Inguinal-related groin pain is a type of groin pain felt around the lower abdomen, pubic bone and inguinal canal, which is the small passage in the lower abdominal wall near the groin crease. It is common in athletes who sprint, kick, cut, twist or repeatedly change direction, such as football, soccer, rugby, AFL, hockey and running-based sports.
People often describe this condition as a “sports hernia”, “athletic pubalgia”, “Gilmore’s groin”, “inguinal disruption”, “lower abdominal groin pain” or “pubalgia”. These terms are still used by patients and some clinicians, but inguinal-related groin pain is usually preferred because it describes the painful region without assuming there is a true hernia.
Inguinal-related groin pain usually develops when the lower abdominal wall, hip muscles, adductors, pelvis and trunk are not sharing load well during sport. The area can become sensitive during sprinting, kicking, sit-ups, coughing, twisting, getting out of bed or pushing off one leg. Because symptoms can overlap with adductor-related groin pain, hip joint pain, pubic-related groin pain and a true inguinal hernia, physiotherapy assessment is important.
Key Facts
- The Doha agreement classifies athlete groin pain into defined clinical entities, including adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain, alongside hip-related groin pain and other causes. 🔗
- Groin pain has been reported to account for approximately 4% to 19% of all injuries in soccer players, although estimates vary because older studies used inconsistent terminology. 🔗
- A 2026 narrative review reported that first-line treatment for inguinal-related groin pain and/or disruption in athletes typically includes physical therapist-led rehabilitation, activity modification and graded return to sport. 🔗
Risk Factors
- Sports involving sprinting, kicking, twisting and rapid direction change
- Previous groin, hip, abdominal or pubic pain
- Sudden increases in running speed, kicking volume, gym load or match minutes
- Weakness or poor endurance of the lower abdominal muscles
- Reduced hip adductor strength or poor adductor-to-abdominal coordination
- Limited hip range of motion, especially if the athlete compensates through the pelvis
- Poor trunk and pelvic control during single-leg tasks
- Fatigue late in training or matches
- Training on heavy, uneven or high-grip surfaces that increase twisting load
- Returning from off-season, injury or illness without a graded conditioning block
Symptoms
- Pain in the lower abdomen, groin crease or area just above the pubic bone
- Pain that increases with sprinting, acceleration, kicking, cutting or twisting
- Tenderness when pressing along the inguinal canal or near the pubic tubercle
- Pain with coughing, sneezing, bracing, sit-ups or getting out of bed
- A dragging, burning, pulling or deep ache in the groin rather than a sharp muscle tear
- Symptoms that ease with rest but return when sport intensity increases
- Pain that may spread into the inner thigh, lower abdomen, testicle or scrotal region in some people
- Reduced confidence pushing off one leg, changing direction or striking a ball
- Stiffness or guarding around the hip, pelvis or lower back after activity
- No obvious hernia bulge in many cases
Aggravating Factors
- Sprinting, especially acceleration from a standing start
- Kicking, long passing, shooting or repeated ball striking
- Cutting, side-stepping and rapid changes of direction
- Twisting through the trunk while the foot is planted
- Sit-ups, planks or heavy abdominal bracing when the area is irritable
- Coughing, sneezing or straining
- Heavy lifting, pushing or carrying
- Hill running or repeated stride length changes
- Sudden increases in training volume, match minutes or gym load
- Returning to sport before strength, speed and cutting capacity have been rebuilt
Causes
Inguinal-related groin pain usually develops when the structures around the lower abdominal wall, inguinal canal and front of the pelvis are exposed to more load than they can tolerate. This is common in sports that repeatedly combine sprinting, kicking, twisting and rapid change of direction.
The inguinal canal is a small passage in the lower abdominal wall. In athletes, this region can become painful when the abdominal wall, connective tissue, hip muscles and pelvic stabilisers are not sharing load well. It does not always mean there is a true hernia. In fact, inguinal-related groin pain is defined by pain in the inguinal canal region without a palpable inguinal hernia.
Common causes and contributors include:
- High-speed running and cutting:
Sprinting, deceleration and change-of-direction movements place high load through the lower abdominal wall, hip flexors, adductors and pelvis. If these loads increase too quickly, the inguinal region may become painful. - Kicking and twisting sports:
Sports such as soccer, AFL, rugby, hockey and martial arts often combine trunk rotation, hip extension, kicking and rapid pelvic movement. This can irritate the inguinal region, especially when repeated at high intensity. - Poor load sharing between the trunk and hips:
If the abdominal muscles, adductors, hip flexors, glutes and trunk muscles are not working together well, more stress may be placed through the groin and lower abdominal region. - Weakness or reduced endurance in the abdominal wall:
The abdominal wall helps control the pelvis during sprinting, kicking and direction changes. Reduced strength or endurance can make the inguinal area more vulnerable during sport. - Adductor or hip-related contributions:
Inguinal-related groin pain often overlaps with adductor-related groin pain, iliopsoas-related pain or hip joint issues. A physiotherapist will assess these areas because treating only the painful spot may miss important contributors. - Training load spikes:
Sudden increases in sprinting, kicking volume, gym loading, pre-season running, tournament play or return from injury can overload the groin region before the tissues are ready. - Previous groin injury:
Athletes with a history of groin pain may develop altered movement patterns, reduced confidence or lingering strength deficits. This can increase the risk of recurrent inguinal-related groin pain. - True hernia or other medical causes:
Some people with groin pain have a true inguinal hernia, hip pathology, urinary issue, abdominal condition or referred pain. Physiotherapy assessment should screen for these possibilities and refer for medical review when symptoms do not fit a typical sports groin presentation.
How Is It Diagnosed?
Inguinal-related groin pain is diagnosed through a detailed history and physical examination. Imaging can be helpful in some cases, but the diagnosis is usually based on the pattern of symptoms and clinical findings.
A physiotherapist will ask where the pain is, what movements aggravate it, how it started, how long it has been present, and whether there are symptoms that suggest another cause. Inguinal-related groin pain is more likely when pain is felt in the inguinal canal region, worsens with exercise, and there is tenderness around the inguinal canal without a palpable inguinal hernia.
A physiotherapist will assess for:
- Pain location:
Inguinal-related groin pain is usually felt in the groin crease or lower abdominal region near the inguinal canal. - Exercise-related symptoms:
Symptoms often worsen with sprinting, kicking, cutting, twisting, coughing, sneezing or resisted abdominal work. - Inguinal canal tenderness:
Palpation of the inguinal canal region may reproduce the athlete’s familiar pain. - Abdominal resistance tests:
Resisted sit-up, resisted abdominal curl or other trunk-loading tests may reproduce symptoms. - Hip and adductor testing:
The physiotherapist will check adductor strength, hip flexor symptoms, hip range of movement, pubic pain and hip joint signs because multiple groin pain categories can occur together. - Hernia screening:
The clinician will check whether there is a palpable groin bulge or symptoms that suggest a true inguinal hernia. If this is suspected, medical review is needed. - Functional testing:
Running, acceleration, cutting, kicking, single-leg control and sport-specific tasks may be assessed when appropriate.
Investigations & Imaging
- Ultrasound
- May be used to assess for a true inguinal hernia, abdominal wall defects or dynamic bulging during coughing or straining. It can be helpful when there is a suspected hernia, but results must be matched with symptoms because imaging findings do not always explain pain.
- MRI pelvis or hip
- May help assess pubic bone stress, adductor tendon pathology, hip joint pathology, muscle injury or other causes of persistent groin pain. MRI can be useful when symptoms are longstanding, unclear or not improving with appropriate physiotherapy.
- X-ray
- May be used if hip joint pathology, bony morphology, arthritis, stress injury or other skeletal causes are suspected. It is not usually the first test for straightforward inguinal-related groin pain.
- Medical review and hernia assessment
- Recommended when there is a lump, marked pain with straining, unexplained abdominal or testicular symptoms, or concern about a non-musculoskeletal cause. This helps distinguish inguinal-related groin pain from a true inguinal hernia or other medical conditions.
- Diagnostic injection
- Occasionally used by sports physicians to help identify whether pain is coming from the hip joint, pubic region or another structure. It is not routine for most cases and does not replace a thorough physiotherapy assessment.
Grading / Classification
- Doha classification: Inguinal-related groin pain
- Pain in the inguinal canal region with tenderness of the inguinal canal and no palpable inguinal hernia. Symptoms are often aggravated by abdominal resistance, coughing, sprinting, kicking or twisting.
- Doha classification: Adductor-related groin pain
- Pain and tenderness around the adductor region, usually reproduced with resisted hip adduction. It commonly overlaps with inguinal-related symptoms and should be assessed during physiotherapy.
- Doha classification: Iliopsoas-related groin pain
- Pain associated with the hip flexor region, often aggravated by resisted hip flexion or hip flexor stretching. It may mimic lower abdominal or anterior groin pain.
- Doha classification: Pubic-related groin pain
- Pain and tenderness around the pubic symphysis. It may occur with high-load running, kicking and cutting sports and may coexist with inguinal or adductor-related pain.
Physiotherapy Management
Exercise
Exercise is the main part of inguinal-related groin pain physiotherapy. The aim is to progressively rebuild the strength and load tolerance of the abdominal wall, hips, adductors, glutes and trunk so the athlete can return to sprinting, kicking and change-of-direction work.
- Early symptom-calming phase:
Early exercises usually focus on low-irritability trunk and hip activation. This may include gentle abdominal bracing, dead bugs, side planks from knees, glute bridges, adductor squeezes, hip mobility and controlled walking or cycling if tolerated. - Abdominal wall strengthening:
Because symptoms are often linked with the inguinal canal and lower abdominal region, physiotherapy commonly includes progressive abdominal loading. This may include curl-up variations, anti-rotation holds, planks, side planks, Pallof presses and controlled trunk rotation exercises. - Hip and adductor strengthening:
Inguinal-related groin pain often overlaps with adductor and hip muscle weakness. Rehab may include adductor squeezes, Copenhagen progressions, side-lying adduction, resisted hip flexion, glute strengthening, split squats and lateral lunges. - Pelvic control and single-leg work:
Athletes need good control through the pelvis during running, kicking and cutting. Physiotherapy may include single-leg bridges, step-downs, single-leg Romanian deadlifts, lunges, hopping preparation and trunk control drills. - Running progression:
A graded running plan often starts with straight-line jogging, then builds to faster running, acceleration, deceleration and repeated sprint efforts. - Kicking and change-of-direction progression:
Kicking, cutting and twisting are reintroduced gradually. This may start with submaximal ball work and controlled direction changes before progressing to high-speed drills and full training. - Return-to-sport testing:
Return to sport should be based on pain response, abdominal strength, adductor strength, sprint tolerance, cutting ability, kicking volume and confidence, not simply time away from sport.
Activity Modification
Activity modification helps reduce irritation while the painful inguinal region rebuilds capacity. The goal is not complete rest. It is to temporarily reduce the most provocative loads while maintaining fitness and strength where possible.
- Reduce high-speed triggers:
Sprinting, repeated acceleration, hard cutting and maximal kicking may need to be reduced early in rehab. - Modify abdominal loading:
Sit-ups, heavy bracing, loaded carries and intense trunk rotation may need short-term adjustment if they reproduce inguinal pain. - Keep training around the injury:
A physiotherapist may use cycling, upper body gym work, controlled lower-body strength, pool running or modified skills to maintain fitness. - Control training load spikes:
Sudden jumps in running distance, kicking volume, gym intensity or match minutes can flare symptoms. Workload should increase gradually. - Use pain response to guide progression:
Mild discomfort may be acceptable in some rehab plans, but symptoms should not progressively worsen during the session or cause a significant next-day flare. - Modify sport participation:
Athletes may need temporary limits on match play, repeated kicking, small-sided games, tackling, high-speed running or change-of-direction drills.
Manual Therapy
Manual therapy may help reduce pain and improve movement in some people with inguinal-related groin pain, but it should not be the only treatment. The main goal of physiotherapy is to rebuild the capacity of the trunk, hip and groin region through progressive exercise.
A physiotherapist may use soft tissue techniques around the hip flexors, adductors, lower abdominals, glutes or lumbar spine if these areas are contributing to symptoms. Gentle hip joint mobilisation may be useful if hip stiffness is affecting pelvic mechanics. Treatment should be specific to the athlete’s assessment findings.
Manual therapy can be useful when it helps the athlete move more comfortably, tolerate exercise better or reduce protective guarding. However, passive treatment alone is unlikely to prepare the inguinal region for sprinting, kicking and sport. It should be paired with strengthening, load management and return-to-sport progressions.
Postural Retraining
Postural retraining for inguinal-related groin pain is usually about improving trunk and pelvic control rather than forcing a perfect posture. Many athletes with groin pain develop protective movement patterns, such as over-bracing through the abdomen, avoiding hip extension, leaning away from the painful side or losing control during single-leg tasks.
Physiotherapy may focus on pelvic position during running drills, trunk control during cutting, hip extension during sprinting and load-sharing between the abdominal wall, adductors and glutes. Small changes in technique can reduce repeated strain through the inguinal region.
For gym-based athletes, postural retraining may include improving bracing strategies during squats, deadlifts, lunges and carries. For field athletes, it may include acceleration posture, cutting mechanics, kicking mechanics and landing control.
Bracing & Taping
Compression shorts, groin supports or taping may reduce symptoms during early return to running or training. However, bracing and taping should not be used to hide pain during loads the area is not ready for. A physiotherapist may trial taping or compression during specific drills to see whether it changes symptoms. If it helps, it can be used temporarily while the rehab plan continues. The long-term goal is still to restore strength, control and sport-specific capacity rather than relying on external support.
Dry Needling
Dry needling may be considered when surrounding muscles such as the adductors, hip flexors, abdominal wall or gluteal muscles are contributing to protective tightness or pain sensitivity. For inguinal-related groin pain, dry needling is not a stand-alone fix and does not repair the abdominal wall or inguinal canal. When used, it should sit within a broader physiotherapy plan that includes progressive strengthening and return-to-sport exposure. Some people feel short-term symptom relief, which can make exercise easier.
Heat & Ice
Ice may help settle pain after a flare-up from training, particularly if the area feels sharp or irritated. Heat may help reduce guarding in the lower abdomen, hip flexors or adductors before gentle mobility and strengthening work. Neither heat nor ice changes the underlying load capacity of the groin, so they are best viewed as symptom tools. A physiotherapist may suggest using heat before mobility or low-level activation exercises and ice after heavier rehab or sport exposure if symptoms are reactive. The choice should be based on what helps the individual rather than a strict rule.
Education
Education is essential because many flare-ups occur when training loads increase faster than the groin can tolerate. A physiotherapist should explain what inguinal-related groin pain is, why it differs from a true hernia, and how the lower abdominal wall, hip muscles, adductors and pelvis share load during sport.
- Understanding the diagnosis:
Patients often hear terms such as sports hernia, athletic pubalgia or groin disruption. A physiotherapist can explain what has been found clinically and whether medical review is needed to rule out a true hernia. - Knowing the key aggravators:
Sprinting, kicking, cutting, coughing, sneezing and resisted abdominal work can all provoke inguinal symptoms. Understanding these triggers helps guide training modifications. - Managing training load:
Rehab usually requires planned progressions in running speed, kicking volume, gym loading and match exposure. Random testing of symptoms can delay recovery. - Using pain response wisely:
Athletes should understand which symptoms are acceptable during rehab and which symptoms suggest the load is too high. - Planning return to sport:
Return to play should be based on objective strength, repeated sprint tolerance, cutting ability, kicking tolerance and next-day symptom response.
Other
Running retraining may be useful if symptoms are linked with overstriding, poor pelvic control, limited hip extension or rapid spikes in sprint speed. A physiotherapist may use graded exposure to running mechanics rather than immediately returning to maximal sprinting.
Kicking retraining may be important for soccer, AFL, rugby and martial arts athletes. This can include controlled passing, submaximal kicking, gradual kicking volume, longer kicking, contested kicking and fatigue-based kicking drills.
Load monitoring is often essential. Weekly running metres, sprint exposure, gym intensity, kicking volume, match minutes and recovery days may all influence symptoms. Physiotherapy for inguinal-related groin pain should help athletes return to sport with a plan, not guesswork.
Other Treatments
Medical review may be needed if there is a visible or palpable groin bulge, worsening pressure symptoms, testicular pain, urinary symptoms, abdominal pain, fever, night pain or unexplained symptoms. These signs may suggest a condition other than inguinal-related groin pain.
Medication may help with short-term pain management, but it does not restore abdominal strength, hip control or sport-specific load tolerance. Anti-inflammatory medication should be discussed with a GP or sports physician, particularly for people with stomach, kidney, cardiovascular or medication-related risks.
Injections are not usually first-line treatment for inguinal-related groin pain. They may occasionally be considered in complex cases, but they should not replace a structured physiotherapy rehab program. If symptoms keep returning despite injections, the underlying strength, control or workload issue may still need to be addressed.
A sports physician, general surgeon, orthopaedic specialist or radiologist may be involved when symptoms are persistent, unclear, or when imaging is required to rule out hip joint pathology, true hernia, pubic stress injury or other causes of groin pain.
Surgery
Surgery is not the first option for most cases of inguinal-related groin pain. Many athletes improve with physiotherapy-led rehabilitation, activity modification and a graded return-to-sport plan.
Surgery may be considered if symptoms are long-standing, clearly related to inguinal disruption or posterior wall weakness, and the athlete has not improved after a well-structured rehabilitation program. It may also be considered if a true inguinal hernia is diagnosed.
Surgical options vary and may include inguinal canal repair, posterior wall reinforcement, mesh repair or other procedures depending on the diagnosis and surgeon’s assessment. Surgical terminology can differ, which is one reason accurate diagnosis is important.
Even when surgery is performed, physiotherapy remains important. Post-operative rehab usually focuses on wound healing, walking, gradual abdominal loading, hip and adductor strengthening, running progression, kicking progression and return-to-sport testing.
Prognosis & Return to Activity
Recovery from inguinal-related groin pain depends on symptom duration, sport demands, strength deficits, training load, overlap with other groin pain categories and whether the athlete follows a structured rehab plan. Long-standing symptoms usually take longer than a recent flare-up.
- Early recovery goals:
Early physiotherapy focuses on reducing painful aggravators, maintaining fitness, improving abdominal and hip activation, and avoiding repeated symptom flare-ups. - Intermediate rehab goals:
As symptoms settle, rehab progresses to stronger abdominal loading, adductor strengthening, glute work, single-leg control, straight-line running and controlled change-of-direction drills. - Later-stage rehab goals:
Later inguinal-related groin pain rehab includes sprinting, repeated acceleration, deceleration, cutting, kicking progressions, gym loading and sport-specific fatigue work. - Return to gym:
Gym work should progress gradually. Heavy squats, deadlifts, loaded carries, sit-ups and rotational exercises may need modification until abdominal and groin load tolerance improves. - Return to running:
Running usually starts with straight-line, lower-speed work before progressing to acceleration, high-speed running, repeated sprinting and direction changes. - Return to sport:
Full return should be based on sport-specific capacity, not just pain at rest. The athlete should tolerate sprinting, kicking, cutting, contact or skill demands relevant to their sport. - Readiness markers:
A physiotherapist may assess abdominal strength, adductor strength, hip strength, single-leg control, sprint tolerance, kicking volume, cutting mechanics and next-day symptom response. - Risks of returning too early:
Returning before the inguinal region has rebuilt enough capacity can lead to repeated flare-ups, compensation, reduced performance and longer time away from sport.
Complications
- Persistent groin pain that limits sport, gym training or daily activity
- Recurrent flare-ups when sprinting, kicking or cutting is reintroduced too quickly
- Compensatory adductor, hip flexor, pubic or hip joint pain
- Loss of speed, kicking power or confidence changing direction
- Reduced abdominal and hip strength due to fear of loading
- Ongoing reliance on compression, taping or pain medication without rebuilding capacity
- Delayed diagnosis of a true inguinal hernia or other medical cause if symptoms are not properly assessed
Preventing Recurrence
- Build sprinting and kicking volume gradually, especially after off-season, illness or time away from sport, to avoid sudden load spikes through the inguinal canal region.
- Maintain lower abdominal, adductor, hip flexor and glute strength so the pelvis is supported during acceleration, kicking and change of direction.
- Include Copenhagen-style adductor progressions, trunk control and anti-rotation work if these are appropriate for your sport and current capacity.
- Avoid jumping straight from jogging to full-speed cutting drills, because inguinal-related groin pain is often provoked by high-force twisting and acceleration rather than easy running.
- Monitor next-day groin response after hard sessions, as soreness around the lower abdomen or groin crease can indicate the training load was too high.
- Use a thorough warm-up that includes progressive running, lateral movement, hip mobility and lower abdominal activation before sprinting or kicking.
- Manage fatigue during training blocks, because tired athletes often lose pelvic control and overload the groin during late-session kicking or cutting.
- Address early groin tightness or discomfort with physiotherapy before it becomes longstanding and harder to settle.
- Progress gym exercises that involve heavy bracing, such as heavy squats, deadlifts and loaded carries, based on symptom response in the lower abdominal and inguinal area.
- Keep hip mobility and trunk rotation adequate for your sport so the groin does not repeatedly compensate for stiffness elsewhere.
When to See a Physio
- Groin pain lasts more than a few days or keeps returning with training
- Pain is felt in the groin crease, lower abdomen or near the pubic bone during sprinting, kicking or twisting
- Coughing, sneezing, sit-ups or bracing reproduce the groin pain
- You are unsure whether the problem is a groin strain, sports hernia, hip pain or true inguinal hernia
- You can jog but cannot accelerate, cut, kick or return to match intensity
- You have reduced confidence pushing off one leg or changing direction
- Symptoms improve with rest but return as soon as training increases
- You have had previous groin pain and want a prevention or return-to-sport plan