• Skip to primary navigation
  • Skip to main content
  • Skip to primary sidebar
Howard J. Luks, MD, Orthopedic Surgeon

Howard J. Luks, MD

Orthopedic Surgeon Sports Medicine Specialist

  • Articles
  • Notes
  • Podcast
  • Book
  • Education
    • Shoulder Injuries
    • Knee Injuries
    • Elbow Injuries
  • About
Blog / Articles / Hip

Groin Pain In Athletes

Howard J. Luks, MD Updated September 17, 2021

Featured image placeholder

Groin pain in athletes is becoming far more common. Single sports participation and relative over-training can put you at risk for developing groin pain. Until recently, most Sports Medicine professionals and their Athletic Trainer colleagues felt there were only a limited number of causes of athletic groin pain.  Most of you as the patients were told you had a sports hernia,  osteitis pubis (inflammation of the pubic bone) or perhaps an adductor strain.  Many of you were told you need hip surgery.  In recent years there has been an explosive growth in the use of hip arthroscopy to manage groin or hip pain in the younger athlete. Current literature and research proves that surgery is rarely necessary in the management of groin pain in the athlete.

Groin Pain
credit to Dr. Andy Franklyn-Miller

Our collective understanding of groin pain is changing rapidly.  Not only have a few fantastic researchers been able to better determine the structures which are bothering you.  These same researchers have proven that the majority of you will be able to return to sports after an appropriate course of rehabilitation and thus avoid surgery.  And no, surgery was not proven to return athletes to the field faster.

Causes of Athletic Groin Pain: Anatomical Approach

  1. PA Pain : Pain which is in the midline … or around the pubic tubercle. This pain is worsened by resisting a sit-up and the midline pain is reproduced with other maneuvers we perform.  This is “PA Pain” or pain due to the pubic aponeurosis. Many muscles converge in this area-including your abdominal obliques, your adductors and your midline abdominal muscles.
  2. Adductor: This pain is slightly lower than the PA pain patient.  The pain occurs where your adductor muscles attach to your pelvis.   This pain will worsen if someone brings your hip outward into abduction.
  3. Hip Pain: For many, the hip joint was never considered a possible cause of groin pain. FAI and other forms of hip problems can cause groin pain that is more medial than we would normally anticipate.  A local anesthetic injected into the hip joint will provide brief relief if the hip is the cause of your athletic groin pain.  That is turn will tell you that the hip is the likely source of your pain.
  4. Hip Flexors.  Hip flexor tenderness is lateral to adductor or PA pain and the Psoas muscle (the strongest hip flexor) is tender to touch.  If your hip flexor is bothering you then you may complain of pain when trying to arise from a seated position.
  5. Inguinal Injuries: Pain classified as inguinal occurs along the upper portion of your groin, above the hip joint and lateral to the pubic area.  There is a little nerve here. The ilioinguinal nerve.  That nerve can become irritated.  To prove that this is the source of your pain, a local anesthetic can be injected to numb the nerve.  That can assist your doctor in determining whether or not the nerve is the source of your pain.

In a group of over 300 athletes with groin pain. more than 60% had pain due to the Pubic Aponeurosis.  The other causes were far less common causes of athletic groin pain. There is a lot of overlap in terms of physical exam findings and complaints that the athlete offers.  Therefore, a meticulous exam is necessary in order to determine the source of the groin pain.  An MRI is useful when the results are put into context with the complaints of the athlete and the findings on exam.

Despite the prevalence of abnormal hip signal on MRI, relatively few patients met the criteria for surgical intervention.

Dr Andy Franklyn-Miller

Perhaps most enlightening … the majority of athletes studied had MRI evidence of hip pathology.  That means they may have been told that the pain was coming from their hip joint and that surgery was indicated.  As I say often, we need to treat patients and not an MRI image.  The MRI should confirm our suspicions and we should not chase an abnormal finding or allow ourselves to suffer a severe case of confirmation bias.  Only 2% of the athletes with hip problems noted on an MRI went on to require surgery.

In future posts we will highlight some of the rehabilitation techniques to manage athletic groin pain without surgery.  S

Stay tuned…

Categories: Hip, Sports Medicine Tags: adductor injury, athletic groin pain, groin, groin pain, hip flexor

Disclaimer:  this information is for your education and should not be considered medical advice regarding diagnosis or treatment recommendations. Some links on this page may be affiliate links. Read the full disclaimer.

Related Articles

Hip Flexor Injury Rectus Femoris
Hip Flexor Injuries and Prevention Strategies
hamstring injury
Hamstring Injury Recovery and Return To Sports
return to running after injury
5 Mistakes Most Runners Make When Returning to Running
proximal hamstring tendinopthy PHT
Proximal hamstring tendinopathy- a true pain in the butt
Outer hip Pain in Runners
Why Does the Outside of my Hip Hurt?
should I have surgery
Sometimes our joints just hurt, and it’s ok not to know why
Howard J. Luks, MD

Howard J. Luks, MD is an orthopedic surgeon & sports medicine specialist. An expert in shoulder, knee, and other sports injuries, he is widely known as one of the country’s best orthopedic surgeons.

Book Appointment · About · Contact

Facebook Twitter LinkedIn YouTube

Like what you’re reading?

Get the latest posts in your inbox

Primary Sidebar

Howard J. Luks, MD is an orthopedic surgeon & sports medicine specialist. An expert in shoulder, knee, and other sports injuries, he is widely known as one of the country’s best orthopedic surgeons.

Book Appointment · About · Contact

Facebook Twitter LinkedIn YouTube

Like what you’re reading?

Get the latest posts in your inbox

Longevity... Simplified: Living A Longer, Healthier Life Shouldn’t Be Complicated

My new book is available now.

Learn More
Read Reviews

Reader Favorites

  • Batters shoulder posterior labral tear
    Batter’s Shoulder : Posterior Labral Tears
  • calcific tendonitis and severe shoulder pain
    Why Does My Shoulder Hurt So Much?
  • knee swelling
    Pain In The Front Of The Knee: 6 Common Causes
  • lactate polarized training
    Lactate, the lactate shuttle, and lactate threshold workouts in polarized training
  • Zone 2 heart rate training
    Zone 2 Heart Rate Training For Longevity and Performance
  • LEg exercises improve longevity
    Runners require strength too: What to do and when to do it
  • should I have surgery
    Sometimes our joints just hurt, and it’s ok not to know why
  • Polarized training for runners
    Polarized training for everyday runners: Part 1

Howard J Luks, MD

Orthopedic Surgery & Sports Medicine
128 Ashford Avenue
Dobbs Ferry, NY 10522

Phone: (914)-559-1900
Book Appointment

Pages

  • About
  • Upcoming Books
  • Testimonials
  • In The News
  • Media Photos
  • Contact

Topics

  • Shoulder
  • Knee
  • Elbow
  • Metabolic Health
  • Osteoarthritis
  • Training

More

  • COVID
  • Ankle
  • Hip
  • PRP
  • Running
  • Sports Medicine
  • Articles
  • Notes
  • Podcast
  • Book
  • Education
  • About

© 2022 · Howard J Luks, MD · Disclaimer & Terms · Privacy Policy
The information on this site is not intended or implied to be medical advice, diagnosis, or treatment.
This site should be used for informational purposes only.