There are many types of groin injury, some of which can occur together. In fact, as many as 90 percent of athletes experiencing groin pain have multiple types of groin injuries simultaneously.1
Common types of groin injury in athletes include, but are not limited to:
Adductor strain (groin strain or pull). By far the most common type of groin injury,2 a groin strain occurs when the adductor muscles, which are the major muscles on the inside of the thigh where it meets the pelvis, are stretched or torn beyond their normal range of motion. These muscles are especially prone to stretching or tearing when athletes make sudden stops or turns. Groin strains are common in runners and soccer players.
Groin strains typically cause pain and tenderness in the groin area and the inside of the thigh. Pain may intensify when patients bring their legs together or raise their knees, such as when taking high steps or doing plyometric (jumping) exercises. Athletes may feel a popping or snapping sensation in the adductor muscle at the time of injury when the fibers are stretched or torn.
Avulsion fracture. An avulsion fracture occurs when the tendons that connect muscles to bone are torn at the connection site, resulting in pain and muscle weakness. Avulsion fractures in the groin are most common in adolescent athletes because the pelvic growth plates have not yet solidified.3,4
Avulsion fractures in the pelvis are most likely to occur along the iliac crest (top of the hip bone). Avulsion fractures can also occur at the ischial tuberosity, which is the lowest point of the pelvic bone where it meets the hamstring.
Stress fractures of the femoral neck and/or pubic ramus bone. Stress fractures are tiny cracks that form in the bone over time and cause pain. The neck of the femur, or the narrow portion between the ball-shaped head and shaft where it joins the pelvis, can be subject to stress fractures in athletes in which repetitive impacts on the lower body are common, such as distance running, soccer, and basketball.
The pubic ramus bone is located at the bottom of the pelvis behind the genital area and is also associated with repetitive-impact fractures. Groin pain from a stress fracture in the pubic ramus bone may also spread to the buttock.
Osteitis pubis. This condition’s symptoms are similar to adductor strain, but the injury is different. Instead of a muscle strain, it is characterized by chronic inflammation in the pubic symphysis joint and its surrounding soft tissue due to repetitive stress on the pelvis. Distance runners, soccer players, and dancers are most at risk.5
Inguinal hernia. Inguinal hernia occurs when the lower abdominal muscles stretch or tear, often resulting in a bulge in the groin area as the abdominal organs press against or push through the weakened muscles. In addition to causing pain, an inguinal hernia can cause a pulling or dragging sensation in the groin, especially when lifting, stretching, bending over, or coughing. Inguinal hernias are more common in men, and are often associated with weightlifting.
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Athletic pubalgia (sports hernia). Sports hernia is a term that is commonly applied to many types of groin injury. However, both the American Academy of Orthopedic Surgeons and the American Orthopedic Society for Sports Medicine have defined the term as applying only to tears occurring in the muscles, ligaments, and tendons of the lower abdomen where they meet the adductors, rather than just a simple strain of the adductor(s) themselves.6
Unlike inguinal hernias, a sports hernia does not cause a visible bulge in the groin but rather pain in the lower abdominal area and hip adductor insertion.
Hip labral tears. Hip joint pain from a tear in the cartilage or labrum is another common cause of groin pain in athletes. These injuries can either occur suddenly or gradually over time. Hip labral tears are commonly associated with subtle bone deformities known as femoroacetabular impingement (FAI). It is becoming a more commonly recognized source of groin pain that may require surgical intervention if unresponsive to conservative treatment.
Snapping hip syndrome. This term is applied to a number of different conditions that can cause a snapping sensation in the hip during movement. It often occurs when a muscle or tendon in the hip area is misaligned. While snapping hip syndrome can be more of an annoyance than a cause of severe groin pain, it can be a precursor to hip bursitis.
Physeal injuries. Also called growth plate injuries, physeal injuries can occur in younger athletes. They occur when a fracture affects the growth plate, a section of cartilage at the ends of longer bones in the body that gradually hardens, or ossifies, as part of the body’s growth process during childhood and adolescence. They can occur due to overuse or as acute injuries. The injury mechanism is similar to other soft-tissue sports injuries, but the weak point is the growth plate, rather than the bone, tendon or ligament. Physeal injuries in the groin generally occur in the top femoral growth plate where it meets the hip.
While uncommon, some types of groin injury have potentially life-threatening complications, such as bone infections or intestinal strangulation. While rare, the possibility of a serious injury, as well as the fact many athletes sustain multiple groin injuries at the same time, means even moderate levels of groin pain merit a prompt doctor visit.