Why Do My Adductors Hurt? Causes and When to See a Doctor

Adductor pain almost always traces back to one of a handful of causes: a muscle strain from a sudden explosive movement, a tendon that has been slowly breaking down under repetitive load, or a neighboring structure in the hip or pelvis that refers pain into the inner thigh. Which one you’re dealing with depends on how the pain started, what makes it worse, and how long it has been hanging around. The answer is rarely mysterious once you know what to look for, but adductor pain is also one of those complaints that can linger for months if the real source is misidentified.

Acute Adductor Strains

The most straightforward explanation for sudden inner-thigh pain is an adductor strain, a partial tear of the muscle fibers that pull your leg inward. This typically happens during a quick change of direction, a hard kick, or a skating stride that stretches the inner thigh beyond its comfortable range. You’ll usually know the moment it happens: a sharp, grabbing pain in the groin or inner thigh, sometimes accompanied by a popping sensation. Across 25 college sports, the overall rate was about 1.3 injuries per 1,000 athletic exposures, but soccer and ice hockey stood out, with rates roughly two to three times higher than the average.¹ If you’ve never played a sport that demands lateral cuts or rapid acceleration, an acute strain is less likely, though it can still happen during something as mundane as slipping on ice or lunging for a dropped object.

Adductor strains also have a frustrating tendency to come back. Recurrence rates run around 18% in professional soccer and 24% in professional hockey.¹ That high reinjury rate is partly why experts focus so much on structured rehabilitation rather than simply resting until the pain fades. Returning to full activity before the muscle has regained its strength and tolerance to load is a well-documented recipe for re-tearing.

Adductor Tendinopathy and Chronic Overuse

If your adductor pain crept in gradually rather than arriving all at once, tendinopathy is the more likely culprit. This is a degenerative condition of the tendon itself, usually where the adductor longus attaches near the pubic bone. It develops when the tendon is subjected to more repetitive stress than it can repair between bouts of activity. Runners, soccer players, and anyone whose sport involves repeated kicking or direction changes are the usual suspects, but it also shows up in recreational exercisers who ramp up training volume too quickly.

Adductor tendinopathy is diagnosed primarily through history and physical examination: chronic groin pain that worsens during activity and pain or weakness when you squeeze your legs together against resistance.² It’s considered a common but under-recognized cause of lingering groin pain, which means people sometimes go months being told they have a “strain” that just won’t heal when the actual problem is a tendon that needs a different management approach than a muscle tear.

Problems That Mimic Adductor Pain

One of the trickiest things about pain in the inner thigh and groin is that several structures sit in close quarters, and pain from one can easily masquerade as pain from another. If straightforward adductor treatment hasn’t helped after a few weeks, the real source may be somewhere else entirely.

Athletic Pubalgia

Sometimes called a “sports hernia” (though no actual hernia is present), athletic pubalgia involves damage to the soft tissues of the lower abdominal wall where they blend into the adductor tendons near the pubic bone. The classic presentation is an insidious, gradually worsening pain in the lower abdomen and deep groin that gets worse with acceleration, twisting, cutting, kicking, or even coughing and sneezing.³ The pain often radiates into the adductor region, which is why many people assume their adductors are the problem. Rest resolves it temporarily, but symptoms return the moment you go back to sport. In one case series, about 43% of athletes with lower abdominal pain eventually developed symptoms on both sides, and two-thirds went on to develop adductor-related pain on top of the original complaint.³ That overlap makes athletic pubalgia one of the most commonly missed diagnoses in athletes with chronic groin pain.

Osteitis Pubis

Osteitis pubis is inflammation of the pubic symphysis, the cartilaginous joint at the front of your pelvis. It causes aching, sometimes sharp pain right at the center of the groin that can radiate along the inner thigh. It’s thought to result from muscular imbalance and pelvic instability, though researchers have not pinned down a single definitive cause.⁴ What makes it relevant here is that osteitis pubis and adductor problems frequently coexist. Among 132 athletes with osteitis pubis, 90% also had concurrent adductor lesions visible on MRI.⁵ Only about 10% had osteitis pubis in isolation. That overlap means treating the adductor problem alone may not resolve symptoms if the underlying pubic bone inflammation is also driving the pain.

Hip Joint Pathology

Pain deep in the front of the hip or groin that gets worse with prolonged sitting, bending, or twisting activities can come from problems inside the hip joint itself, such as a labral tear or femoroacetabular impingement. These conditions sometimes present alongside groin complaints, making them easy to confuse with an adductor issue.³ If your groin pain is worst at the end range of hip motion, feels like it’s located deep in the joint rather than along the inner thigh, or is aggravated by getting in and out of a car, a hip-joint problem is worth investigating.

Obturator Nerve Entrapment

Rarely, inner-thigh pain comes from a trapped nerve rather than a muscle or tendon. The obturator nerve runs through the pelvis and supplies sensation to the inner thigh along with motor control for the adductors. When it becomes compressed or entrapped by surrounding tissue, symptoms include medial thigh or groin pain, weakness when squeezing the legs together, and sometimes numbness along the inner thigh.⁶ This is an uncommon diagnosis and a difficult one to confirm clinically, but it’s worth considering when adductor pain is accompanied by sensory changes that a simple strain wouldn’t explain.

What Makes You More Vulnerable

Certain factors reliably predict who is more likely to end up with adductor pain, and most of them boil down to how strong (or weak) the adductors are relative to the muscles around them.

In professional soccer players, those who went on to develop a groin injury had significantly lower adductor strength at preseason testing compared with players who stayed healthy. The difference was moderate in size but consistent: weaker adductors meant higher injury risk.⁷ A separate study found that imbalances between adductor and abductor strength in the non-dominant leg were a particularly strong predictor: players with greater imbalances were significantly more likely to get hurt.⁸ History of a previous groin injury also elevated risk, which aligns with the high recurrence rates mentioned earlier.

This is why preseason screening of the adductor-to-abductor strength ratio has become a standard injury-prevention tool in ice hockey and soccer. Identifying athletes with low ratios lets medical staff intervene with targeted strengthening before the season starts.⁹ For non-athletes, the practical takeaway is similar: if your inner-thigh muscles are noticeably weaker than the muscles on the outside of your hips, or if one leg is considerably weaker than the other, you’re at elevated risk.

Sex Differences in Groin Injuries

Men develop adductor-related groin injuries far more often than women, and the anatomy may explain why. The wider female pelvis creates a more oblique angle of pull for the short adductor muscles, which likely reduces the tractional force those muscles exert at their attachment points on the pubic bone.¹⁰ That mechanical difference may partly account for why insertional tearing at the adductor origin is less common in female athletes. Women are not immune to groin pain, but their injury patterns on imaging tend to differ from what is seen in men.

How Adductor Pain Is Diagnosed

A clinician will typically start with a physical exam. The most telling finding for adductor-related pain is tenderness at the origin of the adductor longus, which sits right at the pubic bone. In athletes classified with adductor-related groin pain, palpation tenderness at this spot was present in 94% of cases.¹¹ Resisted adduction tests, where you squeeze your legs inward against the examiner’s hand, also help, though the reliability of these tests varies between examiners. Stretching the adductors during the exam and checking for pain reproduction adds another piece of the puzzle.

Imaging comes in when the diagnosis is uncertain or the pain hasn’t responded to initial treatment. Ultrasound and MRI are the primary tools. Ultrasound is quick and can reveal tears and structural changes in the tendon, while MRI offers a broader view that can pick up bone marrow edema at the pubic symphysis, labral tears in the hip, or other conditions hiding alongside or instead of an adductor problem. One important caveat: asymptomatic findings like chronic tendon thickening, calcifications, and small cortical erosions are common in athletes’ groin imaging and don’t necessarily mean those abnormalities are causing pain.¹² The most specific imaging sign of a truly problematic tendinopathy is an intratendinous tear within the adductor longus tendon.

Strengthening and Prevention

The strongest evidence for both treating and preventing adductor pain centers on progressive strengthening exercises, particularly those that load the adductors eccentrically (the lengthening phase of a muscle contraction). The Copenhagen adduction exercise, a partner-assisted side plank where your top leg provides resistance while the bottom leg performs the work, has become the go-to intervention. A meta-analysis of multiple studies found that programs built around this exercise produced large improvements in adduction strength, with eccentric strength seeing the greatest gains.¹³

In professional soccer, a modified progressive Copenhagen program increased hip adductor strength by roughly 24 to 25% over the course of the intervention, with acceptably low levels of muscle soreness during the program itself.¹⁴ Broader warm-up programs like the FIFA 11+ that include strengthening, balance, and plyometric elements have also shown promise, with some evidence of reducing groin injuries by up to 40% in mixed-sex cohorts of soccer players.¹⁵

One honest caveat on the prevention data: a cluster-randomized trial of a groin-injury prevention program in football found a 31% reduction in groin injuries, but that reduction did not reach statistical significance.¹⁶ The direction of effect was encouraging, but the trial couldn’t rule out chance as an explanation. Most experts still recommend these programs because the overall body of evidence points toward benefit and the downside risk of strengthening is essentially zero, but individual studies don’t always deliver the clean confirmation you’d hope for.

The Copenhagen exercise can be scaled to fit nearly any fitness level. It can be regressed to a shorter lever arm or lower volume for someone recovering from an acute strain, and progressed to higher difficulty as the athlete improves.¹⁵ For non-athletes dealing with adductor pain, the same principle applies even if the specific exercise needs to be adapted. The goal is to progressively load the adductors so they regain the capacity to handle whatever activities caused the problem in the first place. Core stability work is a useful complement: strengthening the muscles around the pelvis reduces the compensatory load that the adductors have to absorb.¹⁷

When to See a Doctor

Minor adductor soreness after an unusually hard workout or a new activity often resolves on its own within a week or two with relative rest and gradual reloading. But several patterns should prompt a visit to a healthcare provider:

Sharp onset with inability to bear weight: A sudden pop followed by significant pain and difficulty walking suggests a moderate to severe strain or even a complete tear, especially if bruising develops over the following days.
Pain lasting beyond two to three weeks: Strains that don’t improve within this window may be more severe than initially assumed, or the underlying cause may not be a simple strain at all.
Pain that returns every time you resume activity: This pattern, feeling fine at rest but flaring up the moment you go back to sport or exercise, is the hallmark of both tendinopathy and athletic pubalgia, neither of which will resolve with rest alone.
Numbness or tingling along the inner thigh: Sensory changes suggest nerve involvement, which requires a different diagnostic workup than a muscle injury.
Groin pain accompanied by lower abdominal pain: When pain radiates both down into the adductors and up into the lower abdomen, the problem may involve the abdominal wall or pubic symphysis rather than the adductors in isolation.
Night pain or pain at rest that isn’t improving: Pain that persists even when you’re not loading the area can occasionally indicate a stress fracture of the pubic ramus or another bone-related issue rather than a soft-tissue injury.

A clinician can sort through these possibilities much faster than guesswork at home. MRI and ultrasound, when needed, help rule out the overlapping conditions described above and ensure that treatment targets the actual source of pain rather than a symptom.

Returning to Activity Safely

The temptation with adductor pain, especially in athletes, is to rush back as soon as things feel tolerable. The data suggest that patience pays off. In a prospective study of male athletes recovering from acute adductor injuries, those who achieved a clear clinical milestone before returning to sport, specifically becoming pain-free during resisted adduction and sport-specific movements, had a reinjury rate of just 5%. Athletes who returned before reaching that milestone were reinjured at a rate of 21%.¹⁸ That gap held whether researchers looked at reinjury within two months, six months, or a full year after return. The difference was not subtle.

Criteria-based return, where you progress through rehab benchmarks rather than following a fixed calendar, is the standard recommendation. You shouldn’t be returning to full sport until you can perform adduction against resistance without pain, run and change direction without symptoms, and complete sport-specific drills at full intensity. Skipping those steps to get back a week earlier often costs you months on the back end when the same injury returns. For recreational exercisers, the same logic applies on a smaller scale: rebuild the strength first, then reintroduce the activity that caused the problem, rather than simply waiting for the pain to quiet down and jumping back in.

1
International Journal of Sports Physical Therapy (IJSPT). Adductor Strains in Athletes
2
PubMed Central. Adductor tendinopathy in a hockey player with persistent groin pain: a case report
3
PubMed Central. Groin Injuries (Athletic Pubalgia) and Return to Play
4
PubMed Central. Management of osteitis pubis in athletes: rehabilitation and return to training – a review of the most recent literature
5
PubMed Central. Prevalence and patterns of adductor lesions on MRI in athletes with osteitis pubis
6
PubMed Central. Obturator neuropathy
7
PubMed Central. Adductor Muscles Strength and Strength Asymmetry as Risk Factors for Groin Injuries among Professional Soccer Players: A Prospective Study
8
PubMed Central. Hip Muscle Strength Ratios Predicting Groin Injury in Male Soccer Players Using Machine Learning and Multivariate Analysis—A Prospective Cohort Study
9
PubMed. Measuring the Hip Adductor to Abductor Strength Ratio in Ice Hockey and Soccer Players: A Critically Appraised Topic
10
PubMed Central. Imaging of groin pain in athletes: patterns of injury at MRI and gender differences therein
11
PubMed. Clinical examination tests for adductor- and pubic-related groin pain in athletes with longstanding groin pain: Inter-examiner reliability and prevalence of positive tests
12
PubMed. Imaging of adductor-related groin pain
13
PubMed Central. The Copenhagen Adduction Exercise Effect on Sport Performance and Injury Prevention: A Systematic Review With Meta‐Analysis
14
PubMed Central. Impact of a modified progressive Copenhagen adduction exercise programme on hip adduction strength and postexercise muscle soreness in professional footballers
15
PubMed Central. Current Clinical Concepts: Exercise and Load Management of Adductor Strains, Adductor Ruptures, and Long-Standing Adductor-Related Groin Pain
16
PubMed. Exercise program for prevention of groin pain in football players: a cluster-randomized trial
17
PubMed. Recovery of two elite footballers from adductor strain with dry needling and eccentric strengthening: Two case studies
18
PubMed Central. Return to Sport After Criteria-Based Rehabilitation of Acute Adductor Injuries in Male Athletes: A Prospective Cohort Study