Core Concepts of Groin Pain in Athletes

Jason M. Epstein, MD, MBA October 21st, 2021

Mainstream media has popularized the term “sports hernia” over the years due to injuries that take place in professional sports. Ironically, there is no one injury that defines what a sports hernia is. In fact, “sports hernia” is not an accurate diagnosis for any core or groin injury in an athlete anymore.

In order to better understand the signs and symptoms associated with a core or groin injury, learn more about how these structures are affected within your body. 

Understanding the Core

Your core is an anatomically complex region. Generally speaking, the core refers to the area between the lower portion of your chest and your knees. Because the area is so broad, injuries present themselves in a variety of ways. Core injuries involve strains and tears of the involved muscle and tendon groups.

Standardized terminology for groin pain in athletes include five distinct entities:

  • Adductor-related groin pain: Group of muscles responsible for bringing the thighs together
  • Iliopsoas-related groin pain: Responsible for flexing at the hip joint
  • Inguinal-related groin pain: Anatomically complex region related to the lower anterior abdominal wall
  • Pubic-related groin pain: Localized tenderness at the center of the pubic region and surrounding bone
  • Hip-related groin pain: Hip pathology should always be considered when evaluating groin pain

Other common causes of groin pain include nerve entrapments, referred pain from the back, stress fractures, or intraabdominal abnormalities like urinary tract infections or diverticulitis.

Groin Injuries

Groin injuries usually occur from an overuse shearing force across the pelvis. If the middle of your pelvis were to act as the center of the core, a muscular imbalance across that core could make you susceptible to injury. An imbalance could be due to overall weakness, a congenital issue, or increased stress or training.

Failure to identify and treat the injured area could lead to a worsening of the injury or cause other injuries due to compensation. Investigating external factors that may be leading to a muscular imbalance is paramount for a proper treatment plan and swift recovery.

Core Injury and Groin Injury Treatment Methods

In office ultrasound frequently is used to determine exactly where the pain comes from by having the patient point to the maximum area of tenderness and then using ultrasound to assess which structures (e.g. tendon, muscle) are underlying the most painful spot.

The principal treatment for nonoperative management is an individualized rehabilitation program. Focus is initially placed on protecting the injured area, controlling pain, limiting inflammation, and increasing flexibility. Restoring muscular endurance, strength, balance, and control follows. Location, severity, and pain level will help to determine how long each phase of rehab lasts for. Surgery would be considered for cases refractory to nonoperative treatment.

Core Injury and Groin Injury Prevention Strategies

The key to preventing a groin injury is to strengthen surrounding muscle groups equally and design an exercise program that maximizes core strength to avoid wear and tear.
Strengthening core muscles increases stability and can help reduce injury and maintain mobility.
An exercise program that emphasizes stretching your core can increase flexibility and overall athleticism. 

If you’re dealing with pain within your core or groin, visit Rothman Orthopaedics for relief today.

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