Unravelling Hip and Groin Pain in active adults: What’s worth knowing!

Anterior Hip and Groin pain is a common complaint among the active adult population, it becomes even more common when we engage in sports that involve change of direction, kicking or high speed rotation, think football, rugby and tennis! In more chronic cases, It can be difficult to pin point the exact cause of these symptoms and they can commonly be classified as athletic pubalgia or sporting hernia

So what is Athletic Pubalgia?

Athletic pubalgia is pain at the front of the hip or in the groin that does not come from a hernia. It most commonly occurs if you have an imbalance in the muscles around your hip and pelvis. Having asymmetry in your abdominal muscles (which attach to the front of your pubic bone) and the muscle that control your hip and give it stability ( glutes, adductors, quads and hamstrings) can cause excess force and lead to overuse injuries. Remember, You’re only as strong as your weakest point! Pain usually gets better with rest but can flare up easily when you return to you chosen sport without addressing these issues. This cycle can go on for months and even years until the true source of the issue is identified.

Scans can also be reported as normal in these cases despite being in pain because an MRI scan can’t tell you if you have a weakness or muscle imbalance. This is where seeing an experienced Physiotherapist can be crucial!

What else can cause hip and groin pain?

There are some injuries that are specifically related to isolated structures that must be ruled out before coming to a diagnosis of athletic pubalgia

• Inguinal Hernia: Sometimes the pain could due to a real inguinal hernia. This occurs due to a failure of the lower abdominal wall and inguinal ligament.

• Adductor muscle or tendon: These are common in soccer and tennis players and can be a result of an acute injury or overuse
• Hip joint pain: Conditions like femoroacetabular impingement (FAI), which is a change to the shape of the hip ball and socket, this can lead to pain and instability
• Osteitis Pubis: This is inflammation of the pubic symphysis, usually caused with repetitive kicking
• Nerve Issues: lots of nerves refer into the hip and groin so its important to rule these out
• Gynecological or Genitourinary Issues: pelvic pain can refer into this region and its important to rule out visceral referral patterns

So how can I finally get the right diagnosis?

Due to the non specific presentation of athletic pubalgia it is really important to have an in depth physical assessment with a Physiotherapist. This will usually include a thorough subjective assessment to really understand your symptoms and your journey to date, then a good assessment will look at your range of motion, biomechanics and strength, the use of manual muscle testing and hand held dynamometry will give you real data and take the guess work away. With this information and the support of your physiotherapist you can create a bespoke rehabilitation plan to ensure success and get you back to full, pain free function!