Hip and Groin Pain

Hip and groin pain is common in football, hockey, running and any sport that involves kicking, sprinting and changing direction, but it also affects people who don’t play sport at all. Because the hip, the groin muscles and the lower abdomen are packed close together, getting the diagnosis right is half the battle.

Understanding hip and groin pain

International experts have agreed on a simple way to classify groin pain in athletes, which guides how we assess and treat it. The main categories are:

• Adductor-related: pain from the inner thigh muscles that squeeze the legs together, the most common source in sport
• Iliopsoas-related: pain at the front of the hip from the deep hip flexor
• Inguinal-related: pain in the groin canal area, often with a bulge or pain on coughing
• Pubic-related: pain over the pubic bone where the muscles attach
• Hip-related: pain from the hip joint itself, including impingement and labral problems and osteoarthritis

More than one can be present at once. A previous groin injury is one of the best-established risk factors for a new one.

Symptoms we commonly see

• A pulling or aching pain in the inner thigh or groin, often worse with kicking, sprinting or cutting
• Pain squeezing the legs together or getting out of a car
• Tenderness over the muscle or where it attaches to the pelvis
• A deep, pinching pain at the front of the hip when bending it, squatting or sitting for long
• Stiffness or a catching sensation in the hip
• Pain that eases while warm but returns after training or the next morning

Our evidence-based approach

The best-supported treatment for most groin pain in athletes is an active, progressive strengthening program built on an accurate diagnosis. Our approach includes:

1. Thorough assessment of the hip, pelvis, lower back and groin muscles, including squeeze and resisted tests, to identify the structures involved
2. Load management, so you can keep training in a way that doesn’t aggravate the area
3. Progressive strengthening of the adductors, hip flexors, glutes and trunk, from early isometric holds to sport-specific loading
4. Hands-on treatment and dry needling where appropriate, to ease pain and muscle tension alongside your exercise program
5. VALD ForceFrame testing to measure hip adduction and abduction strength in newtons, compare sides and track progress
6. A graded return to running, kicking and change of direction, with strength and testing criteria rather than a date

You can see typical hip strength targets on our strength standards page. A well-designed adductor strengthening program has also been shown to reduce groin problems in football players, so ongoing strength work is part of preventing a repeat.

See also gluteal tendinopathy for pain on the outside of the hip and hip impingement for pinching at the front of the hip.

What to expect: recovery timeline

• Mild strains: often one to three weeks
• Moderate strains: typically four to eight weeks of structured rehab
• Long-standing groin pain: can take several months of progressive loading, which is why starting early and staying consistent matters
• Hip joint problems: depend on the cause, with exercise-based rehab the usual first step before any surgical opinion

When to seek help urgently

Seek prompt medical attention for sudden severe testicular pain or swelling, a new bulge in the groin, fever with groin or hip pain, or pain after a fall where you can’t put weight on the leg. Persistent pain that wakes you at night should also be checked.

References

• Weir A, Brukner P, Delahunt E, et al. Doha agreement meeting on terminology and definitions in groin pain in athletes. Br J Sports Med. 2015;49(12):768-774.
• Thorborg K, Reiman MP, Weir A, et al. Clinical examination, diagnostic imaging, and testing of athletes with groin pain: an evidence-based approach to effective management. J Orthop Sports Phys Ther. 2018;48(4):239-249.
• Whittaker JL, Small C, Maffey L, Emery CA. Risk factors for groin injury in sport: an updated systematic review. Br J Sports Med. 2015;49(12):803-809.
• Haroy J, et al. The adductor strengthening programme prevents groin problems among male football players: a cluster-randomised controlled trial. Br J Sports Med. 2019;53(3):150-157.
• Light N, Thorborg K. The precision and torque production of common hip adductor squeeze tests used in elite football. J Sci Med Sport. 2016;19(11):888-892.