Groin pain is one of the most frequently reported injuries in sportsmen and women making up 10-20% of reported sports injuries per year. Groin pain is most often associated with sports that involve kicking and quick changes in direction such as football and soccer but can occur in any sport or physical activity where the lower limb is being placed under strain from running along foreshore or even performing your Saturday morning yoga.
Symptoms of groin pain include diffuse pain that can be felt anywhere from the lower half of the abdomen to the inside of the thigh above the knee and in some cases even extends round to the buttocks. Groin pain can be felt on one or both sides and can be associated with both an acute traumatic injury or a slower overuse injury that occurs over time. Common aggravating movements can include pain with kicking, pain with side stepping, pain when walking up and down stairs, pain with quick acceleration/deceleration or even pain with walking.
What causes pain to occur in your groin?
This is the million dollar question as even though groin pain is a well recognised and quite common injury the underlying cause can be difficult to pinpoint due to the large amount of muscle attachments and complex anatomy that are present in the area (as seen in the picture below). Some common diagnosis given to groin pain include adductor tears/tendinopathy, osteitis pubis (inflammation/degeneration of the joint at the front of the pelvis), hernia and illiopsoas (hip flexor) tear/tendinopathy. Often these diagnosis are made and treated as a single entity however recent research has shown that often this is not the case and that patients who have groin pain regularly have 2 or more pathologies that all need to be addressed in order for full recovery to occur particularly in more chronic cases. More recently we have also realised the hip joint itself (including cartilage/labrum injuries, arthritic changes and bony pathology) has a lot more to do with groin pain than was thought 10 years or so ago.
Am I at risk?
Although there is no definitive way to tell if someone will develop groin pain or not there have been a number of studies investigating common risk factors and have identified a few modifiable and non-modifiable factors that are associated with groin pain. The following risk factors can increase your risk of developing groin pain:
- Weakness in the adductors muscles on the inside of the thigh relative to the abductors (muscles on the outside of the hip/thigh most notably the gluts)
- Decreased hip internal rotation range of motion
- Decreased trunk/core muscle function
- Older age
- Previous groin pain
- Lower levels of sport specific training
So what can I do to avoid groin pain or get rid of it if it has already occurred?
Luckily there is a lot that can be done to avoid groin pain in the first place, treat it once it has occurred and to prevent it from coming back in the future.
Prevention is better than a cure and this has never been more true than it is when it comes to groin pain. The best way to avoid groin pain is to develop adequate strength and control in the muscles in the area with particular focus on the adductors (muscles on the inside of the thigh), the abductors (primarily your gluts or bum muscles) and your core, all of which help to provide stability to your pelvis and lower limbs. This strength can be developed with a targeted strengthening exercise program beginning with simple isolated movements, progressing to more compound multi joint exercises before finally progressing to more plyometric, functional and sports specific exercises. While you are working through a strengthening program you should also be working on your cardiovascular fitness by doing some cycling, jogging or swimming at a gradually increasing intensity to improve your endurance (there is no point in having strong core and adductor muscles if after 5 minutes of sport you are too fatigued to use them). It should also be mentioned that adequate warm up before sport including gentle running/jogging, dynamic stretching and plyometric exercises should be included to help reduce the risk of developing groin pain.
Treatment once groin pain has occurred:
If you are unlucky enough to develop groin pain either due to overuse or trauma there is no need to fret as there is still plenty that can be done to get you back to 100% although generally it will mean that you miss between 4-12 weeks of your chosen sport (though this may be more or less depending on the injury).
When groin pain first becomes apparent it is advised to follow the RICE protocol to reduce the pain and swelling that may be present, that is Rest from any aggravating activities, Ice the area for between 15-20 minutes at a time every 2 hours for the first 48-72 hours, Compress the area and Elevate the area above your heart if able (this can be quite hard to do with the pelvis unless you are an accomplished gymnast or have your own tilt table at home, but lying flat will suffice).
It is then advised that you see a qualified physiotherapist as soon as possible so that we may accurately diagnose the injury and provide a tailored treatment plan that takes into account the structure (or more likely structures) that are involved in your specific injury, as well as your own personal goals and activity levels. Although treatment plans will differ from person to person they will generally incorporate advice on strategies to reduce further aggravation to the injury, gentle stretching, some manual therapy to loosen tight muscles and mobilise any stiff joints in the area and a progressive exercise and rehabilitation program targeting your specific weaknesses or deficits that builds from mild isolated exercises right through to sports specific and plyometric exercises and eventually return to play.
Take Home Messages:
- Groin pain is often associated with more than one structure and all structures need to be treated for full recovery
- Strength and control in the muscles of the core pelvis and groin is the best way to avoid groin pain
- Risk factors include; weak adductors, poor core control, previous injury, age and decreased hip range of motion
- Treatment of groin pain is specific to each person and their particular injury and will incorporate reduction of aggravating activities, gentle stretching, manual therapy and progressive pain free strengthening, all of which will you get you back to play faster and keep you there
As always if you have any queries regarding this, or anything else, we are always happy to hear from you.
Ben graduated with a Bachelor of Physiotherapy from the University of Newcastle in 2012 after which he spent his new graduate year working in a diversified practice gaining experience in both private practice physiotherapy and hospital based rehabilitation. Since then Ben has worked exclusively in private practice treating a range of musculoskeletal conditions from neck and back pain to sports injuries and everything in between. During this time Ben has worked with people from all walks of life including elite athletes from the Central Coast Mariners youth league right through to office athletes and the elderly. His time working with elite soccer players has made him a bit of an expert at managing groin injuries.
Ben has a special interest in the treatment of posture related neck and low back pain, acute sport injuries, post operative rehabilitation and preventative exercise or prehab. Ben believes in an individualised approach to treatment believing each patient is different with different goals and expectations and as such ensures all treatment regimes are tailored to your needs.
Milson, (2012). An Introduction to physiotherapy intervention in groin pain [Blog post]. Retrieved from http://blogs.bmj.com/bjsm/2012/05/02/an-introduction-to-physiotherapy-issues-in-groin-pain/
Mosler et al. (2015) Which factors differentiate athletes with hip/groin pain from those without? A systematic review with meta-analysis. British Journal of Sports Medicine. 49(12), 810
Whitakker et al. (2015) Risk Factors for groin injury in sport: An updated systematic review. British Journal of Sports Medicine. 49(12), 803
Almeida et al. (2013) Conservative interventions for treating exercise-related musculotendinous, ligamentous, and osseous groin pain (review). The Cohchrane Library. 6, 1-33.