Skip to main content

Pubalgia and Groin Pain in Athletes

  • Chapter
  • First Online:
Clinical Guide to Musculoskeletal Medicine

Abstract

Groin pain (pubalgia) is a vague term that has been used to describe a constellation of symptoms in a broad anatomical region, including the lower abdominal wall and hip adductor musculature. Recent medical literature utilizes the term “core muscle injury” (CMI) to characterize a patient’s symptomatology. CMI is a chronic overuse injury seen in athletes involved in sudden changes in direction, kicking, and core torsion. Higher-risk individuals typically note weaker posterior abdominal/hip adductor musculature or a high level of athletic competition. There are a variety of physical exam maneuvers, in addition to real-time sonography, that can aid in the diagnosis. Conservative measures involve rest, anti-inflammatory medications, physical therapy, and percutaneous procedures. These should be pursued in all patients prior to surgical intervention. Return to play can take weeks to months depending on which anatomic structures are involved and where the individual is within the spectrum of CMI.

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 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
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. Bradshaw CJ, Bundy M, Falvey E. The diagnosis of longstanding groin pain: a prospective clinical cohort study. Br J Sports Med. 2008;42(10):851–4. Orchard J, Best TM. The management of muscle strain injuries: an early return versus the risk of recurrence. Clin J Sport Med. 2002;12(1):3–5.

    Article  CAS  Google Scholar 

  2. Tyler TF, Nicholas SJ, Campbell RJ, Donellan S, McHugh MP. The effectiveness of a preseason exercise program to prevent adductor muscle strains in professional ice hockey players. Am J Sports Med. 2002;30(5):680–3.

    Article  Google Scholar 

  3. Orchard J, Seward H. Epidemiology of injuries in the Australian Football League, seasons 1997–2000. Br J Sports Med. 2002;36(1):39–44.

    Article  CAS  Google Scholar 

  4. Meyers WC, McKechnie A, Philippon MJ, Horner MA, Zoga AC, Devon ON. Experience with “sports hernia” spanning two decades. Ann Surg. 2008;248(4):656–65.

    Article  Google Scholar 

  5. MacMahon PJ, Hogan BA, Shelly MJ, Eustace SJ, Kavanagh EC. Imaging of groin pain. Magn Reson Imaging Clin N Am. 2009;17(4):655–66, vi.

    Article  Google Scholar 

  6. Serner A, Tol JL, Jomaah N, Weir A, Whiteley R, Thorborg K, et al. Diagnosis of acute groin injuries: a prospective study of 110 athletes: a prospective study of 110 athletes. Am J Sports Med. 2015;43(8):1857–64.

    Article  Google Scholar 

  7. Hölmich P, Thorborg K, Dehlendorff C, Krogsgaard K, Gluud C. Incidence and clinical presentation of groin injuries in sub-elite male soccer. Br J Sports Med. 2014;48(16):1245–50.

    Article  Google Scholar 

  8. Sheen AJ, Stephenson BM, Lloyd DM, Robinson P, Fevre D, Paajanen H, et al. “Treatment of the sportsman’s groin”: British Hernia Society’s 2014 position statement based on the Manchester Consensus Conference. Br J Sports Med. 2014;48(14):1079–87.

    Article  Google Scholar 

  9. Koulouris G. Imaging review of groin pain in elite athletes: an anatomic approach to imaging findings. AJR Am J Roentgenol. 2008;191(4):962–72.

    Article  Google Scholar 

  10. Omar IM, Zoga AC, Kavanagh EC, Koulouris G, Bergin D, Gopez AG, et al. Athletic pubalgia and “sports hernia”: optimal MR imaging technique and findings. Radiographics. 2008;28(5):1415–38.

    Article  Google Scholar 

  11. 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):768–74.

    Article  Google Scholar 

  12. Meyers WC, Havens BK, Horner GJ. Core muscle injury (a better name than “athletic pubalgia” or “sports hernia”). Curr Orthop Pract. 2014;25(4):321–6.

    Article  Google Scholar 

  13. Engebretsen AH, Myklebust G, Holme I, Engebretsen L, Bahr R. Intrinsic risk factors for groin injuries among male soccer players: a prospective cohort study. Am J Sports Med. 2010;38(10):2051–7.

    Article  Google Scholar 

  14. Hölmich P, Larsen K, Krogsgaard K, Gluud C. Exercise program for prevention of groin pain in football players: a cluster-randomized trial: exercise program for prevention of groin pain in football players. Scand J Med Sci Sports. 2010;20(6):814–21.

    Article  Google Scholar 

  15. Larson CM. Sports hernia/athletic pubalgia: evaluation and management. Sports Health. 2014;6(2):139–44.

    Article  Google Scholar 

  16. Schilders E, Talbot JC, Robinson P, Dimitrakopoulou A, Gibbon WW, Bismil Q. Adductor-related groin pain in recreational athletes: role of the adductor enthesis, magnetic resonance imaging, and entheseal pubic cleft injections. J Bone Joint Surg Am. 2009;91(10):2455–60.

    Article  Google Scholar 

  17. Verrall GM, Slavotinek JP, Fon GT, Barnes PG. Outcome of conservative management of athletic chronic groin injury diagnosed as pubic bone stress injury. Am J Sports Med. 2007;35(3):467–74.

    Article  Google Scholar 

  18. Kurowicki J, Kraeutler MJ, Dávila Castrodad IM, Hahn AK, Simone ES, Kelly MA, et al. Diagnostic accuracy of physical examination tests in core muscle injury. Am J Sports Med. 2020;48(8):1983–8.

    Article  Google Scholar 

  19. Serner A, Weir A, Tol JL, Thorborg K, Roemer F, Guermazi A, et al. Can standardised clinical examination of athletes with acute groin injuries predict the presence and location of MRI findings? Br J Sports Med. 2016;50(24):1541–7.

    Article  Google Scholar 

  20. Williams PR, Thomas DP, Downes EM. Osteitis pubis and instability of the pubic symphysis. When nonoperative measures fail: when nonoperative measures fail. Am J Sports Med. 2000;28(3):350–5.

    Article  CAS  Google Scholar 

  21. Branci S, Thorborg K, Bech BH, Boesen M, Nielsen MB, Hölmich P. MRI findings in soccer players with long-standing adductor-related groin pain and asymptomatic controls. Br J Sports Med. 2015;49(10):681–91.

    Article  Google Scholar 

  22. Morley N, Grant T, Blount K, Omar I. Sonographic evaluation of athletic pubalgia. Skelet Radiol. 2016;45(5):689–99.

    Article  Google Scholar 

  23. Rodriguez C, Miguel A, Lima H, Heinrichs K. Osteitis pubis syndrome in the professional soccer athlete: a case report. J Athl Train. 2001;36(4):437–40.

    PubMed  PubMed Central  Google Scholar 

  24. Kachingwe AF, Grech S. Proposed algorithm for the management of athletes with athletic pubalgia (sports hernia): a case series. J Orthop Sports Phys Ther. 2008;38(12):768–81.

    Article  Google Scholar 

  25. De Bruijn R. Deep transverse friction its analgesic effect. Int J Sports Med. 1984;5:35–6.

    Article  Google Scholar 

  26. Gehlsen GM, Ganion LR, Helfst R. Fibroblast responses to variation in soft tissue mobilization pressure. Med Sci Sports Exerc. 1999;31(4):531–5.

    Article  CAS  Google Scholar 

  27. Abouelnaga WA, Aboelnour NH. Effectiveness of active rehabilitation program on sports hernia: randomized control trial. Ann Rehabil Med. 2019;43(3):305–13.

    Article  Google Scholar 

  28. 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.

    Article  Google Scholar 

  29. Poor AE, Roedl JB, Zoga AC, Meyers WC. Core muscle injuries in athletes. Curr Sports Med Rep. 2018;17(2):54–8.

    Article  Google Scholar 

  30. Scholten PM, Massimi S, Dahmen N, Diamond J, Wyss J. Successful treatment of athletic pubalgia in a lacrosse player with ultrasound-guided needle tenotomy and platelet-rich plasma injection: a case report. PM R. 2015;7(1):79–83.

    Article  Google Scholar 

  31. St-Onge E, MacIntyre IG, Galea AM. Multidisciplinary approach to non-surgical management of inguinal disruption in a professional hockey player treated with platelet-rich plasma, manual therapy and exercise: a case report. J Can Chiropr Assoc. 2015;59(4):390–7.

    PubMed  PubMed Central  Google Scholar 

  32. Paajanen H, Brinck T, Hermunen H, Airo I. 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. 2011;150(1):99–107.

    Article  Google Scholar 

  33. Kajetanek C, Benoît O, Granger B, Menegaux F, Chereau N, Pascal-Mousselard H, et al. Athletic pubalgia: return to play after targeted surgery. Orthop Traumatol Surg Res. 2018;104(4):469–72.

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to George Ross Malik .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2022 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Malik, G.R., Avila, J., Rho, M.E. (2022). Pubalgia and Groin Pain in Athletes. In: Mostoufi, S.A., George, T.K., Tria Jr., A.J. (eds) Clinical Guide to Musculoskeletal Medicine. Springer, Cham. https://doi.org/10.1007/978-3-030-92042-5_18

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-92042-5_18

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-92041-8

  • Online ISBN: 978-3-030-92042-5

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics