Skip to main content

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 84.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 119.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 109.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  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):640–643

    Google Scholar 

  2. Anderson K, Strickland SM, Warren R (2001) Hip and groin injuries in athletes. Am J Sports Med 29:521–533

    CAS  PubMed  Google Scholar 

  3. Aprato A, Jayasekera N, Villar R (2012) Timing in hip arthroscopy: does surgical timing change clinical results? Int Orthop 36:2231–2234

    Article  PubMed  PubMed Central  Google Scholar 

  4. Bhosale PR, Patnana M, Viswanathan C, Szklaruk J (2008) The inguinal canal: anatomy and imaging features of common and uncommon masses. Radiographics 28:819–835

    Article  PubMed  Google Scholar 

  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 35:1955–1959

    Article  PubMed  Google Scholar 

  6. Beatty T (2012) Osteitis pubis in athletes. Curr Sports Med Rep 11:96–98

    Google Scholar 

  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 49:681–691

    Google Scholar 

  8. Brooker AF Jr (1979) The surgical approach to refractory trochanteric bursitis. Johns Hopkins Med J 145:98–100

    PubMed  Google Scholar 

  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 45:57–64

    Article  PubMed  PubMed Central  Google Scholar 

  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 102:115–131

    Article  PubMed  Google Scholar 

  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 49:230–242

    Article  PubMed  Google Scholar 

  12. Economopoulos KJ, Milewski MD, Hanks JB, Hart JM, Diduch DR (2013) Sports hernia treatment: modified bassini versus minimal repair. Sports Health 5:463–469

    Article  PubMed  PubMed Central  Google Scholar 

  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 23:141–145

    Google Scholar 

  14. Fricker PA, Taunton JE, Ammann W (1991) Osteitis pubis in athletes. Infection, inflammation or injury? Sports Med 12:266–279

    Article  CAS  PubMed  Google Scholar 

  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 37:1806–1813

    Article  PubMed  Google Scholar 

  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 417:112–120

    PubMed  Google Scholar 

  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 18:815–823

    Article  CAS  PubMed  Google Scholar 

  18. Garvey JF, Read JW, Turner A (2010) Sportsman hernia: what can we do? Hernia 14:17–25

    Article  CAS  PubMed  Google Scholar 

  19. Gilmore J (1998) Groin pain in the soccer athlete: fact, fiction, and treatment. Clin Sports 17:787–793

    Article  CAS  Google Scholar 

  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 92:629–633

    Article  CAS  PubMed  Google Scholar 

  21. Hiti CJ, Stevens KJ, Jamati MK, Garza D, Matheson GO (2011) Athletic osteitis pubis. Sport Med 41:361–376

    Article  Google Scholar 

  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 83:171–176

    Article  CAS  PubMed  Google Scholar 

  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 184:847–851

    Article  PubMed  Google Scholar 

  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, 8

    PubMed  PubMed Central  Google Scholar 

  25. Kagan A 2nd (1999) Rotator cuff tears of the hip. Clin Orthop Relat Res 368:135–140

    Article  PubMed  Google Scholar 

  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 54:487–493

    CAS  PubMed  Google Scholar 

  27. Kong A, Van der Vliet A, Zadow S (2007) MRI and US of gluteal tendinopathy in greater trochanteric pain syndrome. Eur Radiol 17:1772–1783

    Article  PubMed  Google Scholar 

  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. Kunduracioglu B, Yilmaz C, Yorubulut M, Kudas S (2007) Magnetic resonance findings of osteitis pubis. J Magn Reson Imaging 25:535–539

    Article  PubMed  Google Scholar 

  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 260:494–502

    Article  PubMed  Google Scholar 

  31. Larson CM (2014) Sports hernia/athletic pubalgia: evaluation and management. Sports Health 6:139–144

    Article  PubMed  PubMed Central  Google Scholar 

  32. LeBlanc KE, LeBlanc KA (2003) Groin pain in athletes. Hernia 7:68–71

    Article  PubMed  Google Scholar 

  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 75:458–464

    Article  PubMed  Google Scholar 

  34. Leunig M, Beaulé PE, Ganz R (2009) The concept of femoroacetabular impingement: current status and future perspectives. Clin Orthop Relat Res 467:616–622

    Article  PubMed  PubMed Central  Google Scholar 

  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 40:1880–1886

    Article  PubMed  Google Scholar 

  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 94:466–470

    Article  CAS  PubMed  Google Scholar 

  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 36:1189–1197

    Article  Google Scholar 

  38. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON (2008) Experience with “sports hernia” spanning two decades. Ann Surg 248:656–665

    PubMed  Google Scholar 

  39. Marshall PW, Murphy BA (2005) Core stability exercises on and off a swiss ball. Arch Phys Rehabil 86:242–249

    Article  Google Scholar 

  40. Morales-Conde S, Socas M, Barranco A (2010) Sportsmen hernia: what do we know? Hernia 14:5–15

    Article  CAS  PubMed  Google Scholar 

  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 39:544–550

    Article  PubMed  Google Scholar 

  42. Orchard J, Read JW, Verrall GM, Slavotinek JP (2000) Pathophysiology of chronic groin pain in the athlete. Int J Sports Med 1:1–16

    Google Scholar 

  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 150:99–107

    Article  PubMed  Google Scholar 

  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 131:261–266

    Article  PubMed  Google Scholar 

  45. Palisch A, Zoga AC, Meyers WC (2013) Imaging of athletic pubalgia and core muscle injuries: clinical and therapeutic correlations. Clin Sports Med 32:427–447

    Article  PubMed  Google Scholar 

  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) 36:903–914

    Article  Google Scholar 

  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. 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 39:225–234

    Article  PubMed  Google Scholar 

  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 32:45–48

    Article  CAS  PubMed  Google Scholar 

  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):437–440

    Google Scholar 

  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 37:1981–1990

    Article  PubMed  Google Scholar 

  52. Slawski DP, Howard RF (1997) Surgical management of refractory trochanteric bursitis. Am J Sports Med 25:86–89

    Article  CAS  PubMed  Google Scholar 

  53. Schnute WJ (1961) Osteitis pubis. Clin Orthop 20:187–192

    CAS  PubMed  Google Scholar 

  54. Segal NA, Felson DT, Torner JC et al (2007) Greater trochanteric pain syndrome: epidemiology and associated factors. Arch Phys Med Rehabil 88:988–992

    Article  PubMed  PubMed Central  Google Scholar 

  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. Suarez JC, Ely EE, Mutnal AB et al (2013) Comprehensive approach to the evaluation of groin pain. J Am Acad Orthop Surg 21:558–570

    PubMed  Google Scholar 

  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):142–148

    Google Scholar 

  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 35:467–474

    Article  PubMed  Google Scholar 

  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 37:743–747

    Article  PubMed  Google Scholar 

  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 11:99–103

    Article  PubMed  Google Scholar 

  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 43:1036–1040

    Article  CAS  PubMed  Google Scholar 

  62. Williams PR, Thomas DP, Downes EM (2000) Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail. Am J Sports Med 28:350–355

    CAS  PubMed  Google Scholar 

  63. Williams BS, Cohen SP (2009) Greater trochanteric pain syndrome: a review of anatomy, diagnosis and treatment. Anesth Analg 108:1662–1670

    Article  PubMed  Google Scholar 

  64. Wollin M, Lovell G (2006) Osteitis pubis in four young football players: a case series demonstrating successful rehabilitation. Phys Ther Sport 7:153–160

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Nicola Maffulli MD, MS, PhD, FRCS (Orth) .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer International Publishing Switzerland

About this chapter

Cite this chapter

Maffulli, N., Giai Via, A., Oliva, F. (2015). Groin Pain. In: Volpi, P. (eds) Football Traumatology. Springer, Cham. https://doi.org/10.1007/978-3-319-18245-2_29

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-18245-2_29

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-18244-5

  • Online ISBN: 978-3-319-18245-2

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics