Athletic groin pain

What it is

What the name covers

A 2015 systematic review describes athletic groin pain as an umbrella term⁵. It covers the many chronic conditions that show up as pain in the inguinal region (the groin)⁵.

The Doha agreement reports that a systematic review of 72 studies found 33 different names in use, often with different meanings for one name¹.

The Doha agreement came from a one-day meeting in November 2014 of 24 experts from 14 countries¹. Its subject was groin pain in athletes¹. The group chose not to recommend a number of popular names¹. Among them were sports hernia, sportsman’s hernia, osteitis pubis, athletic pubalgia and athletic groin pain, the title of this page¹. Its reasons included a lack of specificity and wide variation in how the names had been used¹.

How the Doha agreement sorts it

The agreement has three groups: defined clinical entities, hip-related groin pain, and other causes¹. In each defined entity, pain in the affected region worsens on exercise¹.

Defined entity	How the Doha agreement describes it
Adductor-related	Tenderness of the adductors (the inner thigh muscles), with pain when adduction (moving a limb toward the midline) is tested against resistance¹
Iliopsoas-related	Tenderness of the iliopsoas, a deep hip muscle¹. It is more likely with pain on resisted hip bending or on stretching the hip flexors (the muscles that bend the hip)¹
Inguinal-related	Pain and tenderness around the inguinal canal, a passage through the lower wall of the abdomen¹. No inguinal hernia (a bulge of tissue through the groin wall) can be felt¹
Pubic-related	Local tenderness of the pubic symphysis (the joint where the left and right pubic bones meet) and the bone right beside it¹

Under the agreement, more than one entity can be present in the same athlete at once¹. The group also accepted that hip-related groin pain is sometimes hard to tell apart from other causes¹. It may sit alongside other types of groin pain¹.

Engraving of an adult male pelvis seen from the front, showing the ring formed by the two hip bones and the sacrum. The ilium, ischium and pubis are labelled on each hip bone, the sacrum and coccyx sit at the back between them, and the two pubic bones meet at the front below the pubic arch. — The pelvis seen from the frontHenry Vandyke Carter, in Henry Gray, Anatomy of the Human Body (1918), Fig. 241. Public domain, via Wikimedia Commons. (source, Public domain)

At the front of the pelvis, the pubis of each hip bone joins the other at the pubic symphysis⁶.

Other agreements

A 2012 British Hernia Society conference agreed on “inguinal disruption” as its preferred term⁷. It rejected “sportsman’s hernia”, because no true hernia exists⁷.

A 2026 European formal consensus drew on 57 experts from 22 countries⁸. For athletes and physically active adults, it recommended naming groin pain as adductor-related, iliopsoas-related, inguinal-related, pubic-related or hip joint-related⁸. Its 13 statements were each graded C, on a scale from A (high-level scientific evidence) to D (expert opinion)⁸.

Who it affects

Which type is most common

Two studies sorted athletes by clinical entity, and the adductor-related type was the most common in both^2,9:

A clinic series. Among 207 athletes with groin pain, mostly football players and runners, the main entity was adductor-related in 58% and iliopsoas-related in 36%⁹. More than one entity was present in 33%⁹.
A professional league. Among 206 time-loss groin injuries in men’s professional football, 68% were adductor-related, 12% iliopsoas-related and 9% pubic-related².

The hip adductors and adductor longus tendon pages cover the adductor-related type². The hip flexor strain page covers the iliopsoas-related type².

How common it is in football

Two studies of men’s professional football counted time-loss injuries^2,10:

In 606 players followed for two seasons, groin injuries occurred at 1.0 per 1000 hours². They affected 21% of players at a club each season².
Across 15 seasons in 47 European teams, hip and groin injuries made up 14% of time-loss injuries¹⁰.

Studies that also count problems without missed play report more³. Prevalence is the share of people in a group who have a condition at a given time. Among 407 amateur male players followed for 39 weeks, an average of 11.7% had a groin problem in any given week³. In a season-long study of amateur male football teams in Spain, counting only time-loss injuries captured 10% of all groin problems³.

Ice hockey

In 163 professional and semiprofessional male ice hockey players in Sweden, 45.4% had a hip or groin problem during one season¹¹.

Men and women

Two reviews reached different results^12,13. A systematic review of 31 studies in team sports looked at incidence, the number of new cases over a set time¹². Men had a higher incidence than women playing the same sport¹².

A 2026 meta-analysis (a study that pools the results of earlier studies) covered nine studies and 3133 team-sport athletes¹³. It found no significant difference between men and women in the prevalence of hip and groin injuries overall¹³. Male football players, though, had higher odds of groin problems¹³.

What goes with it

Three studies point to an earlier groin problem^14,15,16:

A systematic review of seven high-quality studies in field sports found previous groin or hip injury the most prominent risk factor, identified in four studies¹⁴. Older age and weak adductor muscles followed, in two studies each¹⁴.
In 245 male amateur football players, groin pain in the past season was associated with 2.4 times the risk of an in-season groin problem¹⁵.
In 632 male semiprofessional football players, a previous hip or groin injury was associated with 74% more weeks with groin symptoms¹⁶.

A systematic review found strong evidence that a combined rotation of the two hips under 85°, measured at preseason screening, was a risk factor¹⁷. A review of hip range and groin pain in athletes concluded that range-of-motion screening is unlikely to correctly pick out an athlete at risk¹⁷. The adductor stretch page covers studies of hip range in more detail¹⁷.

What studies found

How long it lasts and who was studied

Among 382 male patients presenting with athletic groin pain, the median time in pain was 36 weeks¹⁸. In a systematic review of 72 studies, 95% of the athletes studied were male, and most studies were in football players⁴.

One study of amateur football players with groin pain and signs of pubic overload included a control group that only stopped sport¹⁹. Those 51 players returned to football after 240 days, and 26 of them had groin pain again¹⁹.

Exercise compared with passive approaches

A 2013 Cochrane review, a systematic review done to the Cochrane Collaboration’s standards, looked at conservative (non-surgical) approaches to exercise-related groin pain²⁰. It found two randomised trials, which assign people to groups by chance²⁰. The 122 participants had had adductor-related groin pain for two months or longer²⁰. The review judged the evidence low quality and insufficient to favour any specific approach²⁰.

Two trials in athletes with adductor-related groin pain point in different directions^20,21:

Exercise against passive methods. At 16 weeks, 74% of the strengthening and coordination group had a successful outcome²⁰. In the group given stretching and other passive methods, 29% did²⁰.
A mixed programme with a manual technique against home exercise. Athletes given heat, a manual technique and stretching returned to sport sooner than those given home-based exercise, at 12.8 against 17.3 weeks²¹. Yet 50 to 55% of athletes in either group made a full return to sport²¹.

Readings of the first trial’s long-term follow-up differ. The trial’s authors re-examined 47 of the 59 original participants after 8 to 12 years²². They reported that a significant effect of active training remained²². The Cochrane review found that the difference at 8 to 12 years still favoured exercise but was not statistically significant²⁰.

A 2015 systematic review found moderate evidence that active exercises were more successful than passive approaches for adductor-related groin pain in athletes⁴. A 2015 systematic review of 72 studies rated four of them as high quality⁴. Among 72 studies of approaches to groin pain in athletes, the lower-quality ones reported significantly higher success⁴.

Surgery

One randomised trial compared surgery with non-surgical care in 60 patients with chronic groin pain and suspected sportsman’s hernia²³. Of 30 who had endoscopic (keyhole) mesh repair, 27 had returned to sport at 3 months²³. In the group given at least two months of non-surgical care, 8 of 30 had²³. Seven of the 30 in the non-surgical group later had an operation because of persistent groin pain²³.

A 2015 systematic review found moderate evidence that surgery had better success than non-surgical management for athletes with sportsman’s hernia⁴. A meta-analysis of 56 papers and 3332 athletes found comparable return-to-play rates after surgery and after exercise-based programmes⁵. That held for abdominal wall, adductor and pubic-related groin pain, on evidence that was mostly level IV and of poor quality⁵. Level IV evidence is a low rung on a scale that ranks study designs.

Programmes aimed at lowering groin injury rates

A 2015 meta-analysis of seven randomised trials, with 4191 participants, found no statistically significant reduction in groin injuries²⁴. A cluster-randomised trial assigns whole groups, such as teams, by chance. In one such trial of 55 football clubs, a six-exercise programme did not significantly change the risk of groin injury compared with usual training²⁵.

Another trial assigned 35 semiprofessional Norwegian men’s football teams by chance²⁶. The average in-season prevalence of groin problems was 13.5% in teams doing an adductor strengthening programme and 21.3% in controls²⁶. A statement paper that searched the literature and graded the evidence looked at two programmes, the FIFA 11+ and the Copenhagen adductor strengthening programme²⁷. It found both reduced groin injury risk compared with usual care, on low to moderate quality evidence²⁷. The Copenhagen adductor plank page sets out the trials of that exercise²⁶.

Connections

Structures

Inner thigh. The adductor longus is the adductor most often involved in adductor-related groin pain²⁸. See the hip adductors and the adductor longus tendon.
Hip flexors. A 2026 systematic review of iliopsoas-related groin pain included 71 studies of management approaches and identified no randomised controlled trials²⁹. See the hip flexors and hip flexor strain.
Hip joint. A systematic review of 73 articles covered athletic groin pain that led to surgery³⁰. Causes inside and outside the hip joint were equally common, and the most frequent was femoroacetabular impingement, at 32%³⁰. A 2021 paper describes that condition as early contact between the upper femur (thigh bone) and the hip socket that causes symptoms³¹.

Exercises and stretches

In a randomised trial of 30 male soccer players with adductor-related groin pain, two 8-week programmes were compared³². The one that included the Copenhagen adductor plank gave a larger drop in pain than the same kind of programme without it³².

In the two trials described above, stretching was given together with other methods^20,21. The adductor stretch page covers that stretch²¹.