Groin pain syndrome

Groin pain syndrome

Mitsutoshi Hayashi

Mitsutoshi Hayashi

Doctor of Medicine, specialist in the Japanese Society of Rehabilitation Medicine, specialist in the Japanese Society of Orthopaedic Surgery, specialist in the Japanese Society of Rheumatology, staff to strengthen JOC, and sports physician certified by the Japan Sports Association

Doctor's Editon

Disease Overview

These are described as inguinal pain syndromes (Groin pain syndrome) because many types of groin area pain occur in football and other sports from various causes, making it difficult to identify the true cause.
Differential diagnoses include symphysis pubis inflammation, enthesitis of the adducent muscles of the femur, rectus femoris myositis, rectus abdominis enthesitis, iliopsoas myositis, and inguinal hernias.

Area of pain around the groin

Figure: Area of pain around the groin (Reference 1).

Cause and mechanism of onset

Cause of the injury

Muscle weakness, decreased flexibility, and contracture may be caused by injury or overuse in sports of the leg. And it seems to lead to pain around the inguinal region.
Repeated exercises, such as kicking and running, can inflame and hurt the groin, hip joint, and pelvis through mechanical stress. It also occurs when a person has a direct blow to the hip joint area, such as a tackle.


It is characterized by tenderness, motor pain, and sometimes pain radiating to the groin, medial thigh (adducent muscles insertion), or lower abdomen. Chronic pain always affects the groin. It is particularly likely to be triggered by activities that extend, raise, and abduct the lower extremities, resulting in limited range of motion and weakness muscles of the hip joint.

Common sports

Soccer is the most common type of sport, and it is most common among male athletes around the age of 20, including, track and field, rugby, hockey, and weight lifting.


A definite diagnosis is difficult to make for pain around the groin.

Differential (similar) diagnosis

Symphysis pubis inflammation is inflammation caused by exercise stress on the cartilaginous disks that unite the pubic bones on both sides of the body. It is often a disorder caused by sports.
Typically, symphysis pubis inflammation causes bone lysis at the pubic junctions of the gracilis and adducent muscles, differences in the height of the right and left pubic bones, and deformities of the symphysis. It can also be seen on CT. However, changes to the bones are relatively uncommon.

Pubic stress fractures occur mainly in basketball and tennis, especially involving pain in the groin area.
These include buttock pain due to hamstring injury, iliotibial band syndrome with lateral thigh pain, and gluteal myositis.

Treatment and rehabilitation


Conservative therapy is the first choice in patients with acute disease or within the first six months of onset. People with severe pain may need to stop sports for about 2 weeks. Local bed rest, ice, sometimes heat therapy (hot packs), anti-inflammatory analgesics, and topical injections of steroid hormones (avoided for multiple uses) may be used, but exercise therapy may be effective in the long term.
Early rehabilitation begins with hip joint range-of-motion abduction exercises, muscle strengthening, and adducent muscle stretching, followed by underwater walking, exercise bike followed by jogging, and ball-kick exercises in 2 months. As the pain disappears, please do not judge to return to sports because it may lead to recurrence. Chronic disease requires long-term (more than 2 to 3 months) cessation of sports, so caution is needed.


Surgical treatment may be considered if the pain persists for a long time despite conservative treatment. However, conservative treatment has been successful, and rehabilitation is performed aggressively.

Reference: 1) Niga Sadao: Groin pain syndrome

Hitoshi Takahashi

Hitoshi Takahashi

Associate Professor, the Department of Regional Medicine, Teikyo Heisei University
A certified athletic trainer from the Japan Sport Association, a practitioner of acupuncture and a massage practitioner

Trainer's edition


Preventive measures include ensuring muscle flexibility around the hip joint and strengthening the trunk and hip joint muscles. Football players also improve their sports activities, such as learning kicking movements in which the lower and upper limbs are connected.

On-site evaluation and first aid

People who complain of hip joint pain at a sports site should first seek medical attention for structural problems (such as inguinal hernias or stress fractures). If there is no organic problem, it can be managed as a functional problem (peri-inguinal pain syndrome). If the pain is severe, the person should stop sports and wear ice.



Players who are considered to have peri-inguinal pain syndromes characteristically have reduced flexibility of the muscles surrounding the hip joint. Of particular importance is maintaining hip joint adductor flexibility. This section describes the stretching of the adducent muscles surrounding the hip joint, the extensor muscles (gluteus maximus and hamstrings), and the flexor muscles (iliopsoas and rectus femoris).
Stretching is done statically for 10 to 20 seconds.

Adducent muscles

1 (cog split)

Symphysis pubis flame 1

Place the toes and knees in the same direction. Drop the lower back until stretching is felt in the medial thigh.

Symphysis pubis flame 2

Push the shoulder forward and push the inside of the knee

2: (extensor leg)

Symphysis pubis flame 3

Push gently over the knee and thigh of the extended foot.

Symphysis pubis flame 4

Lower posture (Photo 4)


Symphysis pubis flame 5

Place the leg on the step ladder and bend forward to the side of the support leg

Knee extension (sitting open leg)

Symphysis pubis flame 6

With right and left (photo 6)

Symphysis pubis flame 7

Finally, this is done in the middle. The trainer holds the legs and feet in place so that the open legs do not close.

Knee extension (supine)

Symphysis pubis flame 8

The trainer holds the opposite leg by pressing with the hand to prevent closure.

Knee extension (sitting position)

Symphysis pubis flame 9

The trainer pushes the knee toward the floor. It is done by changing the angle of flexion of the knee joint. Stretching the knee joint with deep flexion.

Symphysis pubis flame 10

Stretches with curvature of about 90 degrees. This is also more effective when the trunk is bent forward.

Knee flexion (supine)

Symphysis pubis flame 11
Symphysis pubis flame 12

Similarly to the sitting position, the knee joint should be angled.

Symphysis pubis flame 13

Can be done unilaterally

Extensor (gluteus maximus, hamstrings)

Symphysis pubis flame 14

From the upright position, the stretching leg is bent forward slightly.

Symphysis pubis flame 15

The legs can also be crossed.

Knee flexion

Symphysis pubis flame 16

The trainer keeps the opposite leg from rising.

Knee extension

Symphysis pubis flame 17

The trainer should keep the contralateral foot from rising.
Flexion to extension: first in flexion and then in extension.

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