Groin and Adductor Pain in Athletes: Causes and What Helps

Groin and adductor pain is a common sporting injuries I see in patients who enjoy an active lifestyle here in Bournemouth and this is also a condition that athletes and sports people of all levels commonly train through hoping it will just fade.

Most groin and adductor pain sits along the inner thigh or where the thigh meets the pelvis and it flares with the exact movements most sport demands: sprinting, changing direction, kicking and pushing off. In clinic, I see two patterns come in fairly often. A footballer with a groin that grumbles every time they twist to pass. A runner when they have pulled something and have waited for it to settle and finds it doesn’t.

The reassuring part is that adductor-related groin pain tends to respond well to the right loading and a sensible return to sport. The caveat is that the right loading is specific and getting better more quickly rests completely on getting the diagnosis right first.

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What is groin and adductor pain?

Groin pain in athletes is an umbrella term of reference rather than a diagnosis. An international consensus panel, the Doha agreement, sorted it into a set of defined clinical entities: adductor-related, iliopsoas-related, inguinal-related and pubic-related groin pain, alongside hip-related groin pain and other causes.[1]

Adductor-related pain is the most common of these in field and court sports. The adductors run down the inner thigh, pulling the leg in towards the midline and helping control it when you change direction. When the tendon, the fibrous anchor to the pubic bone, is repeatedly overloaded it becomes painful and tender and the muscle itself can be strained more acutely in a sudden stretch or sprint.

Knowing which entity is driving the pain is key because the inner-thigh ache of a straightforward adductor problem is managed quite differently from pain that is coming from the hip joint or the abdominal wall.

What causes a groin injury?

The pain pattern is familiar in clinic. Adductor problems build up in sports with repeated kicking, sprinting and rapid changes of direction, which is why footballers, rugby players and runners feature so heavily in this injury demographic. An overstretch or a hard sprint can cause it, but more often the load has outrun what the tissue was prepared for. Causes include: increase in the level of training, a return to sport from the off-season or a set of matches in close succession.

A systematic review of risk factors found reasonable evidence that a previous groin injury, a higher level of play, weaker hip adductor muscles (both outright and relative to the abductors, muscles on the outside of the hip) and lower amounts of sport-specific training were each linked to a greater risk of groin injury.[2] Pre season or pre match training is what matters, because a body copes far better with a sport’s demands when it has been progressively prepared and the adductors and abductors in particular.

An anatomical image of the leg showing the location of the adductor muscles in relation to groin and adductor pain

The location of the adductor muscle on the inside of the thigh

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Types of groin and adductor pain, at a glance

Groin pain isn't one condition. Under the international consensus (the Doha Agreement), six patterns account for most of what I see in clinic. Which one it is shapes the assessment and the plan.

Type	Where you feel it	Common causes	Typical symptoms
Adductor-related The most common, by some margin	Inner thigh, close to the pubic bone, sometimes running down the thigh	Kicking sports, sudden changes of direction, sprinting, a return to sport after a break, or a single overstretch	Tender to press on the adductor tendon; worse squeezing the knees together, worse kicking or sprinting
Iliopsoas-related Deep hip-flexor pain	Deep at the front of the hip, sometimes into the lower abdomen	Long hours sitting, running, hurdling, dance, martial arts, or repeated hip flexion under load	Worse lifting the knee against resistance, worse stretching the hip backwards, sometimes a click or a snap
Inguinal-related Pain in the inguinal canal region	Along the crease between the lower abdomen and the top of the thigh	Repeated twisting and turning, football, rugby, hockey; often develops slowly rather than in one moment	Worse coughing, sneezing, straining or sit-ups. No hernia lump to feel. Sometimes called "sportsman's groin"
Pubic-related Bone stress at the symphysis	Right on the pubic bone in the midline, occasionally spreading to either side	A build-up of load across the pelvis, common in footballers and long-distance runners; also seen after childbirth	Tender to press the pubic bone itself; worse standing on one leg, worse turning in bed, gradual onset
Hip-related Pain from inside the hip joint	Deep in the front of the groin, sometimes wrapping round to the side or the buttock	Hip impingement (FAI), labral irritation, early osteoarthritis, or hip dysplasia missed in childhood	A "C-sign" grip round the hip, catching or clicking, stiffness after sitting, restricted rotation on examination
Other causes Not to be missed	Varies, doesn't fit the patterns above	A true hernia, referred pain from the low back or sacroiliac joint, and non-musculoskeletal causes (urological, gynaecological, testicular)	Any groin pain with a lump, fever, blood in the urine, testicular pain or unexplained weight loss needs a GP first, not a chiropractor

Framework based on the Doha Agreement classification for groin pain in athletes (Weir et al., BJSM 2015).^[1]

Symptoms of groin and adductor pain

Most people describe adductor pain as a pain or pulling along the inner thigh or up in the crease of the groin, sometimes spreading towards the knee or across to the lower abdomen. It is usually worse when you squeeze your legs together, kick, sprint or twist and tender to press where the tendon meets the pubic bone. Coughing or sneezing can catch it and an acute strain may have a distinct moment of pain followed by bruising.

It is worth telling this apart from a couple of things that it is often confused with. Pain from the hip joint itself tends to sit deeper, often felt at the front of the groin or as a catching sensation in the hip and is a different problem with different management and is covered in detail on the hip and pelvic pain hub. Pain referred from the low back can feel similar to groin pain. Diagnosing one from another is what the chiropractic assessment is for.

How chiropractic care may help

My approach as a chiropractor centres what the medical evidence supports: a progressive, graded loading programme for the adductors and surrounding muscles, paced to your sport and your timescale. Hands-on treatment of the hip, pelvis and lower back, with soft-tissue work, plays a supporting role in easing symptoms and restoring movement while that strengthening does the work. Every plan is built around your individual injury and where you are trying to get back to.

That strongest piece of evidence that I referred to previously is a randomised trial showing that an active sports training programme, built around strengthening and coordinating the muscles that stabilise the hip and pelvis, was considerably more effective for long-standing adductor-related groin pain than passive treatment alone.[3] A later Cochrane review across conservative treatments found two randomised trials of reasonable size and concluded the overall evidence remains limited which is a fair reflection of how under-researched this area still is.[4]. I centre my treatment around this evidence.

runners on a beach prom with sunny skies. Running is a common cause of groin and adductor pain

If groin pain is getting in the way of your sport, come and talk it through. I offer a free 15-minute consultation, you can come in for a short no-obligation chat with no examination or treatment.

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Red flags: when to seek medical attention

Most groin pain in active people is a musculoskeletal problem that settles with the right management and is not a sign of anything sinister. A few things, though, warrant a medical opinion first.

See your GP or use NHS 111 if you notice a lump or bulge in the groin that becomes more obvious when you cough or strain, which can point to a hernia; if groin pain comes with feeling generally unwell, a fever or unexplained weight loss; or if you have deep bone pain that is worse at night. Seek urgent, same-day care for a man if you have sudden pain or swelling in a testicle, which is not a sports injury. Or a severe injury after which you cannot stand or bear weight, particularly in a teenager, where the pelvic growth areas can be involved. When in doubt, always get it looked at rather than training through it.

your first visit to Bournemouth Chiropractic

Your first chiropractic visit starts with the history of your injury, since when and how the pain began usually points strongly to the cause.

This is followed by examination: testing the adductors against resistance, checking the hip joint and lower back to rule them in or out and feeling for the tender points that localise the problem. I will explain to you what I think is going on and whether chiropractic care is a sensible route for your groin injury and if you need a scan or another medical opinion first.

Frequently Asked Questions

Can a chiropractor help with a groin strain?

My role as a chiropractor is to confirm the diagnosis, rule out what is not a simple strain, guide a loading programme and use manual treatment to support it. Chiropractic combined with a graded exercise and loading programme as evidence suggests might help with a groin injury . If your problem is not actually an adductor strain, the assessment is where that gets picked up and a correct diagnosis is made.

How long does adductor related groin pain take to settle?

How long adductor related groin pain takes to settle varies with how long it has been there and how it is managed. A minor acute strain may settle in a few weeks, whereas a long-standing more embedded tendon problem trained through for months takes a good deal longer and needs patience with the loading. Rushing back too early is the most common reason it drags on.

Should I keep training through a groin strain injury?

Complete rest is rarely the answer for a groin strain injury, but neither is pushing through sharp pain. The usual middle path is to keep moving within a tolerable level of discomfort while loading the adductors progressively and to ease off the specific movements that flare it, such as flat-out sprinting or long kicking until they settle. What that looks like for you is part of what we work out together.

Is my groin pain a hernia?

It can be hard to tell, and the two sometimes coexist. A hernia is more likely if you can feel or see a bulge in the groin that becomes more obvious when you cough or strain. If so, it is a matter for your GP rather than a chiropractor, and one of the things I check for during the assessment.

When should I go to A&E instead?

Groin pain itself is rarely an emergency. Sudden, severe pain or swelling in a testicle needs urgent same-day assessment and is not a sports injury. So does a severe injury after which you cannot stand or bear weight. For those incidences, seek urgent medical care rather than booking a chiropractic appointment.

Whatever is behind your groin pain, come and find out

A groin strain that grumbles every time you twist, kick or sprint is frustrating and most people want to know is this something serious and is it going affect my sport. At a first full appointment I will take a full medical history, examine the groin and adductors properly and look at the hip and lower back because pain in this area can come from more than one source and telling them apart is a large part of the diagnosis.

Groin and adductor pain is a common reason active people book in to see me here in Bournemouth and Poole. Patients range from footballers and runners to water sports enthusiasts. People who felt a sudden pull during a game or those who noticed an ache building over time.

Where the problem is an adductor strain or a related mechanical issue, hands-on care alongside the graded loading and strengthening work that carries the strongest evidence is a well-tolerated option and I will explain what I think will help in your case when I see you. Some groin problems need another opinion, a suspected hernia or a hip joint cause among them. If that is what I find, I will help you get to the right person who can help you further.

Book an appointment online and you can choose what suits you: a first appointment, which is the full visit with a detailed history, examination and treatment where appropriate or a free 15 minute consultation, which is simply a no-obligation chat about your problem with no examination and no treatment. If you are not sure which you need please call the clinic on 01202 937568 and we will work it out.

Call or message me, whatever is easiest and we will take it from there.

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