Tears

The labrum is a ring of fibrocartilaginous tissue around the edge of the hip socket.

It contributes to the stability and function of the hip joint.

Labral injuries can sometimes occur following a particular injury or develop in association with other hip conditions.

Possible symptoms include:

• Deep groin or hip pain.
• Pain with twisting or pivoting.
• Discomfort during deep hip flexion.
• Clicking, catching or locking sensations in some individuals.

However, labral changes can also be identified on imaging in people who do not experience hip pain.

Clicking alone is not enough to diagnose a symptomatic labral tear.

The whole clinical presentation should be considered before attributing groin pain to an imaging finding.

7. Hip Osteoarthritis and Groin Pain

Hip osteoarthritis is another potential source of groin pain, particularly in adults.

Although osteoarthritis becomes more common with increasing age, it does not exclusively affect older people.

People with hip osteoarthritis may experience:

• Groin or front-of-hip pain.
• Discomfort during walking.
• Difficulty putting on socks or shoes.
• Reduced hip movement.
• Stiffness after periods of inactivity.
• Difficulty with stairs or other daily activities.

Hip osteoarthritis is sometimes described simply as joint wear and tear, but that is an incomplete explanation.

It involves changes in several joint tissues and is influenced by biological, mechanical and individual health factors.

Importantly, structural changes seen on imaging do not always correspond with the severity of symptoms.

Exercise, education and progressive physical activity are important components of conservative hip osteoarthritis management.

Our Hip & Groin Physiotherapy service also supports people experiencing non-sporting hip and groin symptoms, including osteoarthritis-related limitations.

What Other Conditions Can Cause Groin Pain?

Although the conditions above account for many common presentations, groin pain can also arise from other musculoskeletal or medical causes.

Examples include:

• Femoral neck bone stress injury: Can cause deep hip or groin pain, particularly in runners and other impact athletes.
• Adolescent pelvic or hip injuries: Including growth-related apophyseal injuries and, occasionally, avulsion fractures.
• Referred pain: Symptoms may arise from the lumbar spine or other structures.
• Nerve-related conditions: Some nerve disorders can produce discomfort, burning or altered sensation in the groin.
• Urological, gastrointestinal or reproductive conditions: Some medical presentations can produce pain felt in the groin despite not involving the hip or adductor muscles.

This is why a thorough history matters.

The location of pain should help guide clinical reasoning, not limit it.

Why Do Footballers and Other Athletes Develop Groin Pain?

Groin pain is especially relevant in sports that involve high-speed running, kicking and repeated changes of direction.

Football is a common example because the adductors, hip flexors and surrounding structures must tolerate a wide variety of high-force tasks.

Players may experience groin symptoms after:

• A sudden increase in pre-season training.
• Returning to high-speed kicking after a break.
• Increasing sprinting or change-of-direction exposure.
• Repeated high-demand training without sufficient recovery.
• Returning from a previous groin injury.

However, it would be too simplistic to attribute all groin pain to overtraining, weak muscles or poor biomechanics.

Different diagnoses have different mechanisms, and relevant factors may include previous injury, capacity, training exposure and other individual characteristics.

Our Football Physiotherapy service considers the physical demands of kicking, sprinting and changing direction when assessing players and planning rehabilitation.

How Is Groin Pain Diagnosed?

Groin pain assessment begins with understanding the athlete’s symptoms and the circumstances surrounding their onset.

Some useful questions include:

• Did the pain begin suddenly or gradually?
• Was there a particular sprint, kick or change of direction that caused it?
• Where is the most recognisable pain?
• Does resisted muscle activity reproduce the symptoms?
• Is there tenderness around the adductors, iliopsoas, pubic region or inguinal canal?
• Are hip joint movements painful or restricted?
• Are there associated symptoms suggesting another medical condition?
• What running, kicking or daily activities are currently limited?

A clinical examination may then include muscle strength testing, palpation, movement testing and functional tasks.

For athletes, we may also consider the ability to tolerate acceleration, sprinting, kicking and multidirectional movement, depending on the stage and severity of the problem.

Does Groin Pain Always Need an MRI or Ultrasound?

No.

Many common sporting groin presentations can be classified through a detailed clinical history and examination.

Imaging may be appropriate when:

• The diagnosis remains uncertain.
• A significant muscle or tendon injury is suspected.
• Bone stress injury needs to be investigated.
• A true hernia is suspected.
• Hip joint pathology may influence management.
• Symptoms are persistent or atypical.

However, imaging findings should not automatically be treated as the cause of pain.

Some hip, adductor and pubic-region abnormalities occur in athletes without symptoms.

The purpose of imaging is to answer a useful clinical question, not simply to identify every anatomical variation.

How Is Groin Pain Treated?

Treatment depends on the diagnosis and the individual’s circumstances.

An acute adductor muscle injury, a hip joint presentation and a true inguinal hernia should not all receive the same treatment plan.

For many musculoskeletal groin injuries, rehabilitation may include several overlapping components.

1. Modify Aggravating Activity

Some reduction in sprinting, kicking or change-of-direction demands may be necessary when symptoms are particularly irritable.

However, complete inactivity is not always required.

Appropriate training modifications may allow an athlete to maintain useful fitness while the injured region recovers.

2. Restore Strength and Loading Capacity

Progressive strength training is commonly used for adductor-related and other musculoskeletal groin presentations.

Depending on the diagnosis, exercises may target:

• Hip adduction strength.
• Hip flexor strength.
• Quadriceps, hamstrings and gluteal strength.
• Trunk and abdominal wall capacity.
• Single-leg strength and movement tasks.

The exercises should be selected according to identified limitations and progressively developed as the athlete’s tolerance improves.

3. Rebuild High-Speed Sporting Capacity

Returning to sport requires more than being comfortable during a basic strength exercise.

Footballers in particular need to rebuild tolerance to:

• High-speed running.
• Acceleration and deceleration.
• Change-of-direction movements.
• Long and short kicking.
• Shooting.
• Reactive and competitive sporting situations.

The demands of rehabilitation should gradually begin to resemble the demands of the athlete’s actual sport.

Our Return to Sport service supports this progression with physical preparation and objective testing where appropriate.

How Long Does a Groin Strain Take to Heal?

Recovery varies considerably depending on the injured structures, injury severity and the demands of the athlete’s sport.

A relatively minor adductor strain may improve within weeks.

A more significant tendon injury, complete muscle tear or persistent groin pain presentation can require considerably longer rehabilitation.

A prospective study of male athletes undergoing criteria-based rehabilitation for acute adductor injuries reported that many athletes with less severe MRI-graded injuries returned to full team training in approximately three weeks.

More severe grade 3 injuries sometimes required several months.

These results describe one particular study population and rehabilitation pathway, not a guaranteed timeline for every athlete.

Return to sport should consider the athlete’s symptoms, strength, physical performance and ability to tolerate relevant training demands.

Can Groin Injuries Be Prevented?

Not every groin injury can be prevented.

However, regular adductor strengthening has useful evidence for reducing groin problems in football.

A randomised trial involving semi-professional male football players investigated an adductor strengthening program based on progressive Copenhagen adduction exercises.

The intervention group had a 41% lower relative risk of reporting groin problems during the season compared with the control group.

That is an encouraging finding, particularly because the program was relatively simple.

But it is important to interpret the results correctly.

The study involved male football players. Its reported effect should not be assumed to apply identically to all ages, sexes and sports.

And the exercise program did not guarantee that every player remained free from groin symptoms.

Are Copenhagen Adductor Exercises Useful?

Copenhagen adduction exercises provide a way to progressively strengthen the adductor muscles.

They can be adapted to different levels of physical capacity, from shorter-lever variations to more demanding full-lever exercises.

However, the more difficult versions can produce substantial muscular loading.

Someone with a recent groin injury should not assume the hardest version is the best starting point.

The appropriate exercise and progression depend on current strength, symptoms and the wider training program.

Frequently Asked Questions About Groin Pain

Groin Pain and Sports Physiotherapy in Kelvin Grove, Brisbane

At RHP Physiotherapy, we work with athletes and active people experiencing groin pain that limits their training, performance or everyday activity.

Our clinic in Kelvin Grove, Brisbane, provides assessment and rehabilitation for hip and groin conditions, with particular experience in sporting presentations.

Depending on the presentation, our approach may include:

• Assessment of adductor, iliopsoas, pubic and inguinal-related symptoms.
• Hip joint examination and screening for other medical causes.
• Objective adductor and hip strength testing.
• Reviewing sporting and training demands.
• Individualised strength and capacity development.
• Progressive sprinting, kicking and change-of-direction rehabilitation.
• Return-to-sport planning and physical performance testing.
• Medical referral or imaging recommendations where clinically appropriate.

For more information about assessment and treatment, visit our Hip & Groin Physiotherapy page.

Athletes may also find our Sports Physiotherapy and Football Physiotherapy services relevant to their sporting goals.

The key message is simple.

Not all groin pain is an adductor strain, and not all groin pain should be managed with the same exercises.

A useful diagnosis begins with understanding the person, their symptoms and the physical demands they are trying to meet.

This article is intended for general education and does not replace an individual medical assessment. Sudden severe groin, hip, abdominal or testicular pain, or symptoms suggesting a complicated hernia, require urgent medical attention.

Author in the know

Sam Donaldson

Director, APA titled Sports and Exercise Physiotherapist. Sam loves to treat athletes with lower limb injuries and has a special interest in knees of all ages; adolescent knee pain, athlete with knee pain, ACL injuries, ACL rehabilitation, Knee Osteoarthritis and Knee Replacement recovery. He is a Dad, Football enthusiast and loves to move. BAppSci (HMS), MPhtyStudies, MPHTY (Sports)