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Athletic Groin Injury: Causes, Symptoms & Treatment

Athletic groin injury is a chronic pain condition in the groin area common in athletes, caused by overuse and muscle imbalances. Learn about symptoms and treatment.

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Things worth knowing about "Athletic groin injury"

Athletic groin injury is a chronic pain condition in the groin area common in athletes, caused by overuse and muscle imbalances. Learn about symptoms and treatment.

What is Athletic Groin Injury?

Athletic groin injury - also known as athletic pubalgia or the sportsman's groin - is a chronic pain syndrome affecting the groin region, primarily in physically active individuals. Unlike a classic inguinal hernia, there is no complete protrusion of tissue or organs through the abdominal wall. Instead, the condition involves a functional weakness or injury of the posterior inguinal canal wall and the surrounding muscles, tendons, and fascia.

Causes

Athletic groin injury typically develops as a result of repetitive overloading of the groin region. Common causes include:

Repetitive strain during sprinting, kicking, or rapid directional changes (e.g., in football, ice hockey, or rugby)
Muscular imbalances between the adductor muscles (inner thigh) and the abdominal muscles
Micro-trauma at the pubic symphysis or tendon insertions
Insufficient warm-up and stretching routines or overly rapid increases in training intensity

Symptoms

The symptoms of athletic groin injury usually develop gradually and may worsen over time. Typical complaints include:

Dull or sharp pain in the groin area that worsens during physical activity
Radiation of pain into the inner thigh, lower abdomen, or genital region
Pain triggered by coughing, sneezing, or sitting up from a lying position
Relief at rest with recurrence upon resuming sport
In advanced cases, pain may also occur at rest

Diagnosis

Athletic groin injury is often a diagnosis of exclusion, as imaging findings can be non-specific. The following diagnostic approaches are used:

Physical examination: Tenderness at the external inguinal ring, pain provocation through adductor resistance testing
Ultrasound: Assessment of the posterior inguinal canal wall and exclusion of a true hernia
MRI (Magnetic Resonance Imaging): Gold standard for visualizing soft tissue injuries, tendon damage, and changes at the pubic symphysis
Laboratory tests to rule out inflammatory or infectious causes

Treatment

Conservative Treatment

In most cases, athletic groin injury is initially managed conservatively:

Rest from sport and reduction of physical load for several weeks
Physiotherapy: Targeted strengthening and stretching of the abdominal, hip, and adductor muscles
Pain management: Non-steroidal anti-inflammatory drugs (NSAIDs) to relieve symptoms
Local cold therapy and physiotherapeutic modalities (e.g., electrotherapy, ultrasound therapy)

Surgical Treatment

If conservative treatment fails to provide adequate relief after approximately three to six months, surgery may be considered:

Open surgical repair of the posterior inguinal canal wall with or without mesh reinforcement
Laparoscopic (minimally invasive) repair with mesh placement, similar to an inguinal hernia repair
Targeted adductor tenotomy (release of the adductor tendon) in cases of predominant tendon pathology

Following surgery, a structured rehabilitation program typically allows return to sport within two to four months.

Prognosis and Prevention

With appropriate treatment, the overall prognosis for athletic groin injury is good. Preventive measures include regular strengthening exercises for the core and hip muscles, adequate warm-up routines, and a gradual increase in training intensity.

References

Sheen, A.J. et al. - Athletic Pubalgia and the Sportsman's Groin: Consensus Statement. In: British Journal of Sports Medicine, 2014.
Falvey, E.C. et al. - Groin Pain in Athletes: Understanding the Mechanisms. In: British Journal of Sports Medicine, 2016.
Weir, A. et al. - Doha agreement meeting on terminology and definitions in groin pain in athletes. In: British Journal of Sports Medicine, 2015.

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