Getting rid of groin pain starts with figuring out what is causing it, because the groin is a crossroads where muscles, tendons, nerves, joints, and the inguinal canal all converge. Treatment almost always begins with targeted exercise and physical therapy, which work well for the most common culprit: strained or overloaded adductor muscles. But the approach changes substantially depending on whether the pain stems from a muscle injury, a hip joint problem, a hernia, or a nerve issue, and getting that distinction right matters more than any single treatment choice.
Why Groin Pain Has So Many Possible Causes
The groin area is where your lower abdomen meets your thigh, and a surprising number of structures run through it. Six muscles make up the adductor group alone, and any of them can be strained. An adductor injury that is not managed properly can become chronic and threaten an athlete’s career.1PubMed Central. Groin injuries in sports medicine Beyond muscle strains, groin pain can come from the hip joint itself (labral tears, femoroacetabular impingement), the pubic bone (osteitis pubis), the inguinal canal (sports hernia or true hernia), or nerves running through the region.
The quality of the pain offers real clues. Musculoskeletal injuries tend to produce a dull ache, a stabbing sensation, or soreness that worsens with specific movements. Nerve-related groin pain feels different: burning, electric, or tingling sensations that may radiate along a nerve’s path.2PubMed Central. Neuropathic causes of groin pain in athletes: understanding nerve involvement This distinction is clinically useful because musculoskeletal pain and nerve pain respond to different treatments. Nerve entrapment syndromes are less common but represent an important diagnosis that clinicians sometimes overlook.3PubMed. Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock
For children and adolescents, the picture shifts. Conditions unique to growing skeletons, such as Perthes disease, slipped capital femoral epiphysis, and pelvic avulsion fractures, can present as groin pain and require different evaluation.4PubMed Central. Review for the generalist: evaluation of pediatric hip pain These diagnoses are time-sensitive, so persistent groin pain in a young person warrants prompt medical attention.
Getting the Right Diagnosis
A thorough physical exam is the starting point. Your clinician should be pressing on specific structures and testing specific movements: the adductor muscles, the pubic area, the inguinal region, and the iliopsoas (a deep hip flexor).5PubMed. Groin Pain and Injuries: Evaluation and Management The most telling finding for adductor problems is tenderness right at the origin of the adductor longus muscle, which shows up in the vast majority of people diagnosed with adductor-related groin pain.6Physical Therapy in Sport. Clinical examination tests for adductor- and pubic-related groin pain in athletes with longstanding groin pain
When the exam does not give a clear answer, or when symptoms have dragged on, imaging helps. MRI and ultrasound are both valuable for diagnosing groin pathology, and ultrasound has the added advantage of guiding treatment injections.7PubMed Central. Hip Imaging of Groin Pain: Magnetic Resonance and Ultrasound Imaging Features Ultrasound can also evaluate for hernias (using the Valsalva maneuver), hip joint effusions, and snapping hip syndrome in a single session.8PubMed. Ultrasound of the Groin: Techniques, Pathology, and Pitfalls One caveat worth knowing: imaging often picks up findings like tendon thickening, calcifications, or bone erosions in athletes who have zero pain. The most specific sign of actual tendon disease is a tear within the adductor longus tendon, so incidental findings should be interpreted carefully.9Diagnostic and Interventional Imaging. Imaging of adductor-related groin pain
Exercise-Based Treatment
For adductor-related groin pain, structured exercise programs are the best-supported treatment. A randomized trial comparing an active training program to standard physiotherapy (passive treatments, stretching) found dramatically better outcomes with active training: roughly six times as many patients in the active group returned to sport without groin pain.10The Lancet. Active training programme versus physiotherapy in patients with adductor-related groin pain: a randomised clinical trial The active programs that work typically combine strengthening exercises (both concentric and eccentric), core stability work, coordination drills, and sport-specific retraining.
Rehabilitation usually follows a phased approach. Early on, the focus is on education, activity modification, and avoiding whatever aggravates the pain. Then strengthening and flexibility work ramp up progressively. Home exercise programs are a core component, not just what you do in the clinic.11PubMed Central. Non-operative management of individuals with non-arthritic hip pain: a literature review For people with hip labral tears that are causing groin pain, conservative management through hip strengthening and manual therapy also produces measurable improvements in pain and function.12Journal of Sport Rehabilitation. Nonsurgical Treatment of Acetabular Labral Tears
For hip impingement (femoroacetabular impingement syndrome, or FAI), prescribed physiotherapy that includes hip strengthening, joint manual therapy, functional retraining, and education outperforms passive modalities and stretching alone. However, the evidence suggests arthroscopic surgery for FAI probably produces slightly better outcomes than physiotherapy.13PubMed. Femoroacetabular impingement syndrome and labral injuries: grading the evidence on diagnosis and non-operative treatment That does not mean surgery is always the right first step; most clinicians recommend trying a structured rehab program before considering an operation.
Injections and Other Non-Surgical Options
When exercise alone is not enough, injection therapies are sometimes added. Corticosteroid injections can provide short-term pain relief and may speed up recovery for conditions like osteitis pubis, an inflammation around the pubic bone that can take months to settle on its own. Platelet-rich plasma (PRP) therapy has attracted interest as a regenerative alternative. In one case involving a competitive soccer player with adductor-related groin pain, ultrasound-guided PRP combined with phased physical therapy resolved symptoms and allowed a return to the previous level of play with minimal time lost.14PubMed Central. Nonsurgical Management of Adductor-related groin pain with Ultrasound-Guided Platelet-Rich Plasma Injection and Physical Therapy in a Competitive Soccer Player
That said, the broader evidence for injections in longstanding groin pain remains thin. A systematic review of conservative treatments for chronic adductor-related groin pain found that corticosteroid injections and PRP therapy both had low-quality evidence and weak recommendations behind them.15PubMed Central. The conservative treatment of longstanding adductor-related groin pain syndrome: a critical and systematic review A meta-analysis comparing PRP to corticosteroid injections across various tendon injuries found no meaningful difference in short-term pain relief, and while PRP showed a trend toward better long-term functional recovery, the advantage was not statistically significant.16PubMed Central. Platelet-Rich Plasma Versus Corticosteroid Injections for Chronic Tendinopathies: A Systematic Review and Meta-Analysis In practical terms, injections are reasonable add-ons but should not replace exercise-based rehab.
Focused shockwave therapy is another option gaining traction. A study in soccer players with groin pain syndrome found that integrating shockwave therapy into rehabilitation produced substantial improvements in pain scores and functional outcomes over the treatment period.17PubMed Central. Integrating Focused Shockwave Therapy into Rehabilitation for Groin Pain Syndrome: A Prospective Study in Soccer Players It is a relatively low-risk intervention, though the evidence base is still small.
When Surgery Becomes the Right Call
Surgery enters the picture when conservative treatment fails after a reasonable trial, which is usually several months. The specific procedure depends entirely on the diagnosis.
For sports hernias (also called athletic pubalgia), surgery has strong return-to-play numbers. At one center, 98% of athletes who underwent surgical repair returned to competition, typically within three months after at least six weeks of recovery and rehab.18PubMed Central. Sports hernia: the experience of Baylor University Medical Center at Dallas A systematic review found that surgery appears more effective than conservative treatment for sports hernias, and laparoscopic approaches generally allow a quicker recovery than open repair.19PubMed. Sports hernias: a systematic literature review
For standard inguinal hernias, the laparoscopic versus open debate is well studied. A large trial found patients who had laparoscopic repair returned to normal daily activity in about 6 days versus 10 for open surgery, got back to work in 14 days versus 21, and resumed athletic activities in 24 days versus 36.20PubMed. Comparison of conventional anterior surgery and laparoscopic surgery for inguinal-hernia repair Recurrence rates were also lower with laparoscopic repair in that trial. A Cochrane review pooling dozens of trials confirmed the pattern: laparoscopic repair meant faster return to activity and less chronic pain and numbness afterward, though the operations took longer and carried a slightly higher risk of rare serious complications.21Cochrane Database of Systematic Reviews. Laparoscopic techniques versus open techniques for repair of inguinal hernia Modern open mesh repairs have similar recurrence rates to laparoscopic techniques, but laparoscopy still wins on recovery speed and chronic pain.22PubMed. Inguinal hernia repair: current surgical techniques
For hip joint problems like labral tears and FAI, hip arthroscopy is the main surgical option. It allows surgeons to repair labral tears, reshape bone, remove loose bodies, and address cartilage damage through small incisions. Short- and medium-term results are generally favorable, though longer follow-up is needed to know whether the procedure truly slows the degenerative changes that FAI can cause over time.23PubMed. Hip arthroscopic surgery: patient evaluation, current indications, and outcomes One uncommon complication of open FAI surgery is the formation of adhesions inside the joint, which can cause persistent groin pain after the operation. These adhesions can be diagnosed with MR arthrography and treated arthroscopically, though the procedure is technically demanding.24PubMed Central. Groin pain after open FAI surgery: the role of intraarticular adhesions
How to Prevent Groin Pain in the First Place
Two risk factors consistently show up in research on groin injuries: weak adductor muscles and a history of previous groin injury. In one prospective study of male soccer players, clinically weak adductor muscles roughly quadrupled the odds of a groin injury, and a prior acute groin injury more than doubled them.25PubMed. Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study Weakness or delayed activation of the deep core muscles may also contribute.26PubMed. What are the risk factors for groin strain injury in sport? A systematic review of the literature
The most-studied prevention exercise is the Copenhagen adduction exercise, a partner-assisted side plank where the top leg provides resistance through the inner thigh. Adding it to warm-up routines significantly builds eccentric hip adductor strength, something the standard FIFA 11+ warm-up program does not accomplish on its own. A trial found that including the Copenhagen exercise produced about a 9% greater increase in eccentric adductor strength compared to the standard program.27PubMed. Including the Copenhagen Adduction Exercise in the FIFA 11+ Provides Missing Eccentric Hip Adduction Strength Effect in Male Soccer Players In one implementation study with semi-professional soccer teams, the intervention group had a 41% lower risk of reporting groin problems during the season compared to the control group.28PubMed Central. The Neuromuscular Effects of the Copenhagen Adductor Exercise: A Systematic Review
However, a broader meta-analysis found the overall risk reduction was small and not statistically significant when pooling multiple studies.29PubMed Central. The Copenhagen Adduction Exercise Effect on Sport Performance and Injury Prevention: A Systematic Review With Meta‐Analysis An earlier cluster-randomized trial of a six-exercise prevention program (including strengthening, coordination, and core stability) also found a non-significant 31% reduction in groin injuries.30PubMed. Exercise program for prevention of groin pain in football players: a cluster-randomized trial The reductions trend in the right direction, but compliance is a persistent problem in team settings, and the effect is harder to prove when many players skip sessions. For an individual who actually does the exercises consistently, the strength gains alone are a reasonable hedge against injury, even if the prevention signal has not been nailed down in large trials.
Returning to Activity Safely
Rushing back is the single most common mistake with groin injuries, and it explains why so many become chronic. A structured return follows milestones: first becoming pain-free in daily life, then completing controlled sport-specific training, and finally returning to full team or competitive activity.31PubMed Central. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes Experts in the field agree that strength testing and sport-specific performance tests should guide the return-to-play decision, while imaging results should not. In other words, even if your MRI still shows some abnormality, you can go back to playing if your strength and function are where they need to be.32PubMed Central. Return to Play in Long-Standing Adductor-Related Groin Pain: A Delphi Study Among Experts
A practical benchmark many clinicians use is comparing the injured side’s strength to the healthy side. If adductor strength on the injured side is within about 10-15% of the other leg and you can perform sport-specific drills at full intensity without pain, you are likely ready. The temptation to return at the first sign of improvement is strong, but adductor injuries that are not fully rehabilitated have a nasty tendency to recur and worsen.
How Groin Pain Differs Between Men and Women
Most groin pain research has been done on male athletes, and that is a real limitation. The patterns of injury appear to differ between sexes. In female team-sport athletes, iliopsoas-related groin pain (involving the deep hip flexor) was the most common category, accounting for about 59% of cases. Adductor-related pain, which dominates the male data, made up only about 12% of diagnoses in women.33PubMed Central. Hip and Groin Problems in Female Team-Sport Athletes: A Cross-Sectional Study This means treatment programs designed around adductor strengthening may miss the mark for many women.
Several anatomical differences may explain the pattern. The wider female pelvis changes the angle at which the short adductor muscles pull on their attachment points, potentially reducing the tearing forces at the tendon origins. Cam-type hip impingement, where extra bone at the femoral head-neck junction crowds the joint, is more common in men and may predispose male athletes to labral problems that show up as groin pain.34PubMed Central. Imaging of groin pain in athletes: patterns of injury at MRI and gender differences therein There is also a concern about referral bias: women with groin pain may be evaluated and treated differently from men, sometimes leading to delays in diagnosis.
The Psychological Side of Persistent Groin Pain
When groin pain becomes chronic, psychological factors start to matter more than most people expect. Research on chronic pain after inguinal hernia surgery found that preoperative anxiety independently predicted who would develop lasting pain. Dispositional optimism, on the other hand, appeared to be protective.35Springer Nature. Psychological factors associated with chronic postoperative inguinal pain: a qualitative systematic review This does not mean the pain is imagined. Anxiety and catastrophizing can amplify how the nervous system processes pain signals, making the same physical stimulus hurt more and persist longer.
For anyone dealing with groin pain that has lingered for months, addressing the mental side alongside the physical side is not optional. That might mean working with a psychologist, learning about pain neuroscience, or simply understanding that a fearful, guarded approach to movement often feeds the pain cycle rather than protecting against it. Clinicians who treat chronic groin pain are increasingly building these conversations into rehab, recognizing that a stronger adductor is only part of the puzzle when the nervous system has decided that the groin region is under threat.