Published: July 1, 2011
Updated: July 1, 2011
The diagnosis and treatment of chronic groin pain can be difficult. Due to the variety of anatomic structures and the potential for referred pain around the pelvis, the true source of pain can be elusive.
There are many different conditions that can cause pain in the groin, hip, and lower abdomen, including:
All of these conditions must be considered when evaluating the cause of chronic groin pain.
The primary symptoms are pain aggravated by strenuous exercise, especially those involving kicking, sprinting, or rapid directional changes. For this reason, soccer, hockey, basketball, and football athletes seem particularly susceptible.
The focus of pain is in the inguinal region near the pubis, but may radiate to the testicles or inner thigh.
While the pain may last for several hours or days following intensive exercise, it almost always subsides with rest and is seldom present with sitting or other activities of daily living. However, even after prolonged periods of rest, the pain usually recurs when intensive training resumes.
Physical examination will reveal point tenderness at the rectus abdominus muscle attachment. Pain is reproduced with a sit up or resisted hip flexion and internal rotation.
Some athletes will have tenderness both in the inguinal area and at the adductor longus tendon attachment in the inner thigh. In these cases, adductor tendonitis is considered as an additional diagnosis.
Many athletes with either condition are frequently noted to be tight in the hamstrings, lower back, and posterior pelvic musculature. It is thought that this tightness may contribute to the chronic nature of lower abdominal pain or adductor tendonitis.
A detailed history and physical examination will usually allow the clinician to make an accurate diagnosis.
However, further diagnostic testing including x-ray, bone scan, computerized tomography scan (CT scan), or magnetic resonance imaging (MRI) may be indicated to confirm a diagnosis or to rule out other potential sources of pain.
Even with extensive testing, the results may be inconclusive.
If recognized early, physical therapy can be very effective in the treatment of both athletic pubalgia and adductor tendonitis.
The goal of treatment is initially to reduce tightness and improve flexibility in all of the major muscle groups attaching about the pelvis. This is accomplished through a program of deep tissue massage and stretching focused on the lower back, gluteus, tensor fascia lata, hamstrings, and hip flexors and rotators.
Next, progressive isometric and isokinetic core strengthening exercises are added, with emphasis on the hip adductors and abdominals. Controlled aerobic conditioning such as swimming, biking, treadmill, and jogging may begin as flexibility and strength improve.
Progressive sports-specific activities, including slide-board, cutting, pivoting, jumping, may be added as tolerated.
Although anti-inflammatory medications may be helpful for severe pain, they are not curative. Likewise, injections rarely have lasting benefit and are contra-indicated around tendon structures. Passive therapies such as ultrasound, electrical stimulation, and ice are typically of little benefit.
Heat is helpful when combined with an active stretching program.
In cases where symptoms persist despite an adequate trial (at least one month) of physical therapy, surgery has been shown to provide relief in many individuals.