OVERVIEW

What is groin pain?

Groin pain is a common clinical symptom. The skin and muscles in this area are relatively weak, and many diseases can cause pain in the groin.

Among them, sacroiliac joint dysfunction, adductor muscle strain, iliopsoas injury, rectus femoris strain, proximal femoral fracture, rectus abdominis strain, lumbar spine misalignment, postoperative dysfunction of pelvic fractures, hip osteoarthritis, tensor fasciae latae strain, gracilis muscle strain, herniated disc, and piriformis syndrome can all cause groin pain.

SYMPTOMS

What are the typical manifestations of groin pain?

The pain may occur in one or more of the following areas:

• Lower abdomen
• Inner groin
• Pubic region
• Both sides of the hips

(Diseases involving the internal, reproductive, or lymphatic systems may present with specific symptoms.)

Specific manifestations include:

• Localized pain, pulling pain, or radiating pain in the groin area, usually on one side.
• Reduced range of motion in the thigh, weakened strength around the thigh, and difficulty lifting the leg.
• Swelling and tenderness upon touching the groin area, with some individuals experiencing lower limb edema.
• Pain intensity increases with exertion, affecting physical activity ^[1-7].
• Pain occurs during coughing, sneezing, or straining.
• Pain worsens when twisting the abdomen.
• Some individuals may experience severe pain that makes walking difficult.
• Pain may also manifest in the lower abdomen or perineum, with a few male patients reporting testicular or scrotal discomfort.

CAUSES

What are the causes of groin pain?

In addition to pain caused by infections of the lymphatic, urinary, or reproductive systems, other common causes include:

• Acute or repetitive forceful rotation of the body with hip hyperextension and/or abduction, such as kicking, hurdling, or "splits"-type sliding ^[1-4];
• Lower limb strain;
• Osteitis pubis, which is associated with long-term sports strain, trauma, infection, surgery, childbirth, or a combination of factors leading to impaired blood circulation in the pubic symphysis;
• End-stage tendon pathology and bone or cartilage changes due to violent stretching of the gracilis muscle at its insertion point.

Who is more prone to groin pain?

The susceptible population varies depending on the condition. Among them:

• Athletic pubalgia (sports hernia) is more common in athletes, especially those involved in sports requiring frequent directional changes, such as soccer, tennis, and rugby. It is also more common in males than females.
• Osteitis pubis often occurs in males after urological surgery or in females during late pregnancy or after childbirth.

What are the risk factors for groin pain?

• Participation in sports involving repetitive twisting, direct or indirect trauma, or high-frequency acceleration and deceleration (e.g., soccer, rugby, skiing, sprinting or hurdling, or golf ^[1,2,6,7,8]);
• Most common in high-performing male athletes ^[1,4];
• Insufficient abdominal muscle strength and flexibility ^[1,2,3,4,9].

Is groin pain common?

Very common.

However, due to the many potential causes of groin pain, there is no clear incidence rate.

DIAGNOSIS

Can groin pain heal on its own?

• Most cases cannot and require multidisciplinary rehabilitation.
• Pain may lessen over time, but the underlying issue remains unresolved. Active rehabilitation is essential for groin pain—waiting for "self-healing" is ineffective.

How is groin pain evaluated and diagnosed?

Given the complexity of groin pain causes, if rest does not alleviate the pain, prompt medical evaluation and treatment are recommended.

Is imaging (X-rays) necessary for groin pain?

Yes.

X-rays can detect fractures causing groin or pelvic pain.

Rectus abdominis/adductor tendon injuries can be identified via MRI ^[1,3,4,5,6].

X-rays and ultrasound help diagnose common conditions like groin hernias or pubic osteitis ^[2,3,4,5].

Which medical department treats groin pain?

For exercise-related pain: sports medicine, orthopedics, surgery, rehabilitation, pain management, or specialized sports rehab centers.

For other causes: consult triage nurses for guidance.

For genitourinary conditions: urology, gynecology, andrology, or related departments.

For abdominal conditions: internal medicine or relevant departments.

TREATMENT

How to Handle Acute Groin Pain?

If there is no bleeding or open wound, follow the PRICE principle during the acute recovery phase.

The PRICE principle stands for Protect, Rest, Ice, Compress, and Elevate.

• Protect: Stop activity immediately to prevent further injury.
• Rest: Rest for at least 24 hours after the injury.
• Ice: Apply an ice pack, bag of crushed ice, or a towel-wrapped frozen item (e.g., soda can, ice cream) for 15 minutes at a time. Allow the skin to warm fully before reapplying. Note: Avoid direct skin contact with ice, and limit each session to 20 minutes to prevent frostbite.
• Compress: Use a non-elastic bandage or cloth to wrap the injured area, reducing swelling.
• Elevate: Keep the injured area raised above heart level.

Avoid walking if it worsens the pain.

Is Medication Needed for Groin Pain?

If pain is severe, take anti-inflammatory or pain-relief drugs only as prescribed by a doctor. Do not self-medicate.

The type of painkiller depends on the specific condition.

Is Surgery Required for Groin Pain?

Consider surgery if persistent groin pain lasts over 8 weeks despite conservative treatment ^[1,2,3].

For other conditions, follow the doctor’s recommendation.

Can Steroid Injections Help Groin Pain?

For chronic cases unresponsive to other treatments, ultrasound-guided corticosteroid injections may be administered by a doctor. These are typically used for suspected adductor strains or osteitis pubis.

Not recommended: - Acute injuries in non-professional athletes or off-season professionals. - Elite athletes must comply with anti-doping regulations for any invasive/drug therapy.

Avoid injections for reproductive, urinary, nervous, or lymphatic system disorders.

Can Massage Improve Groin Pain?

• Sports massage may temporarily relieve symptoms but isn’t a cure.
• Avoid massage during the acute injury phase.
• Seek professional massage or rehab clinics for manual therapy.
• For reproductive/urinary/nerve/lymphatic issues, refer to other guidelines.

Is Heat Therapy Suitable for Groin Pain?

Depends on the case.

After the acute phase (72 hours post-sports hernia, 1 week post-osteitis pubis, or per specialist advice), heat before stretching improves tissue flexibility and hip mobility.

Contraindications: - Inflammation in the painful area - Reduced skin sensation - Open wounds/skin infections - Cognitive/language impairments - Cancer - Bleeding or edema risk

Rehabilitation Exercises for Groin Pain

Note: Rehabilitation varies by diagnosis. Always confirm the condition before starting exercises.

Sports Hernia ^[16] Phases: Acute (Days 1–3): Pain-free joint movements to prevent stiffness ^[17]. - Towel-assisted hip flexion (supine) - Supine abduction - TFL/gluteal foam ball release Subacute (Day 4–2 weeks): Strengthen thighs/abdomen. - Straight leg raises - Weighted side leg lifts - Sit-to-stand drills - Shallow squats - Core curls - Progressive iliopsoas training Tissue Recovery (2–4 weeks): Add functional lower-body training. - Adductor eccentric exercises - Lateral step-ups - Monster walks - Deep squats - Lunges - Balance drills Functional/Sport-Specific (5+ weeks): - Sled pulls - Medicine ball lateral hops - Depth jumps - Agility ladder Osteitis Pubis ^[21]: Acute (Week 1): Pain-free mobility. - Towel-assisted hip flexion - Supine abduction Subacute (Weeks 2–12): Progressive strength/stretching. - Iliopsoas/adductor training - Eccentric adductor work - Foam rolling - Static stretches - Squats/lunges - Balance exercises Chronic (>12 weeks): Resume normal activity.

How Long Until Groin Pain Heals?

With successful surgery/rehab, return to sports is possible within 15 weeks ^[22,23].

DIET & LIFESTYLE

Does groin pain require bed rest?

Severe cases may require bed rest, but prolonged bed rest should be avoided. Exercise should be resumed as early as possible when pain-free.

What dietary precautions should patients with groin pain take?

No special dietary requirements, just maintain a nutritious, light, and non-irritating diet.

Can groin pain be completely cured?

It depends. Groin pain caused by muscle injuries generally recovers well but has a high recurrence rate, so injury prevention is crucial.

For permanent cures of internal, reproductive, urinary, or neurological diseases, please refer to other links.

PREVENTION

How to Prevent Groin Pain?

• Perform thorough warm-ups and stretches before exercise, including cycling and stretching movements;
• Athletes should undergo targeted training for muscle strength, flexibility, and core endurance before the sports season begins;
• Prevention of medical, reproductive, urinary, and neurological diseases requires visiting other links.