Groin Pain: Symptoms, Causes and Treatment

Groin pain is a common complaint that affects both athletes and non-athletes alike. Whether it strikes suddenly after a sports injury or develops gradually over time, groin pain can be both frustrating and debilitating. Understanding its symptoms, underlying causes, and the best approaches to treatment is essential for recovery and prevention. In this article, we’ll take a comprehensive look at groin pain, drawing on the latest research to guide you through its key features, primary causes, and evidence-based treatment options.

Symptoms of Groin Pain

Groin pain doesn’t always present in the same way for everyone. It can be sharp or dull, constant or intermittent, and may be localized or radiate to other regions such as the hip, thigh, or lower abdomen. Recognizing the variety of symptoms is the first step in identifying and managing the problem.

Symptom	Description	Associated Findings	Source(s)
Pain	Aching, sharp, or burning pain in groin	May radiate to thigh or hip	1 3 5
Tenderness	Soreness upon palpation	Localized or diffuse	1 2 5
Stiffness	Reduced range of motion	Especially in hip joint	3 4
Swelling	Visible or palpable swelling	May indicate underlying lesion	1 4
Weakness	Muscle weakness or instability	Often with activity	2 6
Activity-related	Worsens with sports or movement	Improves with rest	5 6

Table 1: Key Symptoms

Understanding the Range of Symptoms

Groin pain can manifest in a variety of ways, depending on its cause and severity. Some individuals feel a sudden, sharp pain during sports, while others develop a persistent ache that worsens with activity.

Pain Characteristics

• Intensity and Quality: The pain may be sharp, burning, or aching. In athletes, it often starts insidiously and worsens with continued physical activity, particularly sports that involve sudden movements, twisting, or kicking (like soccer, hockey, or running) 1 3 5.
• Localization: While most pain is felt in the groin, it is not uncommon for discomfort to radiate to the inner thigh, lower abdomen, or even the hip joint 3. Sometimes, it may be difficult to pinpoint the exact location, making diagnosis challenging.

Tenderness and Swelling

• Palpation: Many cases present with tenderness over specific muscles, tendons, or the pubic bone. Swelling is less common but may indicate an acute injury or underlying lesion 1 2 4.
• Diffuse vs. Localized: Athletes may notice diffuse tenderness, or it may be very localized depending on the injury (e.g., adductor strain, hernia).

Stiffness and Weakness

• Range of Motion: Stiffness in the hip joint is a frequent complaint, making movement painful and restricted 3 4.
• Muscle Weakness: Weakness or a feeling of instability in the groin is often reported, especially during physical activity 2 6.

Activity-Related Changes

• Exacerbation with Exercise: Most groin pain, especially in athletes, is aggravated by movement and can improve with rest 5 6.
• Chronicity: Some symptoms, like mild discomfort, may persist for weeks or months, especially if the underlying cause is not addressed 6.

Causes of Groin Pain

Groin pain is a symptom, not a diagnosis. Its causes are numerous and often overlap, especially in active individuals. Understanding these causes is key to effective treatment and prevention.

Cause	Description	Prevalence/Notes	Source(s)
Hip Joint Pathology	FAI, labral tears, osteoarthritis	Most common in athletes	3 4
Muscle/Tendon Injuries	Adductor strain, microscopic tears	Frequent in sports	1 6
Sports Hernia	Occult hernia, posterior wall weakness	Insidious, activity-related	2 5 8 9
Abdominal Wall Disorders	Pubalgia, muscle avulsions	May mimic hernia symptoms	2 4 5
Nerve Injury	Ilioinguinal/genitofemoral nerve damage	Post-surgical/trauma	7
Bone Stress Injury	Pubic bone overload, stress reactions	Common in runners	3 4

Table 2: Key Causes

Exploring the Main Causes

Hip Joint Pathology

The hip joint itself is a leading culprit in groin pain, particularly in physically active populations.

• Femoroacetabular Impingement (FAI): Characterized by abnormal contact between the hip bone and socket, leading to pain and labral tears. FAI is the most frequently diagnosed intra-articular cause, responsible for up to 32-40% of cases requiring surgical intervention 3 4.
• Labral Tears: Injuries to the ring of cartilage in the hip joint are common, causing deep, persistent groin pain 3 4.
• Osteoarthritis: Degenerative changes in the hip can also manifest as groin pain, especially in older athletes 3.

Muscle and Tendon Injuries

Groin injuries often arise from overload or strain of the muscles and tendons that cross the hip and attach near the pelvis.

• Adductor Strain: Overuse or sudden movement can cause microscopic lesions in the adductor muscles, leading to both acute and chronic pain 1 6.
• Microscopic Tears: Even without a major injury, repeated stress can cause small tears and inflammation, resulting in lingering discomfort 1.

Sports Hernia (Athletic Pubalgia)

A sports hernia is not a true hernia but represents a weakness or tear in the posterior wall of the inguinal canal.

• Symptoms: Typically presents as deep, unilateral groin pain that worsens with activity and improves with rest. Unlike traditional hernias, a bulge is usually absent 2 5.
• Diagnosis: Physical exams may reveal tenderness along the inguinal canal, but imaging is often inconclusive 5. Surgery is often required for resolution 5 8 9.

Abdominal Wall Disorders

Abnormalities of the abdominal wall, such as muscle avulsions or partial tears, can mimic or coexist with other sources of groin pain.

• Pubalgia: Diagnosed when other causes (like hernia) are ruled out. It often involves the internal oblique muscle or attachments at the pubic bone 2 4 5.

Nerve Injuries

Nerve damage, especially to the ilioinguinal or genitofemoral nerves, can result from surgery or trauma.

• Symptoms: Burning or shooting pain, sometimes with numbness, in the groin or thigh 7.
• Anatomic Variability: The branching patterns of these nerves vary, affecting both diagnosis and surgical outcomes 7.

Bone Stress Injury

Repetitive stress to the pubic bone, especially in runners, can cause pain and even stress reactions or fractures.

• Presentation: Usually develops gradually with increased activity 3 4.

Treatment of Groin Pain

Successful management of groin pain requires a tailored approach, targeting the specific cause and severity. Treatments range from conservative therapies to surgical interventions, especially for persistent or complex cases.

Treatment	Approach/Method	Indication/Outcome	Source(s)
Active Physical Training	Strengthening/coordination exercises	Highly effective for adductor pain	6 10
Multimodal Therapy	Manual therapy + exercises	Shortens return to sport	10
Conservative Care	Rest, ice, NSAIDs, physiotherapy	Initial management	5 6 10
Surgical Repair	Herniorrhaphy, laparoscopy, tenotomy	For sports hernia, persistent pain	2 5 8 9 10
Nerve Management	Nerve block, surgical intervention	For nerve-related pain	7

Table 3: Key Treatments

Deeper Dive into Treatments

Active Physical Training and Rehabilitation

For many cases of long-standing adductor-related groin pain, an active training program that focuses on the strength and coordination of pelvic and adductor muscles is highly effective.

• Benefits: Studies show a much higher rate of full return to sport without pain in athletes who followed structured active training compared to those who received only passive physiotherapy 6 10.
• Program Elements: Targeted exercises, progressive resistance, and neuromuscular coordination.

Multimodal and Conservative Therapies

• Manual Therapy: Adding manual therapy techniques to exercise regimens can further reduce the time to recovery 10.
• Supportive Measures: Rest, anti-inflammatory medications, ice application, and physical therapy are common initial steps, especially in acute or less severe cases 5 6 10.

Surgical Interventions

Surgery becomes necessary when conservative measures fail, particularly in cases involving sports hernia, persistent adductor pain, or hip joint pathology.

• Sports Hernia: Open or laparoscopic herniorrhaphy is often required, leading to rapid return to sport—often within 2-3 weeks post-surgery 2 5 8 9.
• Hip Pathology: Arthroscopic procedures may be indicated for FAI or labral tears 4.
• Outcome Evidence: Surgery for sportsman’s hernia and adductor tenotomy have moderate evidence for efficacy, especially when conservative options have not worked 10.

Nerve Pain Management

When groin pain is due to nerve injury, either from surgery or trauma, specialized interventions may be needed.

• Treatment Options: These can include nerve blocks, medications, or in some cases, surgical exploration and repair 7.
• Anatomical Considerations: Due to the high variability in nerve anatomy, treatment plans must be individualized 7.

Conclusion

Groin pain is a complex and multifactorial problem, particularly prevalent among athletes but also seen in the general population. Its symptoms can range from mild tenderness to severe, activity-limiting discomfort. Causes are varied, often overlapping, and include muscle strains, hip joint pathology, sports hernia, nerve injuries, and bone stress.

Here’s a quick summary of what we’ve covered:

• Groin pain presents with a wide range of symptoms, including aching, sharp pain, tenderness, swelling, stiffness, and weakness, often worsened by activity [1-6].
• The most common causes are hip joint pathology (like FAI and labral tears), muscle and tendon injuries, sports hernia, abdominal wall disorders, nerve injury, and bone stress [1-7].
• Treatment approaches should be tailored to the underlying cause, with active physical training and rehabilitation proving highly effective for many, but surgery being necessary for persistent or severe cases such as sports hernia or advanced hip pathology 2 5 6 8 9 10.
• Early recognition and targeted intervention are key to successful recovery and return to activity.

Understanding the spectrum of groin pain and its management empowers individuals and healthcare providers to seek timely, effective solutions—paving the way for a pain-free return to daily life and sport.