Groin pain can come from any structure in or surrounding your inner thigh where there are numerous arteries and veins as well as large muscles like the adductor group that attaches to the pelvis. First of all it is important to establish where exactly the groin pain is, this can be a very helpful identifying what structure is causing your pain. Your groin pain can be caused by any of the muscles, tendons, ligaments, nerves, or joints in the groin area, so let’s look at front parts of structures that can cause a problem.
You may have had a minor groin problem at one time or another but in most cases hip movements are rarely painful. Pain in the groin, that is not caused by an injury, maybe coming from other parts of the body which this is called radiating or referred pain. The groin is very close is some of the major organs in the abdomen and pelvis, so we can expect referral pains towards the groin. The groin area is located on each side of the body in the fields where the belly joins the legs. The pubic area lies between the two groin areas.
The Adductor muscle group runs along the inside of your thigh, from your pubic bone all the way to your knee. The adductors is made-up out of 4 muscles that play a very important role stabilizing the hip when you are standing on one leg. Adductor Magnus, Adductor Longus (Long), Adductor Brevis (Short) and the Gracillis muscles can be strained when the leg is pulled sideways or stretched beyond their normal limits.
Groin muscle strains are often called “pulled groin” because of the way the injuries happen, when the muscle tissue stretches until they tear. We determine how bad it is by classifying it from a first to a third degree tear depending on the amount of muscle fibers that are torn. Groin muscle tears can cause quite a bit of problems, click here for more information.
Synchronisation and control of the muscles in the groin and the hip play a very important role provide your leg with a stable base well you are walking or running. The smallest problem in the groin can escalate to cause numerous problems.
The main nerve supply to the inside of the thigh and the groin comes from the Femoral nerve. Any irritation, compression or impingement of the Femoral nerves and it’s smaller branches will cause nerve pain in the groin. Burning, stabbing feeling or electrical shock, is the type of symptoms that we usually associate with nerve pain.
Tendons or cables that anchor the muscle to bone. Every muscle has a tendon on either side, the one at the top called the proximal tendon and one at the bottom called the distal tendon. One or multiple tendons can become irritated which is usually due to repetitive movements, finally to cause inflammation in the tendons. A tendonitis of the adductor muscle group is quite common, it can be first sign of a much larger problem. A tendinopathy or even a avulsion fracture (when the tendon rips out a piece of bone) will be the end result of a groin tendonitis that is left untreated.
The Rectus femoris muscle (which is one of the quadriceps) attaches in the front of the pelvis and if this tendon becomes inflamed, it can cause groin pain that radiates along the front of the thigh.
The inguinal ligament connects the ilium to the pelvis, and lies exactly in the fold between your belly and your leg. This ligament supports the muscles that run to the inner farm including the Iliopsoas and Pectineus muscles of the hip.
The joints that are most likely to be involved in groin pain include the pubic symphysis, sacroiliac joints, hip joints and your lower lumbar spine. Oteitis pubis is a condition that develops due to excessive stress on the connection between the pubic bones call the pubic symphysis. The connection between the head of the femur and the socket in the hip (acetabulum) can cause problems like femoral acetabular impingement, this is when the femur catches or scrapes the edges of the hip socket.
Hip arthritis and normal aging of the hip joint may give you a deep ache in the groin, compared to a locking feeling of the hip and groin when the labrum is torn. The labrum is a membrane on the inside of the hip socket that provides cushioning for the femur head inside the acetabulum.
A bursa is a fluid-filled disc that prevents excessive friction between structures like tendons, ligaments and Bones. Bursas can become inflamed due to various reasons but it will cause the disc to swell and limit the normal movement. If you apply direct pressure onto the bursa you will be able to feel the pain in your groin.
A groin injury may occur from a direct blow, a fall, especially when you land on your leg and it is pulled sideways. This can put excessive strain on the adductor muscles causing them to tear. The groin muscles can be pulled or strained during exercise when the muscle needs to contract outside it’s normal boundaries. The sudden pull or strain on the groin muscles while lifting, pushing, or pulling a heavy object may cause sudden groin pain.
Overuse injuries occur when too much stress is placed on the groin area. This often happens when you overdue an activity or repeat the same activity over and over again. This type of repetitive strain on the groin muscles may lead to various other problems.
Overuse injuries may put you at risk of developing any one of the following:
- A hairline crack in the thigh bone (stress fracture of the femur)
- Hip bursitis
- Osteitis Pubis – this is a condition that develops from chronic stress on the pubic symphysis
- Hip joint problems
- Avulsion fractures – this occurs when a force causes a tendon or ligament to tear away from a bone and break off a piece of bone.
It is important to look for other causes of your groin pain when you have not had a specific incident that you can remember, when and where you injured your groin. An inguinal hernia is a condition where a tear develops in your abdominal or pelvic wall causing your abdominal tissue to push through the hole, into the leg, which will result in groin pain that relieves when you are lying down and worse when you’re sitting up.
Towards the hip
- Rectus Femoris tendinitis (Proximal tendon)
- Sartorius tendinitis (of the proximal tendon)
- Quadriceps tendinitis or tendinopathy
- Hip flexor strain
- Pinched Femoral nerve
- Femur Fracture (Stress fracture)
In the Fold
- Groin muscle strain
- Adductor tendinitis or tendinopathy
- Iliopsoas muscle strain
- Femoral nerve entrapment – Pinched nerve
- Inguinal Hernia
- Sportsman’s hernia
- Inguinal Ligament sprain
- Referred pain from Lower back (Lumbar)
- Femur Fracture (Stress fracture)
Towards the Pubic bone
- Adductor muscle strain
- Osteitis Pubis
- Femoral nerve entrapment
- Adductor tendinitis
- Labrum tear
- Vastus Lateralis muscle tear or strain
- ITB syndrome (Iliotibial band syndrome)
- Bursitis of the Bursa deep to the Iliotibial band
- Tensor Facsia Latae muscle strain
Inside the Hip joint
- Hip Labrum tear
- Femoroacetabular Impingement (FAI)
- Hip arthritis
- Perthes Disease
- Slipped Femoral Capital Epiphysis
- Stress Fracture
- Avascular Necrosis of the Femoral Head
- Hip joint pathologies
Coming from other areas
Causes of Groin pain
Groin pain is one of the most common problems that we see in your practice. Your groin contains some of the larges muscles in your body, not to mention you use them every day to walk. The structures in the groin is very vulnerable to injury especially overuse injuries i.e. repetitive movements like a walking, climbing stairs, kicking and running.
Groin pain may be caused by:
- Trauma – Contusions, fractures and labrum injuries as well as muscle or ligament strains and sprains.
- Overuse – Tendon inflammation, labrum injuries and athritis
- Instability – Impingement of the hip joint (The hip’s socket connection with the femur)
- Autoimmune – Rheumatoid arthritis
- Referral from Joints – Pubic symphysis, sacroiliac joints, hip joints and your lower lumbar spine
- Referral from Nerves – Irritation, compression of the femoral nerves.
- Visceral referral – Hernia of the small intestines, Prostate, Overies, ect.
Groin Pain Treatment
As you can see, these are just a few of the common groin injury sources, so an accurate diagnosis is very important to provide you with the best rehabilitation. With accurate assessment and early treatment, most groin pain responds extremely quickly to physiotherapy allowing you to quickly get back to life.
If you are suffering groin pain, we highly recommend that you seek our help because we are experienced in the assessment and management of groin pain. It can be very tricky! You wouldn’t want to undergo a hip replacement early in life due to poor management of that pain in your groin.
Please ask our physiotherapist for their professional treatment advice.
- Acupuncture & Dry Needling
- Heat packs (Thermal therapy)
- Kinesiology Tape
- Rigid Strapping or taping
- Neurodynamics (Nerve tissue mobilizations)
- Dynamic Strapping
- Strengthening exercises
- Guided loading protocol
- Stretches (Static, dynamic and ballistic)
- Moon boot
- Compression Bandage or Sleeve
- Supportive strapping and taping
- Biomechanical Analysis
- Gait Analysis