Hockey-InjuriesGroinGroin injuries occur quite often in sports, and can make a challenging case to treat. Often the symptoms of pain are vague and complicated by multilayered biomechanical deficits. While many athletes are given rest as a form of treatment, this may not prove to be very effective, nor an option for elite athletes who are under pressure to perform.

It is important to be sensitive to groin pain, and it is very important that the area of complaint be evaluated by a health professional familiar with sports related injuries. When dealing with groin pain, it is crucial to understand the different possibilities of injuries. Some injuries that can cause groin pain are groin strains, athletic pubalgia, osteitis pubis, hernias, hip joint arthritis, referral pain, muscle syndromes, and fractures.

Many groin injuries have similar pain patterns, and hence a medical professional must be consulted when groin pain is presented in the athlete. To further understand these injury types, it is important to illustrate that the term “sports hernia”, isn’t a true hernia, as it doesn’t involve a hernia of the abdominal wall like a traditional hernia. Albeit, a sports hernia involves an inguinal disruption, and usually has corresponding MRI evidence of bone marrow edema, capsular ligament disruption and involvement of the enthesis of the hip. Furthermore, a diagnosis of athletic pubalgia is understood to have more of a medial hip pathology involving a disruption of the medial pubic aponeurosis and an adductor tendon pathology, and in some cases the pathology can very much have a disruption of the inguinal ligament, which would fall under the symptoms of a sports hernia. Athletic pubalgia usually presents with chronic pain in the pubic bone, point tenderness along the insertion of the abdominal wall along the pubic tubercle and intermittent weakness of the pelvic wall muscles.


Today most researchers understand the diagnoses of sports hernia as athletic pubalgia, and vice versa. Regardless, of what you would like to call it, the common symptoms of groin pain are understood and the following symptom should be seen upon assessment: deep groin pain/lower abdominal pain, increased pain with exertion, pain over pubic ramus near conjoined tendon, pain with resisted hip flexion at 0, 45, 90 degrees flexion, pain with sit-ups.

Treatment options for inguinal disruptions or athletic pubalgia have been diverse. It is often advisable to begin non-operative treatment immediately, and the program of care should last 8 weeks across 4 phases. The phases are important and overlap one another as the patient progresses. The program aims to reduce swelling and pain, retrain core muscles, hip muscles, and improve global range of motion in the hip and spine, reduce soft tissue restrictions, balance retraining, neurofunctional retraining, and return to sport protocols all within 8 weeks. It is important to prevent the athlete from further damaging the area with over activity and poor biomechanical movements.

Clinical Pearls

Personally, I have seen many groin injuries, athletic pubalgia, sports hernias, hip pointer injuries, and more. They have all been successfully treated at my clinic with my proven methods of treatment. It is important to consider the athlete’s unique injury, as many present with different symptoms, some with MRI evidence, some without. The clinical assessment is my best tool in helping the athlete return to sport, and perform at his preinjury level. I adopt a unique range of treatment that includes medical acupuncture, chiropractic adjustments, soft tissue therapy, exercises and rehabilitation and sport specific rehabilitation.

The most important advice is to get the groin pain checked out. It can save your athletic career!

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Dr. Nourus Yacoub, DC
Medical Director and Chiropractor
Royal Chiropractic and Sports Injury Clinic

Ellsworth A, et al. 2014. Athletic Pubalgia and Associated Rehabilitation. The International Journal of Sports Physical Therapy, 9(6): 774-784.