Groin pain in athletes: causes and assessment

The groin is where several muscles, tendons, joints and connective tissue meet, and pain from here can come from many structures. In 2015, 24 experts from 14 countries agreed on common terms and definitions, called the Doha agreement [1].

The classification is based on the history and clinical examination, not on imaging [1].

The Doha agreement describes four defined conditions in the muscles, tendons and bones around the groin [1]:

• Adductor-related: tenderness in the adductors and pain when squeezing the legs together against resistance
• Iliopsoas-related: tenderness in the hip flexor iliopsoas. More likely with pain on hip flexion against resistance or when the muscle is stretched
• Inguinal-related: pain and tenderness over the inguinal canal, without a palpable hernia. More likely with pain on coughing, sneezing or abdominal pressure
• Pubic-related: local tenderness over the pubic symphysis and the adjacent bone

An athlete can have several of these at the same time [1].

The hip joint should always be assessed as a possible cause of groin pain [1]. NHI mentions cartilage and labral injury in the hip joint and stress fracture of the femoral neck as relevant causes in athletes [2]. You can read about hip conditions on the pages about snapping hip and hip osteoarthritis. There are also causes outside the musculoskeletal system, including neurological, urological and gynaecological ones [1].

The therapist asks when the pain began, how it feels and where it is. Clicking, locking or a feeling that the hip gives way are important details [1]. Range of motion and strength are then examined, and specific hip tests are done. These have good sensitivity but poor specificity, which means they are most useful for ruling out the hip as the cause [1].

When underlying disease is suspected, the doctor may take blood tests and use ultrasound, X-ray, CT or MRI [2].

In a randomised trial from 1999, male athletes with long-standing adductor-related groin pain were divided into two groups. One received an active exercise programme, the other physiotherapy without active exercise. Significantly more in the exercise group were back to full sport without groin pain at follow-up [3].

In a Norwegian study from 2019, the researchers followed 35 semi-professional football teams. The teams that performed an adductor strengthening exercise (the Copenhagen exercise) had a lower occurrence of self-reported groin problems (13.5 versus 21.3 percent) [4].

Both studies concern male athletes, and the results cannot simply be transferred to everyone with groin pain.

NHI recommends changing activities so that the load on the sore area is reduced. A few days of offloading and rest, and avoiding sport that makes the symptoms worse, is a starting point [2].

Persistent pain that does not subside with offloading, and intense or sudden problems, should be examined by a doctor [2]. The same applies to difficulty walking, a hip that cannot tolerate loading, locking, fever or feeling unwell, and morning stiffness [2]. After a fall, a shortened and outward-rotated leg can indicate a femoral neck fracture [2].

A chiropractor can map where the pain is, assess whether the hip joint is involved and set up a plan for rehabilitation. Read more about chiropractic care and diagnostic ultrasound at Dr.Dropin.

What causes groin pain in football players and other athletes?

It can be problems in the adductors, the hip flexor, the inguinal canal or the pubic bone, and pain from the hip joint. There are also causes outside the musculoskeletal system [1].

How do you know if groin pain comes from the hip?

The hip joint should always be assessed. The therapist asks about clicking and locking, and does specific hip tests that are most useful for ruling out the hip as the cause [1].

Can exercise help with groin pain?

In a randomised trial, more of those who trained actively had returned to sport without groin pain than those who received physiotherapy without active exercise [3]. The result applies to a specific group of male athletes.

When should I contact a doctor about groin pain?

With persistent pain that does not subside with offloading, intense or sudden problems, locking, fever or difficulty walking [2].

Read about hip conditions on the pages about snapping hip and hip osteoarthritis. You can find more articles in the overview of articles.

This article was written by Dr.Dropin Fysikalske and is based on the sources listed below. It gives general information and does not replace an examination by a healthcare professional.

The websites were accessed and read on 22 October 2026.

1. Weir A, Brukner P, Delahunt E, Ekstrand J, Griffin D, Khan KM, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768–774. doi:10.1136/bjsports-2015-094869. Link

2. Smerter i hofte, bekken og lyske (pain in hip, pelvis and groin). NHI.no. Published 6 December 2016, last updated 22 March 2026. Link

3. Hölmich P, Uhrskou P, Ulnits L, Kanstrup IL, Nielsen MB, Bjerg AM, et al. Effectiveness of active physical training as treatment for long-standing adductor-related groin pain in athletes: randomised trial. Lancet. 1999;353(9151):439–43. doi:10.1016/S0140-6736(98)03340-6. Link

4. Harøy J, Clarsen B, Wiger EG, Øyen MG, Serner A, Thorborg K, et al. The Adductor Strengthening Programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 2019;53(3):150. doi:10.1136/bjsports-2017-098937. Link