Most cases of chronic groin pain if surgery has not been carried out are due to a combination of factors (40-60%), with treatment of two or more pathologies required.


Inguinal Disruption (sportsman’s groin)

Inguinal disruption is a condition characterised by chronic groin pain. There is no definable hernia identified with a rupture of muscles or tendons in the inguinal canal often attributed to the cause of the condition. Many professional footballers have had surgery for this condition.

Other common definitions include:

  • Athletic pubalgia
  • Incipient hernia
  • Pubic inguinal pain syndrome
  • Pubic Symphysitis
  • Sportsman’s hernia


Where is the pain felt?

The diagnosis is made clinically if at least three out the five signs below exist:

  1. Pin-point tenderness over the pubic bone 
  2. Tender point over the deep inguinal ring (middle of the groin)
  3. Pain and/or dilatation of the external ring with no obvious hernia evident (pain near the top of the scrotum)
  4. Pain at the origin of the adductor longus tendon (deep in the groin area)
  5. Dull, diffuse pain in the groin, often radiating to the perineum and inner thigh or across the mid-line (pain along the middle across both pubic bones and the inner thigh with radiation to between the scrotum)


Who commonly presents with it?

Young athletes both elite and amateur commonly present with this type of groin pain described as a sportsman’s hernia. It is especially common among football, hockey, rugby, fast bowlers in cricket players and runners, with a twisting action causing particular strain and discomfort. Simple walking does not usually bring on the pain, but excessive straining or stretching does exacerbate the symptoms. Various scans have been used to try and diagnose this condition, magnetic (MR) scans are often performed to try and detect a possible hernia or muscle rupture but are generally used to exclude other injuries such as:

  • Osteitis pubis
  • Bone marrow oedema
  • Adductor muscle tendinitis
  • Pubic symphysitis
  • Femoro-acetabular impingement (FAI) of the hip joint


Treatment options?

Treatment involves painkillers, physiotherapy to improve core and pelvic stability with surgery required in some patients.

Surgery involves strengthening the inguinal canal by either open or laparoscopic techniques with a prescribed post-operative rehabilitation programme.

Surgery normally results in a return to chosen sport in 4-6 weeks time with all clinicians quoting up to 70% success.


Adductor tendinopathy or injury

This presents with the adductor tendon(s) being injured or possible torn. There are three adductor muscles with tendons, adductor longus, brevis and magnus. 


Where is the pain felt?

The pain is experienced in the groin and can be of a gradual onset but can also present as a result of a sharp usually ‘stretching’ motion. On occasion bruising on the inside of the thigh is noticed with pain in the adductor tendons elicited by ‘squeezing’ knees together from a sitting position. 

Diagnosis is confirmed by magnetic resonance imaging (MRI) and also can be seen by an experienced radiologist on ultrasound scanning.


Treatment options?

There are various treatments available for an adductor injury including:

Adductor specified physiotherapy

Injection therapy – dry needling

Plasma enriched protein injections (PRP)



Adductor-rectus abdominis-aponeurosis tear


Where is the pain felt?

Pain is again felt in the groin area with on occasion bruising noted on the inside of the thigh. Sharp twisting or turning motions, kicking, sprinting and coughing or sneezing, can elicit pain.

The adductor longus tendon has a ‘covering membrane’ which, extends over and onto the pubic bone to cover the rectus abdominis muscle (6 pack muscle). Both the adductor longus and the rectus abdominis muscles arise from the pubic bone but their actions are directly opposite to one another with the rectus abdmonins ‘pulling’ upwards and the adductor ‘pulling’ downwards. Therefore injury to one can cause an adverse effect on the other tendon. This injury can also have an effect by undermining the pectineus and adductor brevis origins also from the pubic bone with a resultant instability of the pubis area.

Careful assessment is required before any treatment is recommended with MRI  of the area essential to help with the diagnosis.


Treatment options?

Treatment will involve:

Physiotherapy, which is the mainstay of treatment along with good painkillers

Injection therapy and rarely surgery


Osteitis Pubis

This is recognised by inflammation seen around the pubic bone and is commonly seen in athletes.


Where is the pain felt?

It presents with pain in the groin area, particularly over the symphysis pubis and is noted after any kicking or a fast sprinting action. Pain can also be experienced with coughing or sneezing with tenderness felt over the pubic bone on clinical examination.

MRI normally confirms diagnosis, with blood tests sometimes needed to exclude calcium or vitamin D deficiencies.


Treatment options?

Treatment involves painkillers, specified physiotherapy, dynamic stabilisation techniques, injection therapy and ultrasound stimulation. At times more then one treatment is recommended