The Complexities of Chronic Groin Pain

Chronic groin pathology is most commonly related to sports that involve running, agility and repetitive kicking. In most cases, there is no visible injury. Symptoms can appear suddenly with no obvious cause or can be more gradual in onset. Males are more at risk of developing chronic groin pain with reportedly a twofold higher rate in male compared to female football players.
Traditionally chronic groin pain has been divided in to three main divisions; osteitis pubis, adductor tendinopathy and sportsman’s hernia, with the more recent inclusion of hip impingement pathology (FAI). It is also important to also identify when groin pain is not of musculoskeletal origin. A physio or doctor will be able to identify this.

The classification of pubic pathology is more complex than previously accepted. A thorough subjective and objective assessment by a physio as well as appropriate imaging is often required to identify the source and pathological stage of groin pain. Structures which need to be assessed include; the adductor muscle group, their tendons and attachment points on to the pubic bone, the abdominal tendons and their attachment points on to the pubis, the pubic symphysis bone matrix, and the pubic symphysis (the disc between the pubic bones). A specific diagnosis is required to guide treatment and rehabilitation.

As with most injuries, treatment needs to be both specific to both the person, considering their level of sport and goals, and the specific diagnosis. The tissue type and injury history determines the person’s prognosis, suitable training load and the most appropriate rehabilitation program.
Depending on the injury, a rehabilitation program may include myofascial release techniques, joint mobilisation (spine, hip and pelvis), dry needling, stretching, targeted strengthening, control-based exercises, training load management and sports specific technique review (such as running or cutting technique).
Due to the complexities of chronic groin pain, seek advice from a qualified and up-to-date Sports Physiotherapist, or feel free to drop in to the clinic for a second opinion.