Groin Pain

  • Nicola MaffulliEmail author
  • Alessio Giai Via
  • Francesco Oliva


Groin pain is a common condition in athletes and accounts for up to 6 % of all athletes’ injuries. It affects athletes involved in running, jumping and kicking, and it is particularly common in professional soccer players. Groin pain is a serious condition because it can impair athletic performance and cause young athletes to change the level of sport and retire early from sport activity. The diagnosis of groin pain is difficult because of the anatomical complexity of the groin area, the large number of potential sources of groin pain and the coexisting pathologies which can affect the patient. Management is a challenge for physicians because treatment strategies are still debated, because of the little availability of evidence-based protocols and because many therapies are based on poor evidence clinical studies (level IV studies). In this chapter, the most common causes of groin pain that affect athletes and their management are discussed.


Adductor tendinopathy Femoroacetabular impingement Groin pain Groin pain disruption Hip arthroscopy Osteitis pubis 


  1. 1.
    Akermark C, Johansson C (1992) Tenotomy of the adductor longus tendon in the treatment of chronic groin pain in athletes. Am J Sports Med 20(6):640–643Google Scholar
  2. 2.
    Anderson K, Strickland SM, Warren R (2001) Hip and groin injuries in athletes. Am J Sports Med 29:521–533PubMedGoogle Scholar
  3. 3.
    Aprato A, Jayasekera N, Villar R (2012) Timing in hip arthroscopy: does surgical timing change clinical results? Int Orthop 36:2231–2234CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Bhosale PR, Patnana M, Viswanathan C, Szklaruk J (2008) The inguinal canal: anatomy and imaging features of common and uncommon masses. Radiographics 28:819–835CrossRefPubMedGoogle Scholar
  5. 5.
    Bizzini M, Notzli HP, Maffiuletti NA (2007) Femoroacetabular impingement in professional ice hockey players: a case series of 5 athletes after open surgical decompression of the hip. Am J Sports Med 35:1955–1959CrossRefPubMedGoogle Scholar
  6. 6.
    Beatty T (2012) Osteitis pubis in athletes. Curr Sports Med Rep 11:96–98Google Scholar
  7. 7.
    Branci S, Thorborg K, Bech BH, Boesen M, Nielsen MB, Hölmich P (2014) MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med 49:681–691Google Scholar
  8. 8.
    Brooker AF Jr (1979) The surgical approach to refractory trochanteric bursitis. Johns Hopkins Med J 145:98–100PubMedGoogle Scholar
  9. 9.
    Choi H, McCartney M, Best TM (2011) Treatment of osteitis pubis and osteomyelitis of the pubic symphysis in athletes: a systematic review. Br J Sports Med 45:57–64CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Del Buono A, Papalia R, Khanduja V, Denaro V, Maffulli N (2012) Management of the greater trochanteric pain syndrome: a systematic review. Br Med Bull 102:115–131CrossRefPubMedGoogle Scholar
  11. 11.
    Diamond LE, Dobson FL, Bennell KL, Wrigley TV, Hodges PW, Hinman RS (2015) Physical impairments and activity limitations in people with femoroacetabular impingement: a systematic review. Br J Sports Med 49:230–242CrossRefPubMedGoogle Scholar
  12. 12.
    Economopoulos KJ, Milewski MD, Hanks JB, Hart JM, Diduch DR (2013) Sports hernia treatment: modified bassini versus minimal repair. Sports Health 5:463–469CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Ekstrand J, Ringborg S (2001) Surgery versus conservative treatment in soccer players with chronic groin pain: a prospective randomised study in soccer players. Eur J Sports Traumatol 23:141–145Google Scholar
  14. 14.
    Fricker PA, Taunton JE, Ammann W (1991) Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med 12:266–279CrossRefPubMedGoogle Scholar
  15. 15.
    Furia JP, Rompe JD, Maffulli N (2009) Low-energy extracorporeal shock wave therapy as a treatment for greater trochanteric pain syndrome. Am J Sports Med 37:1806–1813CrossRefPubMedGoogle Scholar
  16. 16.
    Ganz R, Parvizi J, Beck M, Leunig M, Notzli H, Siebenrock KA (2003) Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clin Orthop Relat Res 417:112–120PubMedGoogle Scholar
  17. 17.
    Garvey JF, Hazard H (2014) Sports hernia or groin disruption injury? Chronic athletic groin pain: a retrospective study of 100 patients with long-term follow-up. Hernia 18:815–823CrossRefPubMedGoogle Scholar
  18. 18.
    Garvey JF, Read JW, Turner A (2010) Sportsman hernia: what can we do? Hernia 14:17–25CrossRefPubMedGoogle Scholar
  19. 19.
    Gilmore J (1998) Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports 17:787–793CrossRefGoogle Scholar
  20. 20.
    Haviv B, Singh PJ, Takla A, O’Donnell J (2010) Arthroscopic femoral osteochondroplasty for cam lesions with isolated acetabular chondral damage. J Bone Joint Surg Br 92:629–633CrossRefPubMedGoogle Scholar
  21. 21.
    Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO (2011) Athletic osteitis pubis. Sport Med 41:361–376CrossRefGoogle Scholar
  22. 22.
    Ito K, Minka MA II, Leunig M, Werlen S, Ganz R (2001) Femoroacetabular impingement and the cam-effect. A MRI-based quantitative anatomical study of the femoral head-neck offset. J Bone Joint Surg Br 83:171–176CrossRefPubMedGoogle Scholar
  23. 23.
    Jaffe TA, O’Connell MJ, Harris JP, Paulson EK, Delong DM (2005) MDCT of abdominal wall hernias: is there a role for valsalva’s maneuver? AJR Am J Roentgenol 184:847–851CrossRefPubMedGoogle Scholar
  24. 24.
    Jardí J, Rodas G, Pedret C et al (2014) Osteitis pubis: can early return to elite competition be contemplated? Transl Med UniSa 10:52–58, 8PubMedPubMedCentralGoogle Scholar
  25. 25.
    Kagan A 2nd (1999) Rotator cuff tears of the hip. Clin Orthop Relat Res 368:135–140CrossRefPubMedGoogle Scholar
  26. 26.
    Karlsson MK, Dahan R, Magnusson H, Nyquist F, Rosengren BE (2014) Groin pain and soccer players: male versus female occurrence. J Sports Med Phys Fitness 54:487–493PubMedGoogle Scholar
  27. 27.
    Kong A, Van der Vliet A, Zadow S (2007) MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol 17:1772–1783CrossRefPubMedGoogle Scholar
  28. 28.
    Kopelman D, Kaplan U, Hatoum OA et al (2014) The management of sportsman’s groin hernia in professional and amateur soccer players: a revised concept. Hernia. [Epub ahead of print]Google Scholar
  29. 29.
    Kunduracioglu B, Yilmaz C, Yorubulut M, Kudas S (2007) Magnetic resonance findings of osteitis pubis. J Magn Reson Imaging 25:535–539CrossRefPubMedGoogle Scholar
  30. 30.
    Laborie LB, Lehmann TG, Engesæter I et al (2011) Prevalence of radiographic findings thought to be associated with femoroacetabular impingement in a population-based cohort of 2081 healthy young adults. Radiology 260:494–502CrossRefPubMedGoogle Scholar
  31. 31.
    Larson CM (2014) Sports hernia/athletic pubalgia: evaluation and management. Sports Health 6:139–144CrossRefPubMedPubMedCentralGoogle Scholar
  32. 32.
    LeBlanc KE, LeBlanc KA (2003) Groin pain in athletes. Hernia 7:68–71CrossRefPubMedGoogle Scholar
  33. 33.
    Lequesne M, Djian P, Vuillemin V, Mathieu P (2008) Prospective study of refractory greater trochanter pain syndrome. MRI findings of gluteal tendon tears seen at surgery. Clinical and MRI results of tendon repair. Joint Bone Spine 75:458–464CrossRefPubMedGoogle Scholar
  34. 34.
    Leunig M, Beaulé PE, Ganz R (2009) The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res 467:616–622CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Maffulli N, Loppini M, Longo UG, Denaro V (2012) Bilateral mini-invasive adductor tenotomy for the management of chronic unilateral adductor longus tendinopathy in athletes. Am J Sports Med 40:1880–1886CrossRefPubMedGoogle Scholar
  36. 36.
    Malviya A, Stafford GH, Villar RN (2012) Impact of arthroscopy of the hip for femoroacetabular impingement on quality of life at a mean follow-up of 3.2 years. J Bone Joint Surg Br 94:466–470CrossRefPubMedGoogle Scholar
  37. 37.
    Mei-Dan O, Lopez V, Carmont MR, McConkey MO, Steinbacher G, Alvarez PD, Cugat RB (2013) Adductor tenotomy as a treatment for groin pain in professional soccer players. Orthopedics 36:1189–1197CrossRefGoogle Scholar
  38. 38.
    Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON (2008) Experience with “sports hernia” spanning two decades. Ann Surg 248:656–665PubMedGoogle Scholar
  39. 39.
    Marshall PW, Murphy BA (2005) Core stability exercises on and off a swiss ball. Arch Phys Rehabil 86:242–249CrossRefGoogle Scholar
  40. 40.
    Morales-Conde S, Socas M, Barranco A (2010) Sportsmen hernia: what do we know? Hernia 14:5–15CrossRefPubMedGoogle Scholar
  41. 41.
    Naal FD, Miozzari HH, Wyss TF, Notzli HP (2011) Surgical hip dislocation for the treatment of femoroacetabular impingement in high-level athletes. Am J Sports Med 39:544–550CrossRefPubMedGoogle Scholar
  42. 42.
    Orchard J, Read JW, Verrall GM, Slavotinek JP (2000) Pathophysiology of chronic groin pain in the athlete. Int J Sports Med 1:1–16Google Scholar
  43. 43.
    Paajanen H, Brinck T, Hermunen H, Airo I (2011) Laparoscopic surgery for chronic groin pain in athletes is more effective than nonoperative treatment: a randomized clinical trial with magnetic resonance imaging of 60 patients with sportsman’s hernia (athletic pubalgia). Surgery 150:99–107CrossRefPubMedGoogle Scholar
  44. 44.
    Paajanen H, Ristolainen L, Turunen H, Kujala UM (2011) Prevalence and etiological factors of sport-related groin injuries in top-level soccer compared to non-contact sports. Arch Orthop Trauma Surg 131:261–266CrossRefPubMedGoogle Scholar
  45. 45.
    Palisch A, Zoga AC, Meyers WC (2013) Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med 32:427–447CrossRefPubMedGoogle Scholar
  46. 46.
    Papalia R, Del Buono A, Franceschi F, Marinozzi A, Maffulli N, Denaro V (2012) Femoroacetabular impingement syndrome management: arthroscopy or open surgery? Int Orthop (SICOT) 36:903–914CrossRefGoogle Scholar
  47. 47.
    Reiman MP, Goode AP, Cook CE, Hölmich P, Thorborg K (2014) Diagnostic accuracy of clinical tests for the diagnosis of hip femoroacetabular impingement/labral tear: a systematic review with meta-analysis. Br J Sports Med. 2014 Dec 16. pii: bjsports-2014-094302. doi: 10.1136/bjsports-2014-094302. [Epub ahead of print]
  48. 48.
    Robertson BA, Barker PJ, Fahrer M, Schache AG (2009) The anatomy of the pubic region revisited: implications for the pathogenesis and clinical management of chronic groin pain in athletes. Sports Med 39:225–234CrossRefPubMedGoogle Scholar
  49. 49.
    Robertson IJ, Curran C, McCaffrey N, Shields CJ, McEntee GP (2011) Adductor tenotomy in the management of groin pain in athletes. Int J Sports Med 32:45–48CrossRefPubMedGoogle Scholar
  50. 50.
    Rodriguez C, Miguel A, Lima H, Heinrichs K (2001) Osteitis pubis syndrome in the professional soccer athlete: a case report. J Athl Train 36(4):437–440Google Scholar
  51. 51.
    Rompe JD, Segal NA, Cacchio A, Furia JP, Morral A, Maffulli N (2009) Home training, local corticosteroid injection, or radial shock wave therapy for greater trochanter pain syndrome. Am J Sports Med 37:1981–1990CrossRefPubMedGoogle Scholar
  52. 52.
    Slawski DP, Howard RF (1997) Surgical management of refractory trochanteric bursitis. Am J Sports Med 25:86–89CrossRefPubMedGoogle Scholar
  53. 53.
    Schnute WJ (1961) Osteitis pubis. Clin Orthop 20:187–192PubMedGoogle Scholar
  54. 54.
    Segal NA, Felson DT, Torner JC et al (2007) Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 88:988–992CrossRefPubMedPubMedCentralGoogle Scholar
  55. 55.
    Serner A, van Eijck CH, Beumer BR, Hölmich P, Weir A, de Vos RJ (2015) Study quality on groin injury management remains low: a systematic review on treatment of groin pain in athletes. Br J Sports Med. 2015 Jan 29. pii: bjsports-2014-094256. doi: 10.1136/bjsports-2014-094256. [Epub ahead of print]
  56. 56.
    Suarez JC, Ely EE, Mutnal AB et al (2013) Comprehensive approach to the evaluation of groin pain. J Am Acad Orthop Surg 21:558–570PubMedGoogle Scholar
  57. 57.
    Valent A, Frizziero A, Bressan S, Zanella E, Giannotti E, Masiero S (2012) Insertional tendinopathy of the adductors and rectus abdominis in athletes: a review. Muscles Ligaments Tendons J 10(2):142–148Google Scholar
  58. 58.
    Verrall GM, Slavotinek JP, Fon GT, Barnes PG (2007) Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury. Am J Sports Med 35:467–474CrossRefPubMedGoogle Scholar
  59. 59.
    Voos JE, Shindle MK, Pruett A, Asnis PD, Kelly BT (2009) Endoscopic repair of gluteus medius tendon tears of the hip. Am J Sports Med 37:743–747CrossRefPubMedGoogle Scholar
  60. 60.
    Weir A, Jansen J, van Keulen J, Mens J, Backx F, Stam H (2010) Short and mid-term results of a comprehensive treatment program for longstanding adductor-related groin pain in athletes: a case series. Phys Ther Sport 11:99–103CrossRefPubMedGoogle Scholar
  61. 61.
    Werner J, Hägglund M, Waldén M, Ekstrand J (2009) UEFA injury study: a prospective study of hip and groin injuries in professional football over seven consecutive seasons. Br J Sports Med 43:1036–1040CrossRefPubMedGoogle Scholar
  62. 62.
    Williams PR, Thomas DP, Downes EM (2000) Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail. Am J Sports Med 28:350–355PubMedGoogle Scholar
  63. 63.
    Williams BS, Cohen SP (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 108:1662–1670CrossRefPubMedGoogle Scholar
  64. 64.
    Wollin M, Lovell G (2006) Osteitis pubis in four young football players: a case series demonstrating successful rehabilitation. Phys Ther Sport 7:153–160CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2015

Authors and Affiliations

  • Nicola Maffulli
    • 1
    • 2
    Email author
  • Alessio Giai Via
    • 3
  • Francesco Oliva
    • 3
  1. 1.Department of Musculoskeletal Disorders, School of Medicine and SurgeryUniversity of SalernoSalernoItaly
  2. 2.Barts and the London School of Medicine and Dentistry, Centre for Sports and Exercise Medicine, Mile End HospitalQueen Mary University of LondonLondonUK
  3. 3.Department of Orthopaedic and TraumatologyUniversity of Rome “Tor Vergata”, School of MedicineRomeItaly

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